Sharing Our Experience and Tips for Progressives Lenses

Here at McDonald Adams we have a team who have successfully worn progressives lenses. Read our comments and advice.

Alison: I love my progressives - from my very first pair I just put them on and wore them comfortably. I love not having to change between two pairs of glasses, and find today’s coatings very beneficial - especially the anti-reflection and blue coating for digital work (I look at a screen most of my work day). Highly recommend progressive lenses - they make wearing glasses easy!

Sally: Settle your glasses down on top of your ears and nose, this way you will be getting the best vision through your progressive lenses. Remember to look straight ahead for far away, then just drop your eyes (not your chin) to look down for reading. Practice in front of TV with an easy book in your lap for your first evening or two.

Claire: A quick check revealed I have now tried 17 different progressive lens designs! These range from fully customised lenses through to the most widely prescribed progressive designs. While every person’s experience is unique, I can honestly say I don’t notice that I am wearing progressives. The field of vision is so good now that there is no apparent blur to the side at any distance.

Katrina: Progressives are easy, even with my challenging prescription. They cater for all ranges of vision from driving , looking at the speedo and then working on the computer! I have found that the elite customised designed lenses give me maximum clarity though all areas of the lens..

Guidelines for children and screens

Most of us probably think that small children spending a lot of time looking at screens is probably not a good idea. But is there any evidence to back this up? Frustratingly little. But there are very helpful guidelines available, and we should be promoting these recommendations.

As optometrists, we are often asked by parents, what are the implications of screen time on vision development. Now we can refer to the WHO recommendations.

At a glance these recommendations say infants less than one years of age should have no screen time. For one year olds, sedentary screen time (such as watching TV or videos, playing computer games) is not recommended while for those aged 2 years, sedentary screen time should be no more than 1 hour; less is better. Older children of three-four years are recommended to have no more than 1 hour of sedentary screen time; and again less is better.

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Children under 2 years of age No screen time. Excessive screen time reduces language development and increases the likelihood of childhood obesity.

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Children 2-5 years Children who are toddlers and pre-schoolers should have a maximum of 1 hour of screen time a day. Higher rates of screen time are associated with less play, poorer social skills, slow language development and increased risk of obesity.

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Children 5-17 years Should be limited to 2 hours of recreational screen time per day. Children are now using screens more during their education, so limiting screen time during entertainment is important. When families pay attention to their media consumption and parents monitor their children’s digital access, the amount of screen time reduces along with positive improvements in sleep and school performance.

The recommendations made by WHO are echoed by New Zealand’s version: Sit less, Move More, Sleep Well: Active play guidelines for under-fives.

Is screen time harming children's eyesight?

There has been a significant onslaught in the use of technology by our children and teenagers, as the world around us becomes more reliant on screens, all of the time. Children are accessing screens at school, around the home, in the community and for personal entertainment at younger and younger ages.

At the same time, there has been an unprecedented increase in myopia (short sightedness) in children, with higher numbers and earlier age of onset. So is this correlation or causation? It’s seems sensible to blame the screens, but nothing is ever that simple. Increased screen time can be associated with more near work, more indoor time and less outdoor exposure.

Is myopia caused by screen time, or are they co-existing features of the modern visual environment? The increase in myopia rates occurred before the saturation of screens in society, with rates of short sightedness in East Asia increasing before the technology took hold. (1)  Analysis has showed no significant association between screen time and myopia. But even when no statistical association was found, children who were myopic spent more time using screens.

We do know there is an association that children whom spend limited time outdoors, and more time at near have increased rates of myopia, and it may simply be that the screens have replaced other near work modes. (1) This could be supported by the fact that whilst screen time has dramatically escalated in children, the myopia rates, whilst increasing, have not exponentially exploded.

Part of the challenge to figure this out scientifically, is that to ascertain device usage, most studies use surveys and questionnaires. These immediately compromise the data, and are likely not as reliable as objective measures. Who wouldn’t down play the amount of time they spend on social media! A novel survey used data usage as an objective measure of time spent on the device, and correlated that to frequency of myopia.(2) They found a significant relationship between increased data usage and myopia - the myopes used almost twice as much data per day as non-myopes. As a cross-sectional study, the authors were unable to measure the impact of screen time on myopia progression, but they did find that more data usage co-existed with higher myopic refractive error.

How much are children actually looking at screens?

A Philadelphia study suggested that at age four, half of children had their own TV and three-quarters had their own mobile devices. (3) The data usage study suggested that teenagers dedicate double the time to smartphone use than they do to all other near work, and each younger age group spends more time in bed on the devices than the one before them. (2) I can confirm this one from personal observation in my own home!  A 2011 study suggested 47% of children were spending more than two hours a day on screen time for entertainment, (4) and by 2019 that number had skyrocketed to 98% in the US! (5)

What advice should we be giving you?

When families pay attention to their media consumption and parents monitor their children’s digital access, the amount of screen time reduces along with positive improvements in sleep and school performance.(6)  We know there is a protective effect of outdoor time on the onset of myopia, so it is sensible to recommend outdoor time away from any near activities.

The World Health Organization recommends at least 60 minutes of moderate to vigorous physical activity for school aged children per day, yet a UK survey found that three-quarters of UK children aged 5-12 years spend less time than this outside - which is less time spent outside than prison inmates! Shockingly, 20% of the children surveyed never play outside regularly. When it comes to myopia prevention, though, it’s not the physical activity that is the crucial element, it is likely the light exposure (7) - so to combine both benefits, this physical activity time can be undertaken outdoors.

Our advice:

• Reduce screen time: the Australian Department of Health and the American Academy of Paediatrics recommend less than two hours per day of leisure screen time for school-aged children

• Get at least 60 minutes of moderate to vigorous intensity physical activity: recommended by the World Health Organization for children aged 5-17 years

• Be sun safe and protect from UV when outdoors: especially here in New Zealand.

Need more ideas and help? Check out these brilliant resources.

Close Work and Screen Time for Kids

How Much Time Should My Child Spend Outdoors

References.

1 Lanca, C. & Saw, S. M. The association between digital screen time and myopia: A systematic review. Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians 40, 216-229, doi:10.1111/opo.12657 (2020)

2 McCrann, S., Loughman, J., Butler, J. S., Paudel, N. & Flitcroft, D. I. Smartphone use as a possible risk factor for myopia. Clinical and Experimental Optometry n/a, doi:10.1111/cxo.13092

3 Kabali, H. K. et al. Exposure and Use of Mobile Media Devices by Young Children. Pediatrics 136, 1044-1050, doi:10.1542/peds.2015-2151 (2015)

4 Maniccia, D. M., Davison, K. K., Marshall, S. J., Manganello, J. A. & Dennison, B. A. A Meta-analysis of Interventions That Target Children's Screen Time for Reduction. Pediatrics 128, e193-e210, doi:10.1542/peds.2010-2353 (2011)

5 Madigan, S., Browne, D., Racine, N., Mori, C. & Tough, S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatrics 173, 244-250, doi:10.1001/jamapediatrics.2018.5056 (2019)

6 Gentile, D. A., Reimer, R. A., Nathanson, A. I., Walsh, D. A. & Eisenmann, J. C. Protective effects of parental monitoring of children's media use: a prospective study. JAMA Pediatr 168, 479-484, doi:10.1001/jamapediatrics.2014.146 (2014)

7 Read, S. A., Collins, M. J. & Vincent, S. J. Light Exposure and Eye Growth in Childhood. Investigative ophthalmology & visual science 56, 6779-6787, doi:10.1167/iovs.14-15978 (2015)

ADHB Greenlane Eye Clinic Referral Process for Cataracts

Here is some information on the referral process for outpatient appointments at the Greenlane Eye Clinic. This eye clinic is a free service provided by our District Health Board (DHB).

Cataracts

The most common reason we refer people to the Eye Clinic is cataracts. Cataracts are clouding of the lens inside the eye, which reduces vision. The treatment is a surgical procedure, performed under local anaesthetic, to remove the clouded lens, replacing it with an implant. This is usually a highly effective procedure which fully restores vision. No surgery is without risk and this is a consideration when treatment should be undertaken.

Clinical Prioritization Scores

In order to prioritize who gets cataract surgery each year, optometrists and ophthalmologists use a clinical scoring tool. We enter your vision, as recorded at your appointment which is the size of the letters you could read on the chart with the best prescription lenses in place. Also included are details of the examination of your eyes and cataracts.

The final part is your ‘Patient Impact on Life Questionnaire’. With this questionnaire they grade the degree of difficulty your blurred vision is causing you, put another way, it describes how blurred vision may be limiting your life.

Once these details are entered the tool calculates a score. For Auckland DHB the magical number of 48 and above means the referral will be accepted and you can expect to receive an appointment within 16 weeks. Northland DHB has a threshold score of 54.

In our experience this system seems to work, and people we see who are struggling with their vision due to cataracts do in fact get an appointment and go on to have cataract surgery.

Cataracts in both eyes - will both eyes be treated?

Most often cataracts do effect both eyes, although commonly the vision will be worse in one eye. The usual process is to treat the first eye and review. For many people the effect is a significant improvement to their vision, and often the second eye is not treated. Why have a second surgery when you will not notice any difference? This situation is assessed on a case by case basis.

If you have a concerns about cataracts, book to see us.

Book an Appointment Online

or call us on 09 425 9646

Please NO EYE RUBBING

People rub there eyes for a variety of reasons. Eyes can feel dry, burning, and itchy, and it seems that giving them a good rub will make them feel better - BUT DON’T DO IT!

For lots of good reasons eye rubbing is never a good idea. In an allergy situation it just makes everything worse. A safe alternative is eye drops or cool compresses - cool flannel or gel pack applied very gently.

Your eyelids, guess what, you’ve got one pair to last a lifetime. They are delicate. Gravity and a lifetime of blinking are going to change the structure of the eye lids and how effectively your blink reflex works to keep the surface of your eye moist and comfortable. Rubbing will honestly not be good in the long term.

This is particularly important for people who are at risk of developing keratoconus. This is condition where the cornea becomes distorted.

So if you need any further encouragement here is a video of an MRI of a violent knuckle rub to an eye. Dr Damien Gatinel, an ophthalmologist who looks after people which keratoconus studies eye rubbing using MRI imaging.

Measuring the Eye - Axial Length

The thing with health science is it keeps evolving! So let me explain what axial length measurement is, why this is useful, and who should be having their eyes measured this way.

As you may know already, we are concerned about the myopia epidemic. An increasing number of people world wide are becoming short-sighted, at a younger age.

Why is myopia a concern? Short-sighted eyes are often longer than an average eyeball, and this is associated with increased risk of eye disease in life.

Fortunately we now have a number of treatment methods which clinical studies have shown to slow down the progress of myopia in children. (Including Miyosmart spectacle lenses, soft contact lenses, and ortho-K contact lenses.)

How does the Eye Axial Length Measurement fit in? If we can identify eyes which are longer than expected, armed with this information we can try to harness as many strategies as possible, and monitor these eyes closely.

Conversely it will be reassuring to know if an eye is average length.

How is Axial Length (AXL) measured? There are a number of methods, but the easiest uses an biometer. This is a painless and non invasive - no eye drops.

A measurement scan using optical low coherence reflectometry (OLCR) biometry measures the axial dimensions of the human eye. From the cornea (at the front) to the retina (at the back). These instruments are readily available in a Ophthalmologist’s (eye specialist) clinic for measurements before cataract surgery.

Who should have their eyes measured? We recommend young people who are myopic, especially those identified as at risk of rapid progression. These are children with highly myopic parents, children who present needing a high prescription at the start and children who are at primary school when they need their first pair of glasses.

How often should eyes be measured? As this is a new clinical procedure we plan to measure once and review. We may recommend a second annual measurement for eyes which appear to be of normal length, if the prescription progresses.

For eyes identified as longer AXL we will likely recommend a review sooner.

Where do I go? Book to see Dr Mark Donaldson, ophthalmologist, at Rodney Surgical Centre, Morrison Drive, Warkworth. Phone 09-425 1190. Request an appointment for Myopia Eye Measurement.

What is the charge? The appointment fee is $75.00

Related Articles: New spectacle lens for Myopia Control - Myoismart

Myopia Control