I’m sure there are tons of articles and posts out there about keratoconus.  But, in the past month, I have diagnosed 3 kids with keratoconus – two of whom were previously misdiagnosed by another eye doctor, so I thought it might be good to get something out there focusing on this disease in kids.

First, what is keratoconus?  Let’s go back to our diagram of the eyeball I drew a while ago.

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The cornea is the very front part of the eye.  It’s the clear, circular dome shaped outer most part of the eye.  The colored part, or iris, is flat right underneath it.Wong(Opt)Shoot39

Now, lots of people have astigmatism.  Astigmatism is when the cornea is not perfectly round.  I usually tell patients and their parents int he exam room, that most corneas look spherical, like a basketball.

 

Screen Shot 2016-02-11 at 10.17.11 PMCorneas with astigmatism or more egg or football shaped.

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One axis of the circle is a little longer than the other.

But, people with keratoconus, don’t just have regular astigmatism.  They have irregular astigmatism.  It’s common, occurring 50 people per 100,000.  And, unlike regular astigmatism, which usually stays pretty stable throughout life, keratoconus is progressive.  The center part of the cornea starts to become thinner and bulges.  This usually worsens during puberty, which is why many people are first diagnosed in their teens.

Since their corneas are thin, patients shouldn’t be playing contact sports.  One of the hardest things I had to do was tell a 15 year old, up and coming MMA fighter that he couldn’t fight anymore.

This is a topography, or map of the cornea in a normal eye.  There’s a nice symmetric, red bow-tie in the middle.  This patient has regular astigmatism.

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And, here’s  a kid with keratoconus.  See how it has circles of red at the bottom of both eyes?  That means the cornea is really steep there.

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In the past, we would just advise teenage patients to stop all contact-sports and offer contact lenses to improve their vision.  But, now, there is a new FDA approved treatment to stabilize progressive keratoconus.  It consists us using UV light to stiffen the collagen in the cornea, along with riboflavin eye drops.

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Cross-linking-600x185                                                                                                Drawing of Collagen Before Cross Linking            Collagen After Cross Linking (stronger and thicker)

The patient above actually traveled from Hawaii to Seattle to get the treatment, but now, one of the Cornea doctors on the island can perform this procedures.  It is ideal in younger patients, since it does not reverse damage that has already occurred.  Unfortunately, it’s not a cure.  But, it stabilizes their keratoconus thinning, so if we catch kids early enough, then we can offer treatment which can truly change their ocular health.  Of course, all surgery has risks, and this article nicely discusses them, but I think it’s wonderful that it’s finally FDA approved in this country.  We’re hoping that insurance companies will realize this procedure prevents potential future blindness and disability and start covering it.

Severe cases of keratoconus require treatment with a corneal transplant or INTACS, which I will save for a later post.

Two of the kids who I saw in the office were initially misdiagnosed as having “amblyopia”.  Amblyopia simply means poor vision in one eye.  This can be  typically caused by an unequal refractive error between two eyes, misaligned eyes, or strabismus, and something obstructing vision in the eye.  There should be always be a REASON for the poor vision.  And, in these two children’s cases, there was a reason – keratoconus.  One patient was only 9 years old and the other 13 year old, which is definitely on the young side.  But, the fantastic thing is that now there is something that can be done to prevent keratoconus from getting worse.

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I hope everyone had a wonderful holiday season.  Here’s one of our Christmas photos from this year.

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As I prepare to return to work tomorrow, I am trying to institute some change for myself for 2017.  I don’t want to call them resolutions exactly, because it’s not a goal that I’ll achieve and be done with.  Instead, it’ll be an ever-changing process as I evaluate what works for our family and what doesn’t.

My 7 year old son (oldest) wrote this letter to Santa.

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It created all sorts of working Mom guilt.  Does he realize how stressed I am trying to juggle everything is making me?  Was my frantic pace to juggle it all – work, family and friends affecting him?  Should I stop working?  It gives me so much meaning to be a physician, but is it detrimental to my kids?

When I want some special time with him, I’ll take him out for boba tea.  It’s a treat and it encourages one on one time.  Our younger two kids (ages 5 and 3) are so fiesty, that some times my oldest does not get as much attention since he doesn’t demand it in the way the other two do.  Anyone with kids probably knows what I’m talking about.

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So, I asked this sweet boy, pictured above, “Do you want Mommy not to work?”  He thought about it long and hard.  And, he said “I like that you work because you help people.  But, I like when you don’t work too, because you pick me up from school and I get to spend time with you and I love you”.  Cue the water works.  I’m not really a very emotional person, but man, did I feel proud and touched by this little guy’s answer.

So, this year I endeavor to be more intentional in my time with the kids.  I’ve had this discussion with many of my friends who work part time – sometimes it’s the best of both worlds – home and work, and sometimes it’s the worst.  I feel guilty when I’m away from the office, but I also feel guilty when I’m away from the kids.  And  being out of the office, doesn’t mean I’m off duty.  Since I am the managing partner for the office, I feel the need to be ever available to my staff.  So, on my days “off” I’m still fielding at least 3-4 phone calls with the staff, writing blog posts, emailing  our accountant, HR provider, doing Quickbooks, etc.  So, there is a tendency real fast, for work to creep into all aspects of my “time off”.  I’m checking my phone when I’m with the kids on the playground, calling patients back when we are at the aquarium.  Part of this is the price for being able to work from home 2 days a week.  But,I am hoping for 2017 that I can find a better balance.  I may not be available to my children at all hours, but I want to make the time that I with them count.  Quality, not quantity.

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With that in mind, I am trying to create these intentional moments with my children.  Carving out time for just them and only them.  Right now, my oldest son and I are working on an art project for our master bedroom.  His art teacher at school told me she was very impressed with his painting skills and I have always loved art.  Obviously, growing up in a pretty traditional Indian household, academics was always prized above the creative arts, however, now that I have my own time, I thought this was something perfect I could share with my son.

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We are doing our own version of this painting we spotted on minted (but are too cheap to shell out $2K for).  Plus, the trips to Ben Franklin, the time it takes us to construct this piece together, is worth so much more.  And, in the end, I’ll have art in my house which is meaningful to me and something that my husband and I can agree upon (we have vastly differing art styles!).

For my baby girl, she is a girly girl who loves the water and is extremely fearless.

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Climbing too high for me.

Since my husband was an all-American water polo player in high school and college, I let him handle the swim excursions with her. But, she and I have our special time when I give her little manicures.  Some might think 3 years old is too young for nail polish (as my husband says) and I agree, but I have given in on this front.  I do only use these awesome VOC-free nail polishes that I found at Nordstrom.  She has quickly commandeered all of the bright pink shades.

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For my middle, he loves reading with me and getting massages (yeah, I know, I’m spoiling him for my future daughter-in-law, sorry!) and what he calls “date night” with me.

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Usually we just go to coffee bean and I’ll get him a strawberry milk and he tells me about his day.  It’s nice to have separate time with each child, when you have more than 2, some times I feel like I’ve spent the whole day with the kids, but have not been an active participant in their playing or their activities.  It’s all about running them to ballet, soccer, piano, etc.  So, I’m hopeful that creating some intentional moments with them will benefit all of us for 2017.  As my friend said “All moms have guilt”, whether you’re working full time, part time or SAHM.  But my mom (a child psychiatrist) once advised a friend of mine “The fact that you are having guilt about these things means you are a good Mom.  Bad Moms don’t even give these decisions a second thought.”

 

**All photographs courtesy of Daphne Hargrove Photography.  She is amazing!  She does family pics, birthday parties, senior portraits, and even boudoir photos**

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I’m definitely of the mind set that the more prepared you can make your child for doctor’s appointments, the better they turn out.  So, I thought I’d post about the details of what I do all day, in the hopes that maybe this will help calm the fears of our littlest patients.  I’ve had some parents tell me that they show their kids picture of my Honolulu magazine cover before the appointment and just that simple thing, makes my patients much more comfortable with me.

First up in an any eye exam is to check vision.  Vision should be checked with an actual eye chart for any kid over the age of 3.  Your pediatrician (or his/her nurse) should be doing this at the well child visit.  They may either use an old fashioned wall chart or any one of the number of new vision screeners out there that pediatricians are currently using. I’ve actually found that the Plus Optix screener that couple pediatricians use in the area is very accurate.  When your child comes into our office, we try to immediately escort them into our pediatric waiting room. IMG_6963This way they don’t have to feel antsy about sitting in a grown up chairs in an adult waiting room.  Here, they can play and read until they are called for their appointment.  Then, they are called into the exam room by one of technicians.  The child will sit in the chair (on a parent’s lap if necessary) and we will check vision. We have the children wear special glasses that have a hole on one side to check vision.  We have a pair which has the hole on the other side to check the other eye.Wong(Opt)Shoot42Older kids can check vision like adults, using the paddle.

Then we use a vision testing system which is a computer program.  It’s nice because we can isolate the chart to a single letter and can change the letters on any given line (for any of you guys who try to memorize the chart!).  It also has the advantage of having different types of tests to use based on the age of the kid.  This is why we can usually test any child older than 3 years of age.  Sometimes, we’ve even been able to do 2.5 year olds!

IMG_9161 And, if the kids are too young to know their letters, then we do these shapes or the HOTV letters.

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Some pediatricians still use the chart below to test kids who don’t know their letters.  They are called Allen symbols, but most pediatric ophthalmologists don’t like them because each picture is so unique in shape, that they’re easy to guess.

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Which kid now a days knows that that is a picture of a telephone? I had one patient call it a hot dog! I figured, close enough.

Then, we use special polarized glasses to do a test of 3D vision.

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“Grab the wings of the butterfly”

Then, if the child is older than 12 or 13 years old, I will refract them – that means checking to see if they need a glasses prescription.  That’s the whole “1 or 2 ” test.

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“What’s better – 1 or 2?”

If the kids are younger than 12 years old, then I don’t do this for them.  It’s tough enough for most adults to figure out which is clearer – 1 or 2.  For some reason, this simple question seems to provoke a lot of anxiety.  I check the glasses prescription for younger kids only after dilating their eyes.  Click here to read more about how I can figure out if babies need glasses.

If a child is old enough (at least 4 years old), I will try to examine the front part of the eye at the slit lamp biomicroscope. You’ve probably had this done if you’ve gone to the optometrist or ophthalmologist.  This basically gives me a closer look at the eyelids, conjunctiva, cornea, iris and lens.

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Then, on to the dilating drops.  This is probably what gives children the most anxiety.  I try to minimize this by combing all of the various drops into one spray bottle.  This way, the child doesn’t need to have 3 different drops (even though they may need 3 doses even of the spray).  And, the convenience of the spray is that I can apply it to the child’s eyelashes when their eyes are closed and if I really soak them, then whey they open their eyes, the drops get into their eyes.

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It’s actually quite rare for kids to scream and cry for the drops.  OK, maybe rare is an overstatement – my own oldest son cried when I put drops in his eyes to do his eye exam and that was me putting them in.  This is when the teachers at his preschool kept insisting that he needed glasses because he tilted his head to the side when watching TV or thinking.  And, they knew I was a pediatric ophthalmologist!  “Yeah, I’m pretty sure I’ve checked my son”, I condescendingly thought.  However, add 2 more kids to the crazy mix of our life and I will abashedly admit that I’ve never checked their eyes.  So I guess it wasn’t totally out of the range of possibility that I could miss my kid’s need for glasses.  But, that’s a tangent.

Once the eyes are dilated, I use this crazy thing on my head, called the indirect ophthalmoscope to examine the inside of the eye.  For young kids, I use toys to distract them so I can get a good view inside.  For older kids, I have movies playing to hold their attention (best money I have ever spent when setting up my practice!)

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For the young kids, this is when I check the refraction.  I do this both with an automatic machine (pictured below) and then I double check everything by using a retinoscope as well.

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And, that’s about it.  Of course, they get to choose a toy from our treasure chest on their way out.  I have a lot of kids who don’t want to leave our office.  We have the nicest techs and they are just wonderful with children.  We try to make the experience as pleasant as possible!

FullSizeRenderAnd, no I don’t usually have a professional photographer following me around the clinic.  Almost all of these pictures were taken a freshman in college, right before he graduated from college.  His pics are amazing, for any local moms who want to use him when he comes home for summers and breaks.

 

 

 

As many of you know, I have 3 children.

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We found out we were pregnant with my oldest son the first weekend we moved to Honolulu.  We had just taken over Honolulu Eye Clinic, and out of nowhere, I came up with the idea to have a nursery in our office.  My husband thought I was crazy, but I figured, we are the owners, we can do what we want!  And, I also predicted (correctly, as it turns out), that Hawaii is so family centric, so focused on ohana, that I didn’t think patients would mind.  Plus, since I am a pediatric ophthalmologist, there were going to be kids crying from dilating drops anyway, what’s one more kid?

At the back end of the office, there was this room which Dr. Edwards was just using as a storage space.  I told Jeff I thought this would be the perfect nursery.  He didn’t have the vision I did and had a hard time imagining it.  He said “We’re going to put our first born in a storage closet?”.

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It was definitely a bit of a mess.  The 2 nice things about the space was that it was pretty large and that it was right across the hall from the pediatric waiting room. (which we stayed up until midnight before our first day putting together).

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Pediatric waiting room at Honolulu Eye Clinic

 

So, after craig’s listing everything in the room and reorganizing it all, we had a blank slate.  The room is actually bigger than the nursery we have at home. I kept everything pretty simple.  Just some paint on the walls and I found a comfy chair to nurse in off of craig’s list.  I was given a second hand pack and play which fit better in the room than a crib.  Then off to Target for a couple rugs and a changing table.

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Hard to believe it’s the same room ,right? I made some green curtains from fabric from Walmart to hide all the storage we still needed to keep in the room.DSC_0178I cut the top off cardboard letters and filled them with fake flowers from Ben Franklin.

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Lots of books from garage sales! You can never have too many books

It was so wonderful to have my kids close by when I was nursing.  It really helped me go back to work sooner, because I wasn’t worried about who was watching my children.  We were so blessed to find a wonderful nanny, Gabi.  And, I just scheduled a block in my schedule mid-morning and mid-afternoon to breastfeed.  It was ideal.  I never had to pump or worry about not producing enough milk.  Though the downside was that none of my 3 kids ever learned to take a bottle, they were very spoiled!  Our nanny would take the kids for walks, and when they were older to activities like Wee Play, Ohana Music Together, Children’s Discover Center, Aquarium, Hawaii State Library, Honolulu Zoo.  Queen’s is so well centered, that a lot of things were walking distance.  So, as the babies got older, they weren’t actually in the office nursery for that long, but they would come back for lunch and nap, and just seeing them at those times was wonderful too.  Gabi moved to the mainland when Nikhil was a little over a year old, and we were blessed again with another amazing nanny, Shawna.  She truly loved our kids as if they were her own.

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The other plus side of having a nursery in our office was that my children grew up with the wonderful girls we have on staff.  They call them their “Clinic Aunties”.  Again, another reason they could have been a little spoiled.  My kids love coming to the office because not only do they see us, but they adore seeing their aunties too!

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And, that’s what is truly wonderful about Hawaii – my patients loved seeing my kids, they wanted to see the nursery and be updated on how they were doing.  I have one patient who even made her appointment times with me around my baby’s nap schedule so she could see him!

My youngest child juststarted preschool last week – hard to believe!  So we will no longer need the nursery in the office and the plan is to turn it into an exam room next month.  I know, kids growing up is all a part of life, but clearing out this nursery definitely tugs at my heart strings.  And, no, we’re are 100% not having any more children!

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And for any other DIYers out there, here are some pics of our nursery at home.  It’s the same room, just decorated differently.  For Taj’s nursery below, my mom made the crochet airplane mobile with sewed in musical buttons.  I painted the canvas with Taj’s name in Tamil and his Chinese name as well.

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Taj’s cultural/travel themed nursery.

When we had Arya, we moved Taj to another room and I really DIY’ed everything from the crib bedding (thanks Mom!), to the felt mermaid crib mobile (made that while sitting in the doctor’s office during my pregnancy), hand stenciled curtains for Arya’s room with a coral paisley (absolutely never again – want to get back pain? then hand stencil curtains when you’re 36 weeks pregnant and then sew them with black out liner), paint stick mirror, gallery wall from old frames that I got for free from Pictures Plus and spray painted gold.  For some reason, I really love designing and decorating kids spaces.  I think they’re just so much fun and are meant to be creative spaces for your little one to grow.  It’s my stress relief from work!

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Arya’s gold glam mermaid nursery

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I know it’s been a while since I posted on the blog – the holidays were wonderful, hectic and crazy.  I did my usually DIY projects around the house to decorate and bring in the Christmas cheer.

I made these stockings last year, they took forever because though I’m a patient sewer when I am sewing eye muscles, I am a bit a impatient when sewing fabric!

 

I tried to take a little more time off this year to spend with the kids when they were home on break.

Taj at his Christmas show

Nikhil singing Christmas carols around his elementary school

 

 

 

 

 

 

 

 

 

 

 

 

We worked on little projects together, such as making “Reindeer Chow” together to give my middle’s son’s preschool classmates.  Got the idea from this blog.

Making 20 of something is always more time consuming  than I expect it to be.   I thought making it in bulk would be easier, but the packaging took up time.  And, yes I know – are these 3 year olds really reading these labels?  Probably not.  Am I doing this for myself? Possibly.  But, I’m sure any Moms out there understand – there is this pressure to keep raising the bar with these kind of things and not in a good way.  But, I will say, the reindeer chow was darn tasty and even though I was trying to be low carb, I convinced myself this somehow fulfilled that criteria!

My older son is in kindergarten and the room moms asked for locally made presents for his two teachers.  I am ADDICTED to the Magnolia Mom blog and they had this great tutorial on making gingerbread cookie Christmas ornaments.  I actually found this modeling clay at Ben Franklin that was non-toxic so my son could help roll out the dough and cut out the shapes.

And the finished product.

We spent so much wonderful time with my in-laws family.  My husband has 3 older sisters – one of them lives just six houses down from us, but the other 2 live in California.  They traveled to Hawaii for their annual vacation.  That means 9 adults and 10 children!  We found this great high school senior who is an awesome photographer.  We’ve been hiring him lately to take our family photos.  Check out his website here.  I saw the idea for the signs on pinterest and though I was for about half a second contemplating buying wood, sanding, staining and then painting with chalkboard paint to make the signs as in the original idea, better sense actually prevailed for once and I went with simple posterboard and a chalkboard pen.

The entire Wong side of the family

 

We did a lot of things that I’ve just never had the time to do here in Hawaii, even though I’ve lived here for over 6 years!  When we first moved to Hawaii, we were so overwhelmed with getting on insurance plans, learning how to manage a practice, build our patient base that we never had much of a chance for me to truly explore Hawaii.  My husband grew up here and his family has been here for generations, but I am an East Coast girl and hadn’t even been to Hawaii before we got engaged here!  So, it was wonderful to take the time to do these things with our family.

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Koko Head Stairs with my in-laws on New Year's Day (my first time!)

I think that was the most important lesson from this past holiday season – even though I’m busy with work, I really think it’s about creating intentional time and moments with your kids.  Quality, not just quantity, right?

And, then last week, we went to Maui for the annual Hawaiian Eye Meeting.  The meeting conferences were from 6:30-1pm, so it left plenty of time to hit the pool and hang out with the kids.  So, we decided to take the children with us.  Here are we are the beautiful resort – look closely because this was the last 5 minutes that all kids were healthy.

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Yup, that’s right – the flu that’s been going around Oahu hit all of the children.  The first 3 days of the conference, our oldest son had it, then the baby for the next 2 days and then the middle child for the last 2 days.  They weren’t even sick at the same time.  And, if you can imagine – 5 of us crammed into one hotel room, cleaning up vomit off the beds, floor, etc.  Not exactly the vacation we were planning.  So, after this meeting we immediately decided to cancel our plan to attend another meeting in San Diego in April.  Just too hard.  I’m sure parents out there can relate – you come home from a vacation, needing a vacation from your vacation!  And, that was with just a 30 minute plane right.  As Arya gets older (she’s now 16 months old), it just gets tougher to travel!  But, when we moved out here, my husband knew we would need to do a lot of traveling to the mainland, since all of my family is there.  Before we were married, Jeff and I used to try to take one international trip a year.  We scrimped and saved as residents and fellows – lots of ramen, walking instead of paying the $1.50 to take the bus somewhere, you know all those things to save money .  My hope is that we will resume international traveling in the way of medical mission trips and I’d love to take the kids.  I think it’s so important for the children to see how life is in the developing world.  However, the thought of being outnumbered on a plane trip lasting over 15 hours with 3 kids scares my husband to death.  I think it’s just about adjusting expectations – you realize it won’t be pretty and it’s not the same as traveling without kids, but you’ll live through the plane ride and the end result will be to create memories that are amazing.  But, that was a bit of a tangent.

I’ll be back to a more regular posting schedule with an ophtho post about strabismus surgery next week.

 

Why do my child’s glasses keep getting stronger? This is one of the most common questions I encounter in my practice.  I see a patient after they have failed their vision screening exam at their pediatrician’s office and diagnose them with nearsightedness.  The following year, their myopia is worse and the glasses prescription has to be increased.  The year after, same thing happens.  I always reassure parents,”‘This is normal.  Expect the prescription to increase every year until they hit college age”.  But, of course, as a parent, it’s worrisome.   Parents always ask me about TV/video games/foods they can eat, anything that could help “strengthen” their children’s eyes.  Before, I would have to tell them that nothing could be done, it was just genetics.  But, not so anymore!

But, first, let’s just review what is myopia?  Myopia is what most people often call nearsightedness  – you can see up close, but not far away.

 

Myopia is the most common refractive error in kids, and it’s on the rise. My son is obsessed with asking if my husband is nearsighted or farsighted after we read this page in the Cat in the Hat book at bedtime.

 

For myopes, the light rays from the outside world are focused just in front of the retina.  It can be because the eye is a little longer than usual (axial myopia), sometimes for adults, it’s because there is a cataract refracting the light differently.  But, let’s stick to the kids for this discussion.

Myopic eye diagram

So, it makes sense if one parent is myopic, then the child has a good chance of becoming myopic as well.  Eye size is inherited just as hair color, height, etc.  My boys don’t wear glasses for real (though they are modeling them in the picture above), but I should qualify this as a YET.  I am not nearsighted, nor is anyone in my immediate family, however, my husband’s side is a different story.  So, there certainly is a good chance that they may require glasses in the future.

Now, here’s a little throwback to high school physics.  For nearsighted individuals, the lens shape (concave) helps to focus the light on to the retina.

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Now, to the good stuff?  What can be done?  Two new studies have come out which have had some very promising results in terms of decreasing the progression of nearsightedness in kids.

1.  Increase Time Outdoors

One study examined 2000 children in Australia and specifically looked at the type of activities children were doing.  They then followed-up the kids 5- 6 years later to figure out which activities seemed to make a child more nearsighted.

  • Time spent indoors
  • Time spent doing near work (reading, homework, iphone, etc).
  • Family history of nearsightedness

So, what does this mean.  Being outdoors in the sunlight, is protective.  Kids who spent 1-2 hours/day outdoors, were on average a whole diopter less nearsighted than their peers who did not.  That would mean -3.00 prescription instead of a -4.00 prescription. And, the more time kids spent indoors on devices made their myopia worse.

But time spent doing near work, in and of itself, did not cause nearsightedness.  So, the belief that too much time spent on the iPad/iphone will cause a child to need glasses is incorrect.  I am asked this leading question at least daily by parents “Using the iPhone or playing video games is bad for the eyes, right?”  .  They look at me hopefully, expecting me to dispense a lecture to the kids of the dangers of said devices.  But, unfortunately, it’s just not true.  Now, what I do tell them, is that first and foremost, too much time spent on these devices is not great for their brain.  A policy statement issued  by the American Academy of Pediatrics warned about the dangers of attention problems, sleep difficulties and obesity from too much time spent on media devices.  However, there have been no conclusive studies which link media devices with eye or vision problems.  BUT, when kids are playing on these devices, it does make it more difficult to get them outdoors, in the protective UV light and that can make them more nearsighted. So, is it the bright light or the UV light that’s protective?  Well, studies in animals seem to indicate that it might just be bright light which is helpful, though it’s still too early to draw conclusions.  However, I still recommend that kids should always wear protective hats, sunglasses and clothing when outdoors, especially here in Hawaii.

Being myopic is not just a pain for children to wear glasses, it can also have serious consequences in terms of the health of a child’s eye.  People who are myopic have longer eyes than individuals who are not.  That predisposes them to having retinal tears and detachments if their prescription is higher than -6.00 D.   It’s basically because the same amount of retina is being stretched more in a myopic eye than in a normal eye.  This can leads to areas of thinning or tears which can cause retinal detachments.

 

2.  Atropine 0.01%

Another important study assessed the effectiveness of a dilute version of a dilating drop – atropine – in delaying the progression of nearsightedness.  Studies have been done with different strengths of this drop in the past, but as you may know from going to the ophthalmologist, even when dilute, dilating drops can cause side effects, like blurry vision and sensitivity to sunlight.  But, this study looked atropine 0.01%, which is 1/100th the strength we use in the clinic.  When administered daily to kids, it slowed their nearsightedness and also decreased the elongation of their eyeball.  Therefore, they were less at risk for those dangerous retinal tears or detachments.  I now offer these drops to a high select group of patients who have nearsightedness which is worsening quickly.

Schools in China are already applying the outdoor time in an effort to decrease their incidence of nearsightedness.  And, for those kids for whom this preventative treatment is not enough, then there is hope with the atropine drop.  As more studies come out, the research will be even better in helping us slow nearsightedness in our kids.

 

I realize I haven’t written many posts about being a Mom and so I thought it’s about time I did.  I’m not going to lie – juggling 3 kids younger than 5 years old, work and being a wife is challenging.  But, I actually think because of my new found commitment   obsession with being organized, our family is actually able to survive.  I love being an ophthalmologist, I would never give it up in a million years.  But, being a mother and wife are very important to me as well.  To do all of it, I have became extremely organized and have a million checklists for it all. I thought I’d share some of those tips with you.  My favorite blog for tips and tricks is www.iheartorganizing.blogspot.com.  I started reading this blog when I was expecting Arya.  The author of this blog has 3 boys and at the time, I wasn’t sure if Arya was going to be a boy or a girl and I could very easily relate to her need to tame the clutter.  Now, I don’t have the time or energy to spend hours making beautiful labels for everything as many mommy blogs out there do.  I need a system in place to make my life easier, that’s it.  So, here they are, things that have helped me stay organized and allowed us to function as a family.

 

1. Getting Ready in the Morning

Any mom knows this can be extremely tough.  Get yourself dressed, get the kids all packed and ready to go so that you’re not late for work.  My oldest son thrives on routine and schedules (actually I think all kids do), so I made this checklist for him, borrowed from here.  He’s 5 years old, so he’s really old enough to be helping get himself ready for school.  Heck, by the time I was 11 years old, I had to pack my own lunch the night before school!  And, he loves this list.  I laminated it so he can check it off with a dry erase marker.  Often, he will tell me if I’ve done something out of order (I mentioned he loves routine, right?).

Morning Routine

In addition, I have checklists for what goes into each child’s backpack.  I created this because my husband always wanted to help during the morning dash, but he was always asking me “What do I need to pack for them?”  If I have to tell him, then I can just do it myself, so instead I made checklists.


 

 

 

 

 

 

 

 

 

If they have activities for the day, I have checklists for those bags too – swim bag, karate, etc.  I won’t bore you with those.  But, everything is packed and ready to go the night before.

2.  Mail/clutter

I hate mail.  I’m not sure why, but I just can’t stand going through junk mail and paying bills.  I pay the bills at the office just fine, but home bills are another story.  To curb all the mail/bills/multitude of artwork my children bring home from school, I created a filing system.  I basically scoured pinterest and did a combination of things that worked for us.  All mail/art goes into the gold tray when I walk in the door.  Then, I sort it into this wall hanging unit which is set up in our office nook.  It seems to work – haven’t lost bills so far!

 

 

3.  Toys (Clean-up)

I realized I was spending about an hour a each night cleaning up toys, organizing, etc and like Norma Ray, I decided I wasn’t going to do it anymore.  The boys are in preschool and at school, they clean up their toys beautifully, so why not at home?  I love baskets for toys and now all the baskets have labels on them, so the boys know where everything goes.

4.  Meals

I think this is probably the most difficult to do for working Moms.  My kids want to eat at 5:30 pm, they’re starving by then.  So, I need to have as much of the prep work done before I get home so that I can cook in a flash.  To stay organized, I use this meal planner – laminated cards with the recipes on one side and a list of the ingredients on the back and reference number for where the recipe is (Pinterest, particular recipe book, all recipes.com.  I sit down every Sunday and plan out the week, then I can just flip over the card and write out my shopping list from the ingredients).  I have color coded the cards – gray = crockpot, blue = pasta, green = grill, etc.

 

 

 

 

 

 

 

 

 

 

I painted a magnetic board with chalkboard paint and hung it in my kitchen.  I have a little magnet chalkboard container in which I keep the meal cards.

So, those are just a few of my organizational systems.  My house certainly is not a well oiled machine.  There are days where we feel like we barely keep it together, but these things help us juggle it all!

 

Children and infants may not be as interested in the fashion statement of sunglasses.  But, babies and kids spend as much as time outdoors in direct sunlight as adults, especially here in Hawaii.. In addition, the crystalline lens inside the eye of people younger than 30 years old is more susceptible to damage from UVB light than that in older adults.  Not only does this susceptibility potentially cause earlier cataracts, but because their lens lets in more damaging UVB light, the retinas of children are more prone to UV toxicity.

So, UV protection for their eyes is even more important for them than for adults.  In the same way that you cover your children in sunscreen and protective hats and clothing when they go outside, so too should their eyes be protected.  Ultraviolet radiation is a great concern in sunny places like Hawaii.  UV light is a part of the light spectrum from the sun to the earth.  Remember this picture from high school?

uv light jpg
In fact, most experts believe that children get 80% of their lifetime UV exposure by the time they are 18 years old!  UV exposure has been linked to the development of cataracts, macular degeneration and other ocular diseases. The risk of retinal damage from sunlight is greatest in children less than 10 years old, although the eye diseases do not develop until adulthood.  UV exposure is the greatest when children are out between the hours of 10 am and 2 pm and if they’re near large sandy beaches and reflective bodies of water.

All sunglasses are not the same.  Effective sunglasses should protect against UVA and UVB light. What’s the difference, you may ask?  Experts used to think that only UVB was harmful, but now additional research has confirmed that UVA light also penetrates the atmosphere causing skin cancer, premature aging and eye damage.  In fact, UVA penetrates the skin and eyes more deeply than UVB light.

However, many expensive sunglasses do not filter out UVA light.  So, it is extremely important to double check that the sunglasses your purchase protect against both UVA and UVB light.

LENSES:

Look for a label or a sticker that says one or more of the following:

  • Lenses block 99% or 100% of UVB and UVA rays
  • Lenses meet ANSI Z80.3 blocking requirements. (This refers to standards set by the American National Standards Institute.)
  • UV 400 protection. (These block light rays with wavelengths up to 400 nanometers, which means that your eyes are shielded from even the tiniest UV rays.)

It should either be marked on the sunglasses or the optician will be able to inform you.

FIT:

Sunglasses should properly fit your child’s face.  If the glasses are too big around the temples or don’t fit their nose bridge well, then they will be continuously falling down.  For infants, I really like the Julbo line.  They are soft and flexible, so they fit babies’ flat noses well, without indenting their nose.   Also, wrap around styles provide the best coverage and protection.  Here’s my son in his Julbo sunglasses when he was around 7-8 months old.

 

Once we started taking him to the beach with us, I put him in sunglasses.   It’s never too early to start having your child wear sunglasses.  Also, of course, he is wearing a large hat, full length UV rash guard and sunscreen.  I always joke with my dermatologist friend that you can spot the doctors’ kids at the beach a mile away.  They’re always totally covered up, whereas other kids are just wearing diapers or little bikinis.

 

POLARIZATION?  WHAT IS THE DEAL?

Another question I get a lot is about polarized sunglasses.  Polarization reduces glare, by filtering out sunlight that bounces on reflective surfaces so it is helpful for people who spend a great deal of time on the water.  However, it is important to note that polarization has nothing to do with UVA/UVB protection.  Just because a pair of lenses in sunglasses is polarized does not mean that it also has UV protection.

 

Above, my younger son is wearing Babiators sunglasses which we have available in our Optical Shop with polarization.  Department stores like Nordstrom also carry them, but without polarization. My older son is wearing no-name sunglasses that I picked up at the store (but they do have UVA/UVB protection) and I’m wearing the new summer Ray-Ban Erika sunglasses, which we also have in our Optical shop.   I love these, they are so light and I feel like they look like candy.  My husband says I have sunglasses addiction, and I might have a collection to rival Brad Pitt’s.  But, hey, we live in Hawaii and I just reviewed all the reasons why sunglasses are medically necessary, so it’s shopping for a MEDICAL reason (that’s my justification for my 8 pairs!)

But, getting back to the kids.  Kids really only care that the glasses are comfortable, otherwise it’s near impossible to get them to keep them on their face. At Honolulu Eye Clinic, our opticians are skilled at knowing the type and fit of glasses best suited to protect your child’s eyes from harmful sunlight.  Our optical shop carries sunglasses for infants to adults, all of which block UVA and UVB light.  I would avoid buying sunglasses for kids online unless you can try them on your children first to insure a proper fit and that your child will tolerate wearing the sunglasses.

 

© 2011 Honolulu Eye Doctor & Mom Suffusion theme by Sayontan Sinha