Eyeworld

EW NEWS & OPINION 22 August 2015 as pointing out those who are likely to become nearsighted in the future. In addition to ensuring that such a child is followed more closely, this will give the parents an indication that spectacles may soon be neces- sary, Dr. Zadnik said, adding that this should hopefully result in more prompt follow-up. Ultimately, knowing which children are apt to develop myopia could serve another function as well. If practitioners have something that could prevent the abnormal eye growth that occurs with myopia, early refractions could identify chil- dren at risk for myopia who should receive the preventative treatment, Dr. Zadnik concluded. EW Editors' note: Dr. Zadnik has no finan- cial interests related to this article. Contact information Zadnik: zadnik.4@osu.edu by Maxine Lipner EyeWorld Senior Contributing Writer near work. "What we found was that it wasn't a tradeoff, that in fact the children who spent more time out- side actually spent more time read- ing—they were just kids who did more," Dr. Zadnik said. Ironically the question of time spent outdoors was one that was initially tossed in when considering near work. "We were floored that the effect was robust enough that it came through as being protective for the onset of myopia," she said. New realizations Dr. Zadnik hopes practitioners come away from the study with the realization that they should be more vigilant in watching for myopia in certain children. "I think an eye exam on school entry makes sense on a lot of different fronts," she said. An eye exam in first grade could detect difficulties such as an eye turn or problem focusing at near, as well surveyed parents about their child's activity and their own vision status. Predictive factors Investigators found that over time a total of 414 children became my- opic. When they examined the risk factors that might portend myopia, they found that one stood out. "The answer to the question we set out to answer 25 years ago about wheth- er we could predict myopia before it occurred is that the best way to do that is with a refraction," Dr. Zadnik said. Typically, the average first grader has about 1 D of hyper- opia, which tends to protect them from developing myopia, Dr. Zadnik said. "But if in first grade they have only 0.5 D of farsightedness or they're plano, as the eye grows those children are the ones that have the highest likelihood of becoming near- sighted," she said. Surprisingly, one classic factor that did not predict myopia was the amount of near work in which the child engaged. "Everyone thought near work, near work, near work," Dr. Zadnik said, stressing that this wasn't found to be true here. The biggest surprise in the study was that the amount of time a child spent outdoors was found to be protective against developing myo- pia. "Back in 2007 we were the first group to publish that the amount of time a child spent outdoors was related to myopia onset," she said. "If parents reported that their child spent a lot of time outdoors, that child was less likely to be one of those that developed myopia." It wasn't just that the child did less I magine being able to predict which pediatric patients are going to develop myopia. Recent study results suggest that the best indicator for this is already at practitioners' fingertips. By simply considering the child's current refractive error, the practi- tioner can get an idea of how likely the child is to become nearsighted, according to Karla Zadnik, PhD, OD, professor and dean of the College of Optometry, The Ohio State Universi- ty, Columbus, Ohio, and lead author of the study. The study, published in JAMA Ophthalmology, was many years in the making. "Back in 1989 when I was at the University of California, Berkeley School of Optometry, in graduate school, another graduate student and I started a study in a little town right near Berkeley to ex- amine the development of myopia," Dr. Zadnik said, adding that the idea was to follow those who would develop the condition over time. When Dr. Zadnik later moved to The Ohio State University, she was able to expand the project to include kids other than the predominantly white population that had been ini- tially included. The research contin- ued until May 2010 and ultimately included 4,512 ethnically diverse school-age children. "The paper that was just published is the culmina- tion of an idea from more than 25 years ago," Dr. Zadnik explained. Each year investigators conduct- ed the testing on school campuses inside a specially equipped van. In addition to considering 13 differ- ent risk factors, the investigators Easy exam may predict childhood myopia A child's current refraction can offer insight into the likelihood that he will develop myopia. Source: Karla Zadnik, PhD, OD IOP continued from page 20 Being involved Dr. Berdahl, now at Vance Thomp- son Vision, Sioux Falls, S.D., called being involved with the Vision for Mars Challenge "one of the greatest professional privileges" of his life with the exception of caring for his patients. "I think it's going to be a topic of conversation for the next few years and potentially one of the most defining moments of our gen- eration if someone steps on Mars," he said. His involvement relates to the research he has been doing on the relationship between intraocular pressure and cerebral spinal fluid pressure. Dr. Berdahl was also a recent winner of the Space Medical and Related Technologies Com- mercialization Assistance Program (SMARTCAP) of the Vision for Mars Challenge, which will help fund his company, Equinox (Sioux Falls, S.D.), and the Balance Goggles he is working on. Dr. Berdahl discussed how he first came up with the idea of the Balance Goggles and the con- nection he made between IOP and cerebral spinal fluid pressure. Equinox and Balance Goggles When Dr. Berdahl began to work with Vance Thompson, MD, at Vance Thompson Vision, he and Dr. Thompson discussed this topic and tried to brainstorm ways to move forward. "We thought we could alter the microenvironment in front of the eye and pressure in front of the eye and that could translate into the eye," he said. After a couple of studies on cadaver eyes, this seemed like an accurate assumption, and Dr. Berdahl plans to explore this in a deeper way. The NASA money is going to help determine if conceptually this is right, but they believe physics is on their side, he said. "We hope to pressurize the goggles, which would then pressurize the eye," Dr. Berdahl said. This would also balance the elevated intracranial pressure. He hopes to begin clinical trials with the Balance Goggles sometime in the next couple of years. "There is a lot of work in front of us, but it's pretty exciting," Dr. Berdahl said. Currently, there is one version of the prototype of the Balance Goggles, and the second version is being worked on. EW Contact information Berdahl: john.berdahl@vancethompsonvision.com

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