In this episode, Katy and Dr. Barbara L Reiss are talking about Myopia (the medical term for nearsightedness), which is being able to see up close but not far away. This is important because your muscles are not only for moving, but they are also creating physiological states in the body - which includes your eyesight.
(time codes are approximate)
00:09:55 - Is Myopia the Real Problem? (Jump to section)
00:14:17 - What Do We Do About It? (Jump to section)
00:19:50 - Genetics? (Jump to section)
00:26:37 - Natural Light and the Eyes (Jump to section)
00:31:00 - Virtual Reality (Jump to section)
00:33:00 - Ocular Anatomy (Jump to section)
00:39:45 - What’s Good for the Body is Good for the Eyes (Jump to section)
00:44:39 - On Starting Early (Jump to Section)
00:49:00 - New Technologies (Jump to section)
00:59:00 - For Myopia and Beyond (Jump to section)
LINKS AND RESOURCES MENTIONED IN THE SHOW
This is the Move Your DNA podcast, a show where movement science meets your everyday life. I’m Katy Bowman – biomechanist, author, and glasses-wearer. All bodies are welcome here. Let’s get moving!
I have written and talked about this before, and here I am saying it again: Your muscles are not only for moving, they are also creating physiological states in the body. Today we are talking Myopia - that's the medical term for nearsightedness, which is being able to see up close but not far away. So, I am extremely myopic and I have been since I was about seven. When I was in the second grade I got my first pair of glasses and I really can’t see more than about 7 inches in front of my face without correction.
When I was younger, I was one of the few people in my classroom wearing glasses, but myopia has been steadily increasing since the 1970s. So there was recently this really interesting article in The Atlantic which is an online magazine. And the article was titled: The Myopia Generation: Why Do So Many Kids Need Glasses Now. So I'm gonna link to that in the show notes and I encourage you to go read it. But I'm gonna read a little snippet from it just to set up the problem that they're discussing. So here goes:
In the U.S., 42 percent of 12-to-54-year-olds were nearsighted in the early 2000s - the last time a national survey of myopia was conducted - up from a quarter in the 1970s. Though more recent large-scale surveys are not available, when I asked eye doctors around the U.S. if they were seeing more nearsighted kids, the answers were: “Absolutely.” “Yes.” “No question about it.”
In East and Southeast Asia, where this shift is most dramatic, the proportion of teenagers and young adults with myopia has jumped from roughly a quarter to more than 80 percent in just over half a century.
In Europe as well, young adults are more likely to need glasses for distance vision than their parents or grandparents are now. But where Asia was once seen as an outlier, it’s now considered a harbinger. If current trends continue, one study estimates, half of the world’s population will be myopic by 2050.
Ok, that's the end of this portion of the article. So why is this? So, the tension in the eye comes from the failure to use our eyes in their relaxed, long-muscle orientation and to use them in natural light. And, again, it's not really super clear what the main mechanism is. It's hard to tease these things apart. So taking time to look at things far-away, people and stuff, or gazing at layers of trees upon hills or waves on the ocean - they are all using different muscle patterns in the eye than looking at computers and books and iPhones and Kindles do. And not only are we looking at these things, a lot of the time, most of the time we're looking at them, we are also inside. So we've got two issues going on. And it can be the complexity of both of the issues going on at the same time. Or it might be one above the other. It hasn't been possible to tease them apart yet.
I have said it before and will say it again - natural movement, which is including the time we spend moving our bodies outside, especially as we are growing, is the environment our bodies require to develop well. And that doesn’t only go for our musculoskeletal system. It includes how our sensory organs grow and work in the future. So in this case, I'm talking about our eyes - our eyeballs.
I have written about how the rise in myopia relates to our movement habits as a society in two of my books - Movement Matters and Grow Wild. I’ve done entire podcast episodes about it in years past, and I'll link to those in the show notes. But here I am again, talking about why movement matters to our eyes. And it’s a big deal, folks. This is why I keep harping on it. And I don’t think we can keep taking these issues of society not working for our bodies, for our children’s bodies sitting down. Get it?
So my big issue with the article in The Atlantic was it didn’t mention any sort of solution to this large issue it was highlighting. It focused mostly on the technology to solve the vision issue. But it made it seem like humans going outside to do something other than look at their phones was out of the question.
So, again, from the article (and I know it seems like I’ve read you the article by now, but I haven’t. So please go and check it out in its entirety). All right from the article:
We may not know exactly how ogling screens all day and spending so much time indoors are affecting us, or which is doing more damage, but we do know that myopia is a clear consequence of living at odds with our biology. The optometrists I spoke with all said they try to push better vision habits, such as limiting screen time and playing outside. But this only goes so far. Today, taking a phone away from a teenager may be no more practical than feeding a toddler a raw hunter-gatherer diet.
So this is where we’ve ended up, for those of us who can even afford it: adding chemicals and putting pieces of plastic in our eyes every day, in hopes of tricking them back to their natural state.
All right. So, this is me again. And p.s., I did feed my kids close to a hunter-gatherer diet when they were toddlers, which I didn’t find impractical at all. And by the way, impractical means not sensible or realistic. So I’m not quite sure what she means when she's using this term. I think when she uses the term impractical she might mean difficult, or “I can’t think of the alternatives” or “I can’t imagine what alternatives there are” or “kids don’t want to stop using their entertainment boxes so what do we do.” So, I’m not saying that the issue is not a huge challenge, I just don’t know if PRACTICAL is the most accurate word to be used here.
Anyhow, we are going to keep talking about myopia because I don’t think everyone is clear that the juvenile period of a human’s life is when they’re setting their adult body, and right now the habits that we've sort of agreed to societally are not forming our adult bodies well. And human eyes are getting worse, so let’s talk about it.
I’ve enlisted some help today, to help drill down more of the specifics. Right? Dr. Barbara L Reiss is a doctor of optometry. Her career has ranged from contact lens research to clinical practice. While working in the contact lens industry, she developed and participated in clinical studies to design and manufacture contact lenses and care systems that worked safely and effectively. She spent the greater part of her years in clinical practice working in an ophthalmology practice where she provided vision and contact lens care and diagnosed and managed eye disease. She became a Fellow of the American Academy of Optometry in 1980 and has served as chair of their Admittance and Governance committees. She became board certified by the American Board of Optometry in 2010 and has served as chair of that organization.
I met Barbara online, you know, where you meet people now. She was a reader of my blog, and over the years, she and I have discussed the ways that movement and vision affect each other. She has been the eye-muscle/movement editor for my books. Thank you for doing that, Barbara. Barbara is currently retired from practice and lives in Austin, TX, and today she is coming on the Move Your DNA podcast to talk to us about eyeballs and vision, and myopia.
KATY: Barbara, welcome to Move Your DNA Podcast.
BARBARA: Thank you, Katy.
KATY: So I'm gonna start by talking a little bit more about this Atlantic piece. What was your thought when you first read the article?
BARBARA: I thought it was really well-balanced. And I thought that it presented the challenge that we're all facing in a really understandable way. I also thought that it left people not really knowing if there was anything that they could do to change the course of their children's trajectory or their own. And also I don't remember if this was addressed or not, but it's really a huge problem in the world. It's not just a problem in the United States among school children who are growing up but in the world, the medical consequences of long-term high myopia are causing other problems that could be held off if we were able to manage myopia during childhood. Myopia development during childhood.
KATY: Yeah, and I agree that was going to be my next question which is: I do think that there is a sense that myopia, near-sightedness, is the problem. And you solve the problem by adding glasses or contact lenses or chemical eye drops into your eye, you have created a technology that makes it no longer a problem. But there are ... the shape of the eye that is related to myopia is also the shape of an eye that's related to other issues that arise later on, or the pressures within the eye. So that's what you're speaking to, right?
BARBARA: Right the big issue in myopia is not the vision, although obviously, the vision is a problem. But it can be optically corrected. It can even be surgically corrected. You've probably heard of LASIK or other types of refractive surgery. But that doesn't change the length of the eye. So as the eye elongates, there are tissues in the back of the eye that, for lack of - just to kind of simplify how the eye works - and this is extremely simple. If you think of the eye as an old-fashioned camera, it's lined with film, with the retina. And that is fed by blood vessels and nerves and that actually transmits to the brain. As the eye elongates the retina has to stretch to accommodate that elongation. So later in life and the higher the myopia or the more nearsighted you are, the higher the risk for changes in the periphery of the retina - if you thought of it like stretch marks, it's very simplistic - but it can lead to holes or tears. Just like if you took a pair of tights and you stretched them really far, and you held it that way for a lot of time. And there's fluid in the back of the eye creating pressure. Eventually, you would develop holes and tears in those tights, and the same thing can happen which can lead to retinal detachment. And for reasons that are not completely understood, people who are very nearsighted are at risk for developing other eye diseases like glaucoma and cataracts. Cataracts are something that you're going to get if you live long enough but it's one of those things that you want to hold off as long as possible. The effect of the elongation of the eye or what's called the increase of the axial length of the eye causes greater problems the greater the person's prescription is.
KATY: Right. So I have a very high prescription. So just another way of putting that, so like more concrete experience - I need lots of correction to be able to see. That's what high prescription is. I need lots of corrections to be able to see. So I can expect my eye health to be poorer overall because of this situation that started, for me, when I was in second grade.
BARBARA: Well I don't know that you could make it an expectation but it's certainly a risk or consideration.
KATY: Great. That's great. That's good news for me. And I feel like, eye health wasn't brought into the language when I was a child. My children definitely have a sense of eye health. There are things that we do to take care of our eyes. In the same way, many other people, like I've always had great dental care. But when I go to the dentist and I have really healthy teeth, and they're like, you have really healthy teeth, your dental health is amazing. And I'm thinking isn't everyone's? And they're like, no. You'd be surprised. A lot of people don't get great not only dental care but information as children to be able to take care of their teeth. She said there's many people who grow up not brushing their teeth at all. That was radical for me. But then I can talk about it with eyes and see no one talked about eye health to me, but I have made that change. So, I agree that the article did not talk about really the medical reason we should be concerned about. Half the population of Asian countries and a quarter percent rise of this issue. And they also, as you said, did not really talk about what you do about it. So what do you do about it?
BARBARA: Well I think people in my world have been thinking about what to do about it for a very long time. My father is an optometrist and when we were children, and I'm the oldest of four, we all wore bifocal glasses because there was a belief - and there were no randomized studies or even thinking about that then - but there was a belief that reading without any kind of help would lead a child to become near-sighted. And I remember having these little red and white cat eyeglasses that were like peppermint striped. And I'm pretty sure all four, all three of my siblings had bifocal glasses too. And so in our own little study, the result is, I was nearsighted in one eye and not significantly. I was nearsighted in one eye and farsighted in the other. Which has served me well, actually, as an adult because my need for glasses has been very minimal. Two of my sisters didn't need glasses until they were in their 40s and my brother is pretty significantly nearsighted. So that has been the thought but it's not a clear-cut "if you do this then this will happen". The current research is a lot more sophisticated and there are medical interventions. There are more sophisticated bifocal glasses. There are bifocal contact lenses, some of the new ones have very sophisticated designs that are based on all the current research on where to cause different focal points and that sort of thing. The other thing which is kind of a misconception that I want to clear up for your listeners is: It's not better to undercorrect myopia. One of the stimuli to the eye elongating is blur. So if you cause blur at distance by making vision less perfect, you can stimulate more myopia even though you think you're doing the right thing by cutting the prescription back. It's very important for people to have the right prescription so that they can see as well as possible. And what that means is that the image that they are seeing is focused directly on the retina, not in front of it, not behind it. So there's no stimulation to the eye to grow. Because the stimulation seems to come from the eye itself. And so that is why you want to make sure that you have clear vision. So parents are in a hard place because if you're seeing that your child is becoming nearsighted, once children become nearsighted it's very difficult to go back, if not impossible. But what you want to do is limit the growth. Because over a certain prescription... so you said you have a high prescription, Katy. You wear contact lenses, obviously.
KATY: I wear contacts obviously.
BARBARA: Do you know what the power on your box is?
KATY: Negative 7 on both eyes even.
BARBARA: Ok, so negative 7 is pretty high. Over negative 4 is where the risks of near-sightedness get greater. It doesn't mean that there's no risk under negative 4 but that's kind of a cutoff that we think about. It puts somebody in a more significant category.
KATY: Well is negative 7 considered above?
KATY: So I am not, I'm not yet to the cutoff point? Or am I past it?
BARBARA: No you are. So think of it on a number line. So the center of the number line is zero. That's where we would all like to be. There's a whole world of people with plus prescriptions. Those are not the people we're talking about.
BARBARA: When I say higher than minus I mean that -4 is less than -7. It's better than minus 7.
KATY: Right. So I am in the risk group. Like I wanted to clarify.
BARBARA: You're in the risk group but you're not... a minus 7 you're in a high-risk group for sure.
BARBARA: If you're over minus 6 which is another cutoff. But here's what that means for you and for your other adult listeners. Get your eyes examined every year. Make sure that your eyes, your retinas, your eyes are dilated so you know that your retinas are healthy. Get the pressure in your eyes checked. Have someone look at your full lens for cataracts. And just do that every year. And also if you ever get an eye injury, you know you're playing frisbee and the frisbee hits you in the eye, and you start seeing things in your vision, the back of the eye doesn't heal itself. Get it checked out. Even if you go and get it checked out and the person says you're fine, the doctor says you're fine, and you feel like I just wasted a medical visit, you didn't because anything like that can cause problems to the retina. And changes in the retina secondary to an injury can be worse than just the normal aging changes.
BARBARA: The symptoms of problems with the back of the eye that would be concerning are seeing light flashes, floating spots, changes in your peripheral vision that seem weird or like a veil or a shadow. Don't ignore those. Make sure that you get those checked out as soon as you can.
BARBARA: Even spontaneous ones.
KATY: Ok, I definitely, just like dental care, I think of eye care as a must do especially because, again, I feel like my eyes are more susceptible to other things. Ok, so...what about, we have, let's say you have children. I mean my children obviously they have a higher risk of inheriting some of these genetic contributors to myopia. Right? There are myopic genes, correct?
BARBARA: Yeah, there's not a clear understanding of what the genetics of myopia are. There's probably a lot of genes that contribute to myopia. We know for sure that if a child has two parents who are myopic it's highly likely that they will be myopic. So in your case, a -7 person, your myopia is probably somewhat genetic. Because when myopia is really high like that, I mean not that you can't develop myopia that high, but generally speaking the higher the myopia the more likely that there's a genetic component. What I think of as developmental myopia, and I don't even know if that's a term that's currently used, but I kind of think of it that way, it tends to stay in the under minus four range, meaning from zero to four not...
BARBARA: It's just unfortunate that we describe myopia with a minus sign. But just think of it as the higher the number, the worse the myopia.
KATY: Right. I think of it as - is it right to say that my prescription of 7 inches means my focus point is 7 inches from my face?
BARBARA: No, it's not correct to say that. It's actually - it's the reciprocal of the distance in millimeters. Like if you're number zero, the reciprocal of zero is infinity, right?
BARBARA: If your number is minus 1, the furthest way you can see clearly is 100 centimeters. If it's minus two, it's 50 centimeters. If it's minus 3 it's 33 centimeters, roughly. And then it gets closer and closer. So just like when you take your contact lenses off, you can't hold a book a foot away and still see it, you have to bring it up within a couple of inches.
KATY: Oh it's within a few inches of my face, for sure.
BARBARA: And so ...
KATY: Which interestingly enough was the position that I chose to read in before I had glasses. I was just always so - I like to lie in bed and read and use my face to hold the pages open. It was the epitome of really not expending energy at all. I'm gonna be lying down and I'm gonna wedge my face in there. And look I don't have to use my arms either and still read this book.
BARBARA: That's very interesting. So forget everything that I said about developmental myopia. It's possible. And what's interesting to me is that I know you're one of several children, right?
BARBARA: That no one in your family said, "Katy, you might want to hold your book further away."
KATY: No. No. I think that's the flip side. Once you start adding a lot of children no one really cares what you're doing at all.
KATY: Nobody's paying attention anymore. But it's interesting to see - I have two children. They're both readers. But one is...they're both even voracious readers. But one has this tendency to be sucked physically into a book. And that's really how I would say the experience is more like, the relationship between me and the symbolic was so strong that I just had to get my face there. And I've got these pictures of my newborn child obsessively staring at the label inside of the car seat upon travel. And I was like, I just feel so, and I don't know, this is complete conjecture, but my understanding of what was going on as a parent and relating to this other human being who shares so much of my DNA is, this kid is already trying to figure out what the symbols next to them mean. It's like coming just like the genetically maybe just coming into like I'm here to decipher these symbols. And the look on the eye of just like squinting even to try to make sense of it all. To me, that's what reading was about. Not the story, but about there's information being transmitted in the symbols that is like access to another portal of reality. So for me as a parent knowing that nobody came and took my book away, how I tied it to movement was to explain - let's say there's oral hygiene, we have sleep hygiene, but we don't have a word for eye hygiene yet beyond washing your hands before you put stuff in your eye. But the idea of care. Eyes need these movements. So you've been doing one set of movements for your eye. Now you have to exercise your eyes in other ways. We use that sort of language. Or also, I want you to put the book significantly farther away. You don't have to stop reading but we need you to exercise your eyes a little bit differently if you want to continue. And my myopia started like I said when I was seven. Where I was actually in glasses, couldn't see the board anymore at seven. But now my kids are 10 and 11 and they get their eyes checked regularly. And no one needs glasses yet. We haven't seen signs of myopia. But of course, we prioritize lots of movement, which means just simply perhaps movement affects the eyes in other ways than just health - blood flow and just being mobile. But certainly, you're not reading when you're moving. You're not doing things up close when you're moving. And you're moving outside. Lots of natural sunlight and seeing if we can't at least - the way I understand myopia is as the eye is going through its growth spurt and elongating, that would be the time during growth that you would want to sort of make sure there's not a lot of restriction around the eyeball as far as the muscles in the eyes are concerned. I think of even, I talk about the ciliary muscles for accommodation. Being a band of tension that the eye is under as it's becoming larger/growing - growing into an adult-sized eye.
BARBARA: Well it's actually very interesting and it's been/being studied pretty extensively right now and probably for the past 10 or 15 years. There's certainly a correlation. You know correlation isn't causation but you're not going to do a randomized study where you keep a child indoors for 15 years.
BARBARA: Let one go outdoors and see what happens. So but there's definitely correlation between children who get more outdoor time have lower incidences of myopia. And even in Asian countries where there's rapid increases in myopia during childhood. During covid shut down when they were allowed to spend more time outside because they weren't in classrooms all the time, doctors saw a decrease in the increase of myopia. So I want to be clear that once a child starts becoming myopic, it's very difficult to go backward.
BARBARA: There's still a lot of reason to try to stop from going forward. And sunlight and outdoors are definitely very important. In fact, I would say that there's - based on what I was reading about some of the research when we were preparing for this - there's definitely some indicators that light, outdoor light itself can stop the growth - can keep it from elongating. So the things that you've been naturally doing with your children, making sure that they have lots of outdoor time in addition to allowing them to read. And also asking them to vary their distances at reading or... You know I remember when I was a child the television was the center of the family. So we would all go and sit really close to the television and my father would come and pull us away.
BARBARA: We didn't know about outdoor time like you, but having grown up in the 50s and 60s, we were just naturally outdoors more. We just had a life where there were four of us and my mother said "go outside and don't come back til dinner"
KATY: We'll see you in the dark.
BARBARA: Right. So it's very different than the world for most people today where kids spend a lot more time indoors and on screens. But your children - I can't say that your children will never become near-sighted because there's no way to predict that. But you seem to have passed the critical period with them. So it's usually the early school years when the children who are readers start becoming near-sighted. You know there's some predictor models but I don't know that they would be meaningful to your listeners. Again, it's just a matter of making sure that your children have their eyes examined every year. And if they start becoming near-sighted, the thing that's hard is that the initial part of being near-sighted it feels like no big deal. Right? It's like, "oh, everyone in my family has always worn glasses. He has to wear glasses to see the board in school. No big deal. It'll be fine." And that's a very understandable way to feel. Especially for those of us who wear glasses and contact lenses. It's just like, "ok, well that's just another right of passage." I mean I can even remember myself saying "well you know it's the smart kids that become near-sighted." And it is. It's the kids that do the reading. But now we're in a world where there's so much screen time. There's so many kids who, even if they're not readers, they're spending time with a device four inches from their face. I wonder if you can see a phone if you balanced it on your nose?
KATY: Right. Right.
KATY: Just propped it up against my forehead.
BARBARA: You could get a little headset where you could slide it in the front of your eyes. Which is kind of what virtual reality has done.
KATY: Oh that's right. What's the distance of a virtual reality screen from your eyeball? I mean that is the closest of all the screens. Is it not?
BARBARA: Super close. And it mimics distance. This is totally pie in the sky. I have no idea what it does to the accommodations system. Are you focusing - you're focusing on this thing that's up close, but your brain perceives it as things that are far away? And which of those things has a bigger impact? Who knows?
KATY: Well, who knows but as I understand accommodation, because the thing that you're looking at is, I don't know, I've never put goggles on - 2 inches, 3 inches?
BARBARA: Really close.
KATY: Really close to your eyeball. You wouldn't - you're ciliary muscle would have to contract to focus on that point, right? Or are you ...
BARBARA: I don't know about that. Because I think there's something in the virtual reality itself that it creates an image. I have done it and it creates an image that's really far away. I mean you can do virtual reality where it feels like you're standing on top of the Eiffel tower looking out and the brain and the eye are intimately connected. So I don't know if that would create a stimulus to accommodation in the same way that letters on a page create or an image on a screen creates the stimulus. Because it's complicated.
KATY: Yeah. Right.
BARBARA: And as much as you're right that in order for the eye to focus... so just a little backup into ocular anatomy. If you think of your eye as this sphere which it roughly is, there are tissues that are inside of it. Maybe we should have talked about this in the beginning. I'm not sure.
KATY: I like to keep everyone on their toes.
KATY: We're gonna put the stuff that they need in the middle of the episode.
BARBARA: Laughs. So if you look at the eye as a sphere, there's a clear tissue that covers what you think of as the color part of your eye that we call the iris. The clear tissue is called the cornea. If you wear contact lenses that's what your contact lens sits on. And then there's fluid in between the cornea and the iris. The black spot in the middle of the iris is called the pupil and you can notice that your pupil can get bigger and smaller. It's actually a hole or an aperture that lets light in or lets less light in. Behind that is a lens. And it's the lense that's affected by the ciliary muscle to enable you to see up close when you focus. And that is a contraction of the ciliary muscle. And it's difficult to parse out all the things that cause one to become myopic. Because constant ciliary action can certainly cause people to become more nearsighted. As can being indoors. As can being on a screen. So we don't really know 100% although there's tons of research going on right now. Is it just the ciliary muscle? Unlikely. There seems to be some receptors in the retina also that in the space of either blur or lack of light will cause the eye to elongate. Because the message you're giving your brain is, "I need to see up close." So especially in childhood, your body is so adaptable that if you tell the brain, "I need to see up close" all the time, you're going to start developing an eye that can see up close all the time. And then if you correct that vision, and then you keep holding things up close then you're telling the brain "you didn't give me enough close, so I need more." So then the eye elongates further in order to accommodate the ability to see up close. In the beginning when I was telling you about my situation of far-sighted in one eye and near-signted in the other and I said, "that has served me well." You lose your ability to accommodate as you get older. So by the time most of us are somewhere between 45 and 50 if our vision is corrected at distance either naturally or with glasses or contact lenses, we start needing additional help with reading. Because that lens inside the eye becomes harder. And it ages, basically And it doesn't focus as easily. So you start needing help with reading. So for your listeners who are saying "oh but I always wore contact lenses and now I can't see up close with them" just to kind of make that clear, it's a different mechanism than what we're talking about. And there are always discussions about is the ciliary muscle becoming weaker or is it that the lens is so hard? And I don't know how to get out of those weeds. So but we know that the lens definitely gets hard and that the ciliary muscle can't act on it in the same way.
KATY: Like stiffer? Like our other body parts. Your ciliary muscles could still theoretically have the same ability to generate strength. But the lens itself is resisting a change in shape.
BARBARA: Right. So back to anatomy. So then behind the lens is the vitreous humor which is kind of a gel-like fluid that fills up the back of the eye. And behind that is the retina and the optic nerve. And the optic nerve is what communicates between the retina and the brain.
KATY: It's very interesting. Do you know Andrew Huberman?
BARBARA: I'm listening to a podcast of his right now, actually.
KATY: Well he just put out a nice statement which was probably a response to the same article and sort of the rise in discussion about myopia and its increase that's happened here in the last couple of months. It's not clear if it's looking at things up close or being inside, but either way, the correction to make is clear. I just appreciated that clarity. The correction meaning the behavioral change of we need to be going outside and moving around more. And to your earlier point about if you're children are already becoming myopic which I still fully expect at least one of my kids to make that transition at some point. I do not think it will be to the severity of mine. And I don't think the severity of mine is genetics alone. My genes and my lifestyle put together. And so I was happy to make those changes for our family. Not only for the myopia. So again as you were saying before, the parent, we don't want to use this habit change in lieu of actual correction of myopia. It's not like, "Oh we noticed we had myopia so I'll put my kids outside to put their eyes back. It doesn't work in that way.
KATY: But even if you start off myopia/myopic with some degree, there are so many other benefits to going outside in the light. It's not something that you only take once there's a problem. We're sort of taking these things that we know we need and going, "well, if I can't correct this problem, we're just gonna stay as is." The train stays on course of staying inside on the screens. There's no reason to fix it now because, I guess, it's the damage has already been done. But as I understand it, these are things that progress in nature. And so the damage is not already done. The damage continues to happen by us staying inside and not using our bodies including our eyes dynamically. Including periods of time outside. I know it's hard as a parent, I felt like parenting is only becoming more and more challenging as society makes these changes that make finding your basic needs being met so difficult to do. Right? It requires work to meet any of your needs now. Like uphill salmon against the stream type of things. Just to remember that there is value in doing it and all hope is not lost. As soon as you go outside, it's good for you. Doesn't matter about the future payoff. As soon as you go outside and move around it's good for you.
BARBARA: Well there's a lot to unpack there. I'll start by saying what I've always told patients is: In almost any circumstance including diet, exercise, outdoor time, movement, vitamins...what's good for your body is good for your eyes. What's bad for your body is bad for your eyes. And as Dr. Huberman who, by the way, is an ophthalmologist...
KATY: Oh I didn't know that.
BARBARA: Yeah. As he said in his podcast or post that he saw, there is no downside other than having to change habits, which I honor is very difficult...
BARBARA: But other than that, there's no downside to saying, "Look, after dinner, we're gonna take a walk." In the morning we're gonna park a mile from school and walk to school together so we have to leave the house at 7 instead of 7:30. Is that difficult from an emotional/time, you know, parent relationship thing? Absolutely. But there's no, there's no downside to it. It's like the thing about does chicken soup cure the common cold. You know it's the old Yiddish joke: Does chicken soup cure the common cold? No, but it couldn't hurt. So you're not gonna cure myopia that way. But you're going to develop better health habits in your family which to me is even more important. There are modalities for attempting to reduce myopia and we can talk about those if you'd like.
BARBARA: If you want to get into more technical stuff. But I want to say that with all respect to what parents are going through right now, I actually think the problem is that it used to be that we had to do hard things in order to live. We had to chop our own wood. We had to grow our own food. We had to walk a mile to the store because even in car times the person, the breadwinner, had the car so the person who took care of the house had to make sure that there was food in the house and you had to do that outdoors. We had chores because you had a cow to milk, or eggs gather, or whatever. And now all of those things are very easily gotten. You could never have to leave your house as we found out during covid, right?
KATY: I could lay on my side with my nose tap my phone 3 inches from my face and get it to show up at my door.
KATY: We've gone from needing to do hard things to having hard things done quite easily without much labor or movement.
BARBARA: Right. And that's how our children have grown up. So our children are growing up in a world where everything is ... I'm gonna say that everything is very easy. But it's not.
KATY: Yeah, it's not.
BARBARA: Because what happens is, when you say to your child, as I have to mine, the school is only a half a mile away. And you have to be there at 6:30 in the morning for chorus, I really think that you can walk to school. It's not that far. You have a difficult situation on your hands and you multiply that by more children and more circumstances and it becomes a parent-child issue so I think that the fact that you, from the beginning I think of your children's lives, were committed to this outdoor life and more movement. And maybe even not as much as you are today because I did see your videos of when you were pregnant.
BARBARA: I know how you've transitioned over the years. But you also live in this beautiful place where it's wonderful to be outdoors and you've created that as part of your own family community. And by doing so, I have no idea, but I'm hoping that it's not so much of a fight. That your children have a sense that my life has increased value because I'm able to spend so much time outdoors.
KATY: I don't think probably they really think about it. It's just the life that they know. And me being, I would say as we've sort of already defined, kind of a lazy creature by nature, I found that a lot of what we're talking about is the battle. I think of everything that is happening in inertia and having to deal with other people's inertia and trying to get everyone to move in the same direction is really challenging. And I think just earlier on what I realized was, I create a home where I don't need to deal with inertia. Right?
KATY: So I get rid of the chairs. I have to create an expectation or at least a habit where the inertia takes care of it. So in this way, I am still lazy. I'm just trying to leverage our tendency to continue to do the same thing. I don't think of it as setting up good habits. It's just more like removing the infrastructure - it's about taking away purchased things. Buying less. Spending less money. So it's actually, even though it sounds like it would be more expensive, it's the less expensive version of getting rid of the things that are hurdles to some of those very primal foundation things we needed. Like to be able to go outside and take a walk without it being a major epic battle every single time. And so I know that I am fortunate in that because I started so early. It's easier. It would be - I don't even know how I would transition a 12-year-old and a 14-year-old hearing about this. And you know, figuring out how... it doesn't mean that I do'nt still try to think about it all the time and I don't have areas of my life where we're working on this but I do know that starting earlier is easier.
BARBARA: Yeah. And you also have a life where you're able to do that.
BARBARA: You and your husband don't commute to Seattle to work every day.
KATY: That's right. Even the fact that we have two parents. Two parents - there's many privileges that go into making it so much easier. And I very much understand that. And at the same time, I can see that, as you were talking, about these benefits are often found in places that don't have so much. Right? Like it's just like so many things - so many of those traditional health things that were so common 50 years ago that everyone had equal access to without even trying. It was just sort of the way things were. Now they're more of a choice. And to be able to make that choice to do some of those things is harder.
BARBARA: Oh for sure. And when you were saying that I was just thinking about the things that we do with our kids to make sure that they have access to the same things as everyone in their peer group are the things that make it harder to get them outdoors or to get them to move more. So you're right. In areas where everyone can't afford an iPad, the kids get together and walk to the library and go and look at and do their homework on their computer at the library. Although now I think they're giving everybody Chromebooks so forget I said that.
KATY: And it's challenging. You're trying to make - give equal access to all the things that everyone has which means that there is a greater...
KATY: It allows some of the problem that comes with access to those things to spread more often as well.
BARBARA: Right. But to your point, so if you live in a community that it's not safe for the kids to go outside ...
BARBARA: ... we can sit and talk about how important outdoor light is from now until Friday, but if I'm sitting at my office and I'm terrified that something's going to happen to my child if I let them leave the house then ... or I have to go to work, I can't say to the child "go and play basketball" because it could be dangerous. We live in really challenging times.
KATY: Yeah. It is definitely societal structure. These aren't parenting fails. It really has more to do with the collective ways society has shaped itself. And it's interesting because there is a relationship between culture and biology. So it'll be interesting to see, you know if culture shifts biology what that would look like in terms of the eye. What will the eyes of the future be?
BARBARA: Well I think we're seeing it.
KATY: Well that's right. Are we though? It sounds like it's blurry.
KATY: Ok let's talk a little bit about ... well the Atlantic Article was really about how much money was going into the technology of "I care now that myopia was rising". There's this relationship between sort of getting the best eye care now ... and it's very similar she brings up the relationship too between dentistry as something we all need more of... You think of what we've become - as we progressed downtime and technology that we would become better physically. But many of the benefits have come with detriments. Teeth is one of them where because of the diet and the lack of chewing and there's a lot more dental work that goes into making healthy teeth. When healthy teeth would occur more naturally without all the progress that's happened. And so she likens it to the eyes as well. So this is sort of an evolutionary mismatch. Our eyes don't do well in the environments that we are currently placing them, so there's all this new technology that's developed to deal with the mismatch of this not being a great environment for eyeballs in general now. So one of the things that she was mentioning and I had read this also was eyeglasses in a drop. Right. Eye drops that essentially are providing some sort of daily change that would mimic what normally glasses would do. What do you think about those?
BARBARA: It's not exactly eyeglasses in a drop so that's ...
KATY: Ok, that's my take on it.
BARBARA: I mean there is something like that but it's more for presbyopia which is the aging change that happens to the eye. And I think when you and I met last month we were talking about that a little bit. But if we stay with myopia, there have been many studies lately about using a drop called atropine in the eye to manage myopia. And I'm gonna start using the word manage because that seems to be what the profession is using. In fact, there is an academy of myopia management that people can get board certified so that they can start adopting all these new techniques and demonstrations that they're doing it in an appropriate way. But how the drop atropine works is it stops the normal functioning of muscle that we talked about, the ciliary body, and also of the pupil (this is very simplistic for anyone technical listening to this). So that the ciliary body cannot focus at all. And the pupil is very very large. So in full strength atropine, 1% atropine, which there were studies on probably 50 years ago on children becoming myopic. Because really optometrists and ophthalmologists were concerned about myopia forever. Is this something that we can stop, just like my dad giving us bifocals when we were little? If you basically paralyze the internal workings of the eye which is what atropine does, you will be able to reduce the progression of myopia. The problem with that is that you then have a person who cannot focus up close and is extremely sensitive to light because enormous quantities of light are getting into their eye because the pupil can't constrict in response to light. So what the researchers did is they started titrating atropine down to lower concentrations to see if there was a sweet spot where you could administer the drug, it would have the appropriate effect and not have the disconcerting side effects. And somewhere between 1/100ths of a percent and 5/100ths of a percent seems to be what people are using right now. And especially in children who are progressing rapidly, it does seem to help. And some parents use it in the winter when the kids are not outside so much and then use it less in the summer. Because it can still have a little bit of a pupillary dilation effect but it doesn't have anywhere near the effect that full strength does. And yet the effect it has on the ciliary body, whatever that is contributing to the increase in myopia, it does seem to slow down myopia. Now once it's stopped, there is a rebound effect. And atropine or derivatives of atropine have been used in Asian countries for some time. I could be wrong about that. I might be thinking about orthokeratology which is the contact lens that we can talk about too. But that is one modality. And it's something that parents have to decide if that is what they want with their children. But if the child is progressing rapidly and would mean that they need glasses changed every three/six months in order to see clearly or there's huge jumps every year, it just depends. It might be something worth considering or at least talking to your optometrist about. It would be used off-label because I don't know if you know what off-label means.
KATY: I do, but you can explain it to everyone.
BARBARA: The FDA approves a drug but they approve it for a specific indication. So right now 1% atropine is approved for children with amblyopia which is where one eye didn't fully develop vision either because there's a big prescription difference or because the eye turns and by putting atropine in the functioning - the eye that is seeing well - you can force the other eye to work. So it's kind of a liquid eye patch in a way. It doesn't prevent the other eye from seeing and it's not physically disfiguring like wearing a patch all the time is. But it does, it is used to force the eye to work. So off-label means that people are using this drug for other things which is to try to manage myopia. And the lower percentages of the drop have to be compounded especially by a pharmacy. They're not available commercially. So all those are potential hurdles I guess is what I'm saying. And there's the potential hurdle of putting drops in your child's eye every night and atropine can have some pretty significant effects systemically if it's taken in high doses. But the studies haven't shown any long-term effects. But parents are going to be concerned about any substance that they put in their child's body. So there's those concerns that have to be addressed as well. But it is a modality that is being used to try to manage myopia. The other one that I was talking about, it's called orthokeratology. And it's also has been around for a long time in different forms. But the form that's being used right now is ... in orthokeratology you use a rigid contact lens. The rigid contact lens is made of a material that's very oxygen permeable so that even though this is a layer between the eyelid and the eye, oxygen can pass through it. And the child wears it at night, much like braces. And what it does it essentially flattens the cornea. Remember we talked about the cornea being the tissue that the contact lens sits on?
BARBARA: And when the child takes the contact lens off in the morning or the parent takes the contact lens off in the morning depending, the child can see for pretty much the rest of the day. So you're managing vision in a way that, you're putting this modality in, it's correcting the vision - it's a temporary correction. And it again works well and there's lots of barriers. Will your child tolerate a contact lens? Do you want to put a contact lens on your child every night? It's expensive. It requires lots of maintenance. There's changes in the lenses. There's a lot of visits. There's some risk of eye infection although if hygiene is well managed that's really manageable. And again, it's a modality that when children do it they like it because during the day when they're at school and they're doing their activities they don't have to wear glasses in order to see. And once it's discontinued there is rebound. So it's, again, not a permanent solution. But it is another way of managing myopia. And some of the newer - people are using multi-focal soft contact lenses that are available in daily disposables. You can use them once and throw them away. Which is a very hygienic way to wear contact lenses. And those seem to have some effect on reducing the progression of myopia. And again, I just want to be clear, we're trying to reduce progression. We're not trying to cure.
BARBARA: There's not a cure. And there's a new design that uses optics in a way that changes the peripheral image on the retina relative to the central image which is in line with a lot of animal research of how myopia develops. And in the studies anyway, that particular lens has worked very well. I think it was just FDA-approved but don't hold me to that. It's called my sight. And again this is another thing just for your listeners to just talk to their optometrists about and find out about what they recommend to try to limit or reduce the progression of myopia. But there is absolutely no downside to saying get outside and move more. None.
KATY: But it is nice to have a little bit of both. When I was thinking about the benefits of wearing a contact lens at night to sort of get a temporary reshape of the cornea so that you don't have to wear glasses, I do think that wearing glasses from age 7 was a big deterrent to me moving for so long. And again, this is during a time when only the nerdy kids had glasses. So then it sort of reinforces the "you don't know how to use your body very well - you're more in your head". Well, I have these one-pound glasses on my face. And if I take a ball to the face, it breaks my glasses or hurts. I have such heavily corrected vision that if I just happen to see over it, I instantly lose my balance. So there are things - I just think of - because this is a podcast about movement - thinking about the impact on someone's overall ability to move and feel comfortable. That doesn't relate necessarily directly to myopia but to the correction of needing to wear glasses at such a young age. It definitely affected my teenage years and my ability to develop at athletic skills and robust movement because of glasses, right? So I think that this isn't a podcast about me and my psychological issues but I do think that ... but it also is. And like everything that I do, I do think that one of my interests, just like anything as a child when we have our own kids, we're like, "man I want to do this better that it was done for me." I think vision was one of those things. Because I don't think I would be here today so obsessed with movement and the barriers to it along the way if I hadn't been sort of, I feel almost robbed of my ability to move as a child.
KATY: Even though it wasn't done on purpose. And it wasn't - these aren't conscious choices. Everyone is just trying to do what they are doing but I think knowledge is definitely power. And in this case, having you on today just so people can be thinking about some of these things. And that they have greater impact. Well is there anything else you want to tell us about myopia? Feel free to respond to that.
BARBARA: Well what I was going to say was it's also a safety issue. So you probably, if you don't have your contact lenses on you probably need your glasses next to the bed to get around the house at night. And people don't feel safe. If you're a person living alone and you hear a noise and you can't see, it's a safety issue.
BARBARA: So it's another argument for managing it so that not only can you move but you can move safely and comfortably. I was going to ask you was how old were you when you started wearing contact lenses.
BARBARA: So in the world of now, that's old. And if you were seven now you would have been able to wear contact lenses now that you could throw - soft lenses that were comfortable - that you could throw away every day. And now there are soft lenses that have a multifocal built into them that will take away some of the excess focusing that you do up close when you wear contact lenses. Because one of the challenges, when children start wearing contact lenses, is now their vision is corrected for distance but yet they're still doing the same work in front of a screen or in front of a book. So now they're giving their eye more information to say grow longer because now my vision is corrected for distance but I still need to be up close. Contact lenses are freeing and they're wonderful. And if an 8-year-old can wear contact lenses and some can and some can't. But if an 8-year-old can wear contact lenses ... like my eleven-year-old granddaughter is a dancer and the day she got contact lenses was the happiest day of her life. But I do tell her please take them off to read.
BARBARA: It's just how that goes. But when you have that freedom, then you have the freedom to move. And then you have the freedom to be outside. So it could change the calculus. I'm not going to spend eight hours a day reading because it's so fun to be outside and my world is big. The other thing about your prescription, Katy, is also that everything is constricted. For parents that don't wear glasses - put your kids' glasses on. Everything gets smaller and closer...
BARBARA: and the edges are somewhat distorted. It's very challenging to then go out and play football. Or run track or something. Your glasses are sliding off and you're sweaty and things like that. So at the very least yes, parents should be thinking about it. Definitely get kids outside more and get more light. Everybody should. And consider contact lenses and talk to the practitioner about multi-focal contact lenses. Because those are readily available on the market today. And just try - do everything you can to try. Recognizing that it's really hard to change those habits but contact lenses are very freeing and there are contact lenses that can help. And then if you're an adult and you're already near-sighted, just get your eyes examined every year. And don't ignore any symptoms that seem strange to you. The eye will not heal itself. You do have to get any changes checked out and make sure that you're not developing a problem that's serious.
KATY: And I love your other point which is if it's good for your body, it's good for your eyes. So just more motivation to make those other changes that we know are good for our eyes. Like I think of humans as very - all animals are sensory dependent. Vision is such a dominant sense for us to really - it's the same thing with foot pain. You just don't think it's gonna be a problem until it is. So just take good care of your eyes. And that just means take good care of your body. It's the same thing. So prioritize that change. I know that changes are hard. It's not to diminish the effort it takes but that it is worth it. It's worth it. Thanks for coming on today.
BARBARA: Thanks for having me. I really enjoyed it.
KATY: Yeah. That was great.
So thanks to Barbara for coming on and thanks to everyone for listening. And can we just take a minute to celebrate podcasts as a thing? So I’m a huge lover of books and reading, but I have found that listening is easier on my eyes. Humans are great storytellers and again, storytelling and that oral tradition is so tied up with our humanity. And so perhaps our transition to podcasting and audiobooks provides a better environment for our bodies. Just something to think about. And if you like audiobooks, and you want to hear more about myopia and long-distance vision and the importance of natural light, check out my two books: first a book of essays about natural movement, alignment, movement science, and sedentary culture called Movement Matters. You can listen to it. And, of course, if you want a new approach to getting kids outside more often, moving, learning how to be in green spaces, and letting those green spaces shape their bodies well, my book Grow Wild is also available on audiobook via my website, Audible, or any place you get your audiobooks including the library! And with that, I’m going to take myself and my eyeballs outside. SEE you later. Get it? See you? All right. Bye.
Hi. My name is Summer Teixeira from Maui Hawaii. This has been Move Your DNA with Katy Bowman, a podcast about movement. Hopefully, you find the general information in this podcast informative and helpful. But it is not intended to replace medical advice and should not be used as such. Our theme music was performed by Dan MacCormick. This podcast is produced by Brock Armstrong. And the transcripts are done by Annette Yen. Find out more about Katy, her books, and her movement programs at NutritiousMovement.com.