Quick Hits
More screens, more myopia
A study of children finds “screen time” increases risk of nearsightedness
By Robert Stoneback, Associate Editor
One vital way to stop rising childhood myopia rates is to have kids turn off the TV, switch off the computer, put away the cell phone and go outside, according to a report from the USC Eye Institute.
It can’t happen too soon, either — the Eye Institute’s study confirms that the burden of childhood myopia in America has more than doubled over the last 50 years.
A press release detailing the results of the Multi-Ethnic Pediatric Eye Disease Study was released in January on USC’s website. After examining 9,000 Los Angeles-area children ages 6 months to 6 years from 2003 to 2011, the study listed a possible culprit as spending too much “screen time” in front of electronic devices and not enough time spent in outdoor activities especially in daylight. The report also noted that these trends were seen especially among Asian children.
While there is evidence of a genetic component in Asian children, the rapid and recent rise of myopia suggests that close-up, daily use of mobile devices, tablets and computer screens, coupled with lack of outdoor activities in sunlight, “may be the real culprit behind these dramatic increases,” said Rohit Varma, MD, director of the USC Eye Institute, via a press release.
“More research is needed to uncover how these environmental or behavioral factors may affect the development or progression of eye disease,” Dr. Varma continued.
This nearsightedness, called “axial myopia,” can worsen as children grow and their eyes develop, Dr. Varma said via phone. Eye development usually stops when a child reaches age 18, though cataracts can cause the eye to change again if they develop during adulthood.
This research suggests that children need to be screened early to catch any vision problems. Dr. Varma recommended screenings at ages 6 months, 3 years, 5 to 6 years and then regular vision tests after that point, especially if nearsightedness is involved. Children with high levels of myopia are likelier to develop conditions like cataracts, glaucoma and retinal detachment.
Dr. Varma does not recommend corrective laser surgery for myopic children, not only because it could damage their still-developing eyes but because underlying factors have a greater influence on myopia. While some factors, like genetics, can’t be changed, there are others over which people have greater control.
Dr. Varma and his team found myopia to be most common in African-American children, at 6% of those studied, followed by Asian-American children, at 4%. While the genetic predisposition towards myopia in Asians has been well established, “We don’t have a real explanation as to why African-Americans have a higher prevalence compared to non-Hispanic white and Hispanic children other than to speculate,” Dr. Varma says. He hypothesized that it could be related to African-Americans more often living in urban areas, with less space for outdoor play and thus more time spent indoors in front of computers or TV.
Outdoor activities and natural light help reduce the development of myopia as the child’s eyes can focus on objects in the distance, Dr. Varma says. Conversely, time spent indoors, looking at screens, forces them to focus on nearby objects. For this reason, children should balance their indoor activities with outdoor activities.
A study performed in China, and published by PLoS One in June 2015, sought to examine the link between outdoor activity and myopia prevention in children by observing two groups of young rhesus monkeys. At adolescence, the group raised in artificial light showed much greater signs of myopia than the group regularly exposed to natural light while young.
Among children and adults in Asia, 90% or more of the population has been diagnosed with myopia, according to the USC Eye Institute’s research. Sixty years ago, the rate was 10% to 20% of the Asian population, as reported by Dr. Varma and his research team.
A meta-analysis conducted by researchers from China’s Wenzhou Medical University found a number of interventions to reduce myopia progression. The most effective method, according to their 2016 report published in Ophthalmology, was using muscarinic antagonists such as atropine (AtroPen) and pirenzepine. OM
REFERENCES
1. Wang Y, Ding H, Stell WK, et al. Exposure to sunlight reduces the risk of myopia in rhesus monkeys. PLoS One. June 1, 2015; 10(6):e0127863.
2. USC Eye Institute study seeks cures to childhood myopia. University of Southern California. https://news.usc.edu/91007/usc-eye-institute-study-seeks-cures-to-childhood-myopia/. Last accessed Feb. 9, 2016.
3. Huang J, Wen D, Wang Q, et al. Efficiency Comparison of 16 Interventions for Myopia Control in Children. Ophthalmology. Published online Jan. 26, 2016.
Dear Colleague:
On the January 2016 cover of Ophthalmology Management, an image of the Glaukos iStent incorrectly portrayed the procedure as suffering dramatic reduction of Medicare reimbursement in 2016. Subsequent images in the January issue, on pages 16 and 17, again incorrectly linked the iStent device with recent reductions in CMS payments of glaucoma surgery. CMS has not reduced physician or ASC reimbursement for the iStent procedure or for the associated cataract surgery.
The cuts in CMS reimbursement for ASCs, as reported in the January article (“CMS wields the axe; now what happens”), apply only to IOP reduction procedures that use aqueous shunts — CPT codes 66179, 66180, 66184 and 66185. The iStent is not considered by Medicare to be an aqueous shunt device. Additionally, cuts in physician reimbursement are associated with trabeculectomy and laser trabeculoplasty procedures including CPT codes 66170, 66172 and 65855. The iStent, a trabecular micro-bypass stent, is reimbursed under CPT code 0191T, and is not affected by the reimbursement reductions to the ASC or physician described in the article. CPT code 0191T APC payment rates for iStent in the ASC actually increased 4.59% in 2016. To avoid further confusion, the images of the iStent, used on both the January cover and feature, have been removed from the Ophthalmology Management website.
“For 2016, Congress required CMS to address Medicare payment rates for overvalued procedures in the Achieving a Better Life Experience Act of 2014. Of note, some glaucoma and retina procedures were dramatically impacted, although 0191T (insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach) was not one of those. Further, the reimbursement cuts in glaucoma procedures only affected physicians since reimbursement for ambulatory surgery centers and hospital outpatient departments for the same services increased in almost every case,” says Kevin J. Corcoran, COE, CPC, CPMA, FNAO, president and co-owner of Corcoran Consulting Group.
Robert J. Noecker, MD, MBA of Ophthalmic Consultants of Connecticut adds, “The Medicare cuts for laser trabeculoplasty and large glaucoma drainage devices that use a reservoir have not affected my use of iStent for the treatment of glaucoma. In fact, they have made me re-examine my own treatment patterns for surgical and laser glaucoma therapy and have increased my use of MIGS procedures (i.e. iStent).”
The editorial staff of Ophthalmology Management deeply regrets this error and apologizes to Glaukos Corporation and their customers for any confusion we may have caused.
Sincerely,
Larry Patterson, MD
Chief Medical Editor
Ophthalmology Management
Eye care for all
Two brothers, ophthalmologists both, started a clinic for the needy.
By Robert Stoneback, Associate Editor
The Chang brothers wanted to make eye care a right, not a privilege, for the people in their community.
“The idea of ACE [Advanced Center for Eyecare] is we wanted to take everybody,” says Daniel Chang, MD, who serves on ACE’s board of directors. His brother and fellow ophthalmologist, Joseph Chang, MD, is also a board member, as well as the CEO of the Chang brothers’ clinic, Empire Eye and Laser Center.
Empire, in California’s Kern County, is designed as a “concierge, high-technology” facility, says Dr. Chang. Translation: It isn’t intended to serve the uninsured and underinsured county residents.
But the Changs did not want to turn away the people who needed help, so in 2010 they opened the Advanced Center for Eyecare to provide affordable treatment for those in need.
Cheap medical insurance does not pay a medical provider much money, says Dr. Chang. Because of this, many providers will not accept certain insurances, which can effectively leave patients without coverage in their area.
Like, presumably, many of the people living in Kern County.
About 870,000 people live in Kern County, including a large proportion of laborers whose median household income, $48,574, is lower than the rest of the state’s, at $61,489, according to U.S. Census estimates from 2014. Fifteen percent of Kern residents have a bachelor’s degree or higher, which is half that of the state’s.
About 40% of Kern County residents have Medicaid or no insurance, according to Dr. Chang.
To better reach those in need, ACE has partnered with local school districts and other nonprofits to provide free eye screenings.
ACE has a yearly partnership with the nonprofit group OneSight, which establishes a nine-lane vision clinic to give free exams and eyewear to children in Kern County. At their most recent clinic in January, 1,777 children were tested and received glasses, at no expense to their families.
ACE had meager beginnings, originally seeing 25 to 40 patients a month in space borrowed from a local clinic, says Justin Cave, ACE’s executive director. Dr. Chang calls Mr. Cave “the catalyst, the engine that allowed us to develop as a nonprofit.”
ACE also lacked its own equipment when it first started, and borrowed optometric equipment from the Empire clinic. ACE moved into its own facility, in the city of Bakersfield, in March 2012.
ACE now sees 35 patients a day, Monday through Friday, and is funded through grants and donations. While the Chang brothers still see ACE patients on a monthly basis, the non-profit has added full-time and part-time optometrists since its founding.
“The community support is amazing,” says Mr. Cave. Bakersfield is a close-knit, philanthropic community, that always pulls together to help people, he adds. “We were able to thrive because of our private donations and community support.”
Support regularly comes from of local businesses, primarily ones associated with the region’s oil and agricultural communities, according to Mr. Cave. In addition to donations, ACE holds two annual fundraisers, a spring poker tournament and a fall “Appetite for Sight” gala.
With that patronage, ACE went from having almost no budget, seeing patients in a borrowed clinic, to a $1.5 million annual budget and an 8,000 square foot facility within four years.
“That’s … a testament to the support we receive from the community,” Mr. Cave says. OM
Two new products are on the market
The FDA has given clearance to Optovue’s AngioVue Imaging system, which can help visualize abnormal blood vessels in the retina. The Optovue uses a noninvasive, dyeless technique to quickly display the presence or absence of flow in the retina’s blood vessels. The dyeless process leads to greater accuracy, as the dye won’t obscure the target, and fewer complications during procedures, according to the company. Light rays are used to form detailed, three-dimensional images of the retina, and the AngioVue system can acquire an image to complement fluorescein angiography in less than three seconds.
Topcon’s High Definition Video system for Topcon Operation Microscopes allows doctors to use an HD video camera during examinations. The unit also contains a camera control unit, power supply and interface cable. The video system can be attached to all current models of Topcon Operation microscopes.
Video can be displayed on an optional HD color monitor or on other operating room monitors connected to the camera control unit. Video from the monitor can be recorded for later use with an optional video recorder. A TV relay lens mount is also available, according to the company.
![]({"src":"/media/lbpinz0d/32016.jpg","focalPoint":null,"crops":[{"alias":"thumbnail","width":1110,"height":700,"coordinates":null}]})