In one way I was a little surprised when my wife called me at work to tell me that Chynna, our almost 5 year old daughter had woken up that morning and had complained that she couldn’t see. Carrie told me that she had stood Chynna up against the far wall in our kitchen and she was amazed that Chynna couldn’t even see the calendar on the opposite wall. She had brought Chynna to within about 2 feet of the calendar before Chynna could read the dates on the calendar. Now this calendar has pretty big numbers on it, so there was something seriously wrong with Chynna’s vision if she had to come to within a couple of feet of it to read anything. I suggested that Carrie should call around and see if she could get an immediate appointment for Chynna, and while she was at it it likely wouldn’t hurt for Chloe to have her eyesight tested as well as I thought I had noticed Chloe doing a bit of squinting recently. It seemed that a number of our friends’ children had needed to get glasses recently for myopia. And when I had noticed Chloe squinting and drawing closer to the things she was looking at I was pretty sure she would be joining the girls’ glasses club. Carrie, my wife. had been a member since she was 8 years old, and her glasses were one of the things that attracted me to her. Carrie was just nearsighted enough that she had to use all the tricks to get her very expensive glasses thin enough that she didn’t feel that they looked like bottle bottom lenses, but even with all the thinning tricks they do, a -14.25D prescription still can’t hide the cut in. The cut in is due to the optical power of the lenses, and thick or thin doesn’t matter. But it was a bit of a surprise that Chynna was showing evidence of being very shortsighted. I was stuck in an office every day earning the money it took to keep a roof over our heads, clothing on our backs and food on the table every week. Carrie had worked as a teacher for the 5 years after we were married, and she planned to return to teaching once the kids were in school full time, so she was home with the girls. Chloe was only 6, and Chynna was a year and a half younger, so being able to leave Chloe alone after school with Chynna was still a few years away. But the teacher in Carrie had been doing such a good job of teaching the girls that I think both girls could have skipped right into junior high. Well, maybe not quite but Chloe was reading at a grade 6 level and Chynna was not far behind. And while Chloe had some friends she went out and played with occasionally Chynna would rather read a book or play on her tablet. Both girls read and did a lot of close work so along with their mom’s genetic background they were predestined for myopia. I would have been surprised if the girls had not developed myopia at some time, but for Chynna to not be able to read the calendar from right up close indicated that something was really wrong. Carrie called me back to tell me she had gotten appointments for both girls with the eye doctor at the mall for that evening. I asked her if Chynna’s eyesight had improved at all, and I wanted to know what she was doing at the moment. The answer was exactly what I expected. Both Chynna and Chloe were in their rooms reading on their tablets. Over the past few months, I had told both girls so many times to get their nose out of their tablets, or their books, to get back from the TV screen, to not put their face so close to their coloring books that I had finally given up. I felt that on a nice sunny day 5 and 6 year old kids should be outside, but I knew Carrie had grown up spending a lot of time indoors and she seemed to think that there was nothing wrong with the girls doing the same thing. A few months ago, one of my co workers had a similar experience with his 13 year old daughter. She became quite myopic almost overnight, and he and his wife had taken their daughter to a behavioral optometrist. Their girl tested with -3D of myopia, but the optometrist suggested that this sudden onset of myopia was likely caused by the girl doing a preponderance of near point work without taking a break every half hour and changing her focus from near point to distance. Apparently, an excessive amount of continuous near point work combined with a lack of sunshine can cause pseudo myopia to remain and there is a chance, by making the child take a break from near point work and getting them out into the outdoors for a couple of days that possibly this will allow the ciliary muscles to release the myopia. After obtaining relief from the pseudo myopia the girl was instructed on how to prevent further episodes of pseudo myopia and so far, she had been successful in not having to wear glasses. Placing glasses on a child with pseudo myopia at this time of their life will only lock in the myopia, cause it to become permanent and allow it to increase yearly. I was confident that any optometrist that was well trained in the cause and prevention of myopia would recognize the symptoms and the danger of prescribing glasses to both of my girls. My wife was not interested in hearing an anecdotal case of how playing outside and not doing any near point work for a couple of days could possibly correct the girl’s myopia. Being a teacher, my wife had a very black and while point of view, and to her, glasses were needed to correct both our daughter’s vision. We ended up leaving the optical store that evening with Chloe wearing a pair of glasses with a prescription of – 2.50D with -1.00D of astigmatism on a 70 degree axis for one eye and a 90 degree for the other eye. What was worse in my mind was that Chynna was now sporting a pair of glasses with a prescription of -5.50D in each eye. Both girls were ecstatic that they could see everything so clearly. I wasn’t quite as happy, but if you knew my wife you would realize that if a professional eye doctor said our children needed glasses, there was no way I could possibly argue with that and win. Over the next few days, I got used to seeing my 2 young ladies wearing their glasses. And while I realized that no amount of talking on my part was going to help, I was upset. I knew that within 30 days both my girls would, by having worn glasses all the time, have changed the pseudo myopia to the point where they now had actual axial myopia. The teacher in my wife would not have listened to anything I said because I was not an expert. But everything I had learned about myopia was written in a book. The truth of what I could tell her could be found, if only she was willing to open her mind. Unfortunately, with the passage of the first few days of the girls wearing their lovely new glasses the chance to reverse the pseudo myopia was probably gone. I like girls that wear glasses. I am attracted to girls that wear glasses. And the only reason I was upset about my daughters being myopic was that they were still so young and being myopic at the age they were would likely lead to very high myopia by the time they were out of their teens. My only position now was just to sit back and watch as things unfolded. I predicted that both girls would be back at the eye doctor withing the first 3 to 4 months of getting their glasses. And sure enough, soon after the three month mark Chynna started to complain that she couldn’t see as well with her new glasses anymore. Chynna’s new glasses were -7.00D for both eyes and Chloe needed -3.75 x -1.50 x 75 for her right eye and -4.00 x -1.75 x 90 for her left eye. This had been an afternoon visit, and the optical store was again able to have both pairs of glasses ready that day. With Chynna having such a strong prescription now, Carrie voiced her first bit of concern, and I was a little sarcastic when I replied to her that if that is what the eye doctor said she needed then he must be right. Carrie did not detect the sarcasm and that was likely a good thing for me. Over the next few months, I was quite upset by the fact that both girls, Chynna especially, seemed to be reading and holding everything at a distance of 25cm (10”) or less. Sometimes I saw Chynna getting as close as 10 to 12 cm to whatever she was reading. I was really worried about my youngest daughters’ vision, as the amount of myopia that she already had was pretty significant. And she had only started kindergarten so what would happen in the coming years. I had to at least try something. I could locate the web sites I had gotten my information from, so I looked everything up once again. However, this time I printed all the relevant information so that all I had to do was give it to Carrie to read. She probably would have been upset if she knew I had all this information from before the girls even needed glasses but knowing her, she wouldn’t have believed a word I said unless I had gotten her the hard copies. Carrie took her time carefully reading the various studies – and opinions because not everything can be proven in black and white. Nobody had even done a study by taking a child who presented with an initial case of myopia and then had them continue their bad habits to see how much the myopia progressed. Although, I felt we had done this with our daughter Chynna, and I was pretty sure that Carrie would realize this as well. After she finished reading everything, she looked at me and asked me what we should do now. “My first suggestion would be to get the girls to maintain a better reading distance. Also, they need more outdoor time so they can get more sun. This will also help cut down on their reading time. I will talk to Ken at work to see what behavioral optometrist he took his daughter to, and possibly he might have some suggestions as well. But we don’t have a choice. We have to do something, or we could end up with a daughter who can no longer see.” I said. “What do you mean by that?” Carrie asked. ‘The first step is high myopia, and you and Chynna are already there. Chloe is getting close, but I think we have a better chance of keeping Chloe’s myopia at lower levels. But if Chynna keeps on as she has been going, she could be even higher than a -20D myope at the age of 16. And the chance of retinal problems and other inner eye problems increases exponentially after a person reaches a prescription of -6D.” I told Carrie. I could tell that what I had revealed to Carrie had worried her a lot. Now she was telling the girls to get their noses out of the book or get off your tablet and get outside all of the time. I wanted to tell her that this was a little like shutting the barn door after the horse got out, but this would have gotten her upset. I did chat with Ken at work, and he told me the name of the behavioral optometrist he and his wife had used for their daughter Bianca. I passed the name and phone number on to Carrie and left it up to her to make an appointment for one or both girls. I asked to get the day of the appointment off work, so I drove them to the offices of Gerald Blascoe. Chloe and Chynna were not happy campers because their mom had really been restricting their near point activities since I had given her all that printed information. Dr. Blascoe’s offices were clean and airy, with plenty of windows. Chynna went in first and before too long it was Chloe’s turn while Chynna was in with Dr. Blascoe. Both girls had their eyes dilated and after the dilation drops took effect they were examined again. The machines took pictures of the insides of their eyeballs, and the doctor had them each back in his office for further testing. Finally, it was time for us to all meet. The news was not good. Chynna required another -2D added to the -7.00D that she was already wearing to get her back to 20/20. This meant that our little first grader would be wearing -9.00D glasses. Chloe’s news wasn’t quite as bad, as she now needed OD -5.00 x -1.00 x 75 and OS -5.00 x -1.00 x 90. But the worst news was that if there had been pseudo myopia in the beginning the pseudo myopia had been eliminated and all of their myopia was now axial myopia. Both girls had longer than normal eyeballs and that indicated that the myopia they had was not ever going to be able to be reversed. The doctor was hopeful that with the addition of a reading add of +1.50D in both the girls glasses along with them getting more sunlight as well as increasing their reading distances that further increases could be kept to a minimum. But he could not guarantee anything, and he did want to see them both again in 6 months. I really didn’t expect anything different, but I was pleased when he told Chynna that she should wear her old glasses for doing close work. Dr. Blascoe didn’t have an optical store attached to his office, so we had to go find one. The girls selected new frames for their bifocals. They had to have a little bigger lens opening than what looked good on Chynna’s face, but we finally found one frame that both Chynna and the optician were satisfied with. Then we had to get past the “you need hi index lenses, so they won’t be as thick” routine. The optician finally settled down when I told her that this would be the third pair of glasses for a 6 year old girl in 9 months and that the doctor had no idea if her prescription would stay where it is for even another 6 months. The new frames with bifocal plastic lenses were not cheap, but this is what the doctor prescribed so I paid the bill, and we were now at the mercy of whoever supplied the lenses as for the delivery date. Apparently because some container ship got stuck in the Suez Canal delivery dates for everything were way off. We did get a call early in the following week, so we took both girls in to have their new glasses fitted properly. Chloe didn’t look much different, but Chynna’s glasses looked to be a lot thicker. And the bifocal section was more pronounced for Chynna because the front of her lenses were completely flat. I suppose I could have spent another couple hundred bucks for the thinnest lenses, but I felt that the thickness of her glasses might help drive the point home. At our return visit 6 months later, unfortunately Chynna required an increase of -1D. But Chloe was able to keep her old glasses as her eyes had not changed. Chynna got her new -10D glasses with the same +1.50D add. But now the doctor told her that she should no longer wear her old -7D glasses for reading because -3D difference for the reading was just too much difference and her eyes might begin to depend on the high reading prescription. One of the recent articles I had been reading had suggested that a solution of 0.01% Atropine drops might slow down the myopic progression and Dr. Blascoe told us that he was considering the use of atropine but first he wanted to make sure that Chynna had progressive myopia instead of myopia caused by excessive near point work. Carrie told the Doctor that for the last 6 months both Chloe and Chynna had been following the rules very well, and that not only had they been wearing and using their bifocals for reading, but they had also been taking plenty of breaks and had been spending more time outside. Finally, the doctor told us that if Chynna had any further increases in her myopia, he would start her on the Atropine drops. Carrie almost went ballistic and wanted to know why it couldn’t be done right away so Dr. Blascoe had to tell her that first he had to submit Chynna’s name to allow her to enter a study group, as these drops were only experimental and had not yet received full approval for use in the general public. He did agree to submit Chynna’s name for admission to the group, so that calmed Carrie down. He did tell us though that if Chynna had progressive myopia the only thing the Atropine drops would do would be to reduce the increases slightly and she could still end up extremely myopic. In the general population you do not have to be myopic to have a retinal detachment. Retina’s can detach without prior warning, from a bump on the head and from various other causes. But as the diopters associated with myopia increase, so does the chances of having a retinal detachment. Low myopia is under -3D and the chance of having a detached retina is minimally higher than having no myopia. From -3D to -6D, which is classed as moderate myopia, the risk factor is slightly higher, but as the myopic person gets into the high myopic region the risk is much higher. Chynna was already in the high risk factor group, which is pathological myopia, and the only higher risk was for someone with degenerative myopia. I didn’t know this but apparently you can be a high myope with pathological myopia or you can have the same amount of myopia, but it can be degenerative myopia. It just depends on what is happening inside your eye that determines how well you can see. Six months later we were back for our next appointment with Dr. Blascoe. Chloe again did not need an increase in her prescription, so it appeared that for her the outdoor breaks from near point work had slowed, or hopefully stopped her myopic progression. Chynna was another story though. Her prescription had jumped another -1.50D to -11.50D. And what was worse was that she absolutely hated her bifocals. After a consultation with Dr. Blascoe, who seemed to be too happy that Chynna’s prescription had increased for my liking, I found out that Chynna was going to be accepted into a study on the use of Pirenzepine. If Chynna had not had any increase, she would not have been eligible, and apparently so far in tests a 2% pirenzepine gell treatment had been shown to have a 50% reduction in myopic progression. Atropine had been proven to work the best with the 0.01% dose, but the 0.1% and the 0.5% doses had reduced the initial myopia more and faster but there had been a rebound effect as the doses got higher so the 0.01% had proven to be the more effective solution. But now they were in need of volunteers to test the effectiveness of the pirenzepine treatment and because her prescription had climbed higher over the past 6 months she had been selected. Dr. Blascoe cautioned Carrie and I that this might not be a silver bullet. He did say that everyone in the study got the same pirenzepine treatment because everyone selected really needed to have their myopia progression stopped or reduced so there was no advantage to using the double blind study that was used with most new drugs. The only answer they were looking for was did the drug decrease the child’s myopic progression, and since Chynna had increased -2.50D over the past year if they could use the drug and keep her myopia to less than a -1.00D increase over the next year they would consider it a successful trial. A date was set for Chynna’s first treatment, and we went off to buy her a new pair of glasses with a -11.50D prescription. Since Chynna was not going to have the bifocal segment in her new glasses, we probably could have reduced the size of the lenses in her new glasses, but Chynna wanted the same size frame she was already wearing. Despite the warning from the optician that her glasses would be very thick Chynna wanted that frame, so that is what she got. And when we picked her new glasses up, they were quite thick. Extremely thick glasses do give people the impression that the wearer is visually handicapped, and while I knew Chynna saw close to 20/20 with her new glasses on, I also realized that other people who saw her would not know that. I felt bad for my 8 year old daughter, and I was determined that if her myopic progression slowed down, I would buy her the thinner lenses next time. At the 6 month mark Chynna was still seeing well with the -11.50D glasses. Chloe didn’t need an increase either, although Chloe wanted to get rid of her bifocals. If another 6 months went past without Chloe needing an increase, I promised her a new pair of glasses without the bifocal add. Six months later I bought Chloe a new pair of glasses and she was happy to be rid of the bifocals. Chynna had now gone a full year with the same prescription and while I wasn’t doing a happy dance yet, Dr, Blascoe was quite pleased. At the 18 month mark Chynna required a -1.00D increase, bringing her prescription up to -12.50 D. She was now 9 years old, and she only had 2 more diopters to go before her prescription matched her mom’s. Her rate of progression had dropped considerably though and both Dr. Blascoe and my wife were happy about that. A year and a half later Chloe reached the high myopia point when her new prescription needed to be OD -6.00 x -1.00 x 75 and OS -6.00 x -1.00 x 90. It had been over 4 years since her previous increase, so we were pleased. Chynna did need to increase another -1.00D but that was only 2D in 3 years, where before she had gone up -2.50D in only a year. The pirenzepine treatment was working in a similar way for the other people in the study as well, according to what Dr. Blascoe told us. We were quite willing to leave Chynna in the pirenzepine study until she aged out at 18, and we hoped that her myopic progression would possibly slow down even more, but she was soon going to be going through puberty and what would happen then could only be speculation. Specs4ever July 2021