June 2019

MYOPIA: BEYOND GENETICS
THE INSIDE STORY OF FLASHES AND FLOATERS
HAVE A GOOD CRY
NOT CHILD'S PLAY!
THE POWER OF PERSPECTIVE
SIX MONTHS IN

MYOPIA: BEYOND GENETICS

Myopia, or shortsightedness, is an error of the eyes, in which light is not refracted effectively. In the normal eye, light enters the eye, passes through the cornea and lens and focuses on the retina at the back of the eye. The image is relayed via the optic nerve to the brain where it is interpreted. Myopia occurs when the eye is longer than normal or the cornea is too steep, and the light focuses in front of the retina instead of on it. As a result, close objects are seen clearly while distant objects appear blurred. Myopia is easily diagnosed and treated with glasses, contact lenses or refractive surgery.
 
Millions of people are living with myopia, a common condition throughout the world. Myopia in children may become obvious between the ages of 8 - 12 when they become aware that they do not see the world as others do, that their blurry vision is not normal and that certain visual tasks are difficult for them. The signs of myopia may include squinting to see distant objects clearly, sitting too close to the TV, holding books too close to the face and experiencing eyestrain or headaches. During adolescence, when the body is undergoing rapid growth, myopia may worsen. Thereafter, it tends to stabilise and there is usually little change.
 
In recent decades there has been a marked rise in the prevalence of myopia worldwide and this trend is continuing, with some even calling it an epidemic. Previous studies have shown that the risk of acquiring myopia is largely determined by hereditary factors; if parents are shortsighted, there is a good chance that their children will be, too. However, heredity alone does not explain the extent of the increase in the condition, and researchers are now reporting on some of the environmental factors which are influencing its development. One of the most significant environmental factors is education-related behaviour. "We know from the Gutenberg Health Study conducted at Mainz that the number of years of education increases the risk of developing myopia," commented Professor Norbert Pfeiffer, Director of the Department of Ophthalmology at the Mainz University Medical Center.
 
This view is supported by researchers in South East Asia, where the incidence of myopia in school children has risen notably, and the theory is that increased educational level is a likely trigger. They suggest that people who read a great deal also perform other close-up work, usually in poor levels of light. As the eye adjusts to these visual habits, the eyeball becomes more elongated and the image is focused in front of the retina instead of on it, resulting in blurry distance vision. While others are of a similar opinion, some people are asking the question whether it is the increased amount of close work or the decreased amount of natural light that plays the more significant role.
 
The impact of technology is an obvious factor being considered in the increased incidence of myopia. It is thought that reading the screen of a smartphone or tablet at a distance of 20 cm rather than the normal distance of 45 cm to 50 cm has a role to play. The impact is increased when this is done in inadequate ambient lighting. The influence of blue light emitted by screens is another factor to take into account. "While screens are contributing to children spending more time indoors than in previous years, the research shows they are not the direct cause of the increased incidence of myopia," said an optometrist reporting on research in Australia. He continued that it is not near work on computers and other screens but lack of adequate daylight that is the predominant issue. "Send your kids to play outside for two hours every day" is his suggestion. "And it's not just their eyes that will benefit."
 
Parents need to be proactive in their children's eyecare. The earlier myopia is detected, the more effectively it can be managed long term and the less of a negative impact it will have on academic performance and lifestyle. Schedule regular appointments with your optometrist for a comprehensive eye exam and to check the progression of myopia if it has been previously diagnosed. As children grow and develop their vision changes and their visual needs should be re-assessed. By doing this you will be able to help your children function optimally today and learn about solutions that could potentially slow down their myopia progression in the future. High Myopia is a significant risk factor for eye conditions like retinal detachment in adults, making it essential to manage it as early as possible.
 
Limit screen time, particularly in younger children. While school requirements and demands need to be taken into account, screen time with older children should be monitored. If daily screen hours can't be significantly reduced, ensure regular breaks preferably outdoors engaging in activities that involve physical activity and distance vision. To reinforce the advice already mentioned, encourage your children to play outdoors, which will benefit them in many more ways than visual health.


THE INSIDE STORY OF FLASHES AND FLOATERS

Do you ever experience small specks or threads in your line of vision? Do they disappear when you try to focus on them? Do you see sparks or flashes of light flickering across your field of vision when there is nothing there? These floaters and flashes are common occurrences experienced by most people at one time or another. They may appear separately or simultaneously, often depending on the underlying cause. They may be irritating or even alarming, but they are usually harmless.
 

WHAT ARE FLOATERS?

Floaters are small shapes, which may appear as spots, strings or cobwebs floating in the line of vision. They drift when you move your eyes but seem to dart away quickly when you try to look at them directly. Floaters are most noticeable when you are looking at a plain bright background such as a blue sky or blank wall. While they seem to be outside the eye, they are actually inside the eye itself. Floaters are tiny clumps of gel or cells inside the vitreous, the jelly-like substance that fills the inner eye. As we age, microscopic fibres within the vitreous tend to clump and cast tiny shadows on your retina. These shadows are what you experience as floaters.
 

WHAT ARE FLASHES?

Flashes can look like flashing lights or lightning streaks in the field of vision and are particularly noticeable in dim light. Like floaters, they seem to be outside the eye but there is no external light and they are coming from within the eye itself. They are usually experienced in one eye at a time, and it is not uncommon to see them on and off for weeks or even months. Flashes are often caused by the vitreous as it shrinks over time and pulls on the retina at the back of the eye. This stimulation of the retina causes it to send signals to the optic nerve which transmits them to the brain. The brain interprets the signal as light even though there is no light present.
 
Sometimes people have light flashes that look like jagged lines or heat waves. These can appear in one or both eyes and may last up to 20 minutes. This type of flash may be caused by a migraine and is often followed by a migraine headache.
 

WHAT ARE THE RISK FACTORS?

People who are most likely to experience floaters and flashes include those who are shortsighted, have had eye surgery, trauma to the eyes or eye inflammation. Age-related eye changes are a common factor. As we age, the vitreous, which helps to maintain the shape of the eyes, tends to liquefy, causing it to shrink and pull away from the interior surface of the eye and to become stringy. Bleeding into the vitreous as a result of conditions such as diabetes or hypertension may cause you to experience the blood cells as floaters. Retinal tears can occur when the vitreous tugs on the retina with enough force to tear it. Without treatment, a retinal tear may lead to retinal detachment, which, if left untreated can cause permanent vision loss.
 

ARE FLASHES AND FLOATERS SERIOUS?

Most often, seeing a few flashes and floaters is normal and generally no treatment is required. However, sometimes they can be signs of a serious eye problem. Contact your optometrist or doctor if you become aware of a sudden increase in flashes or floaters or changes to your peripheral vision. Although usually painless, these symptoms could be an indication of a torn or detached retina which is a serious condition and needs to be treated promptly.
 

WHAT DOES AN EYE EXAMINATION INVOLVE?

After obtaining a detailed history of your symptoms, family history, general health and the medication you are taking, your optometrist will assess your vision and check your eye pressure. Your pupils will be dilated to allow examination of the vitreous gel and the retina. Regular eye examinations are advisable.
 

WHAT DOES TREATMENT INVOLVE?

As mentioned previously, treatment is generally not necessary, but they can be irritating and adjustment to the floaters and flashes can take up to 6 weeks. If there is an underlying cause such as inflammation or diabetes, this will be treated. If the eye floaters impair your vision, which happens rarely, there are treatment options which should be discussed with your optometrist who will refer you to an ophthalmologist. The vitreous can be surgically removed and replaced with a solution which helps the eye maintain its shape. Some people report improvement after laser surgery to break up the floaters and make them less noticeable. There are advantages and disadvantages to these treatments, which would be explained by the ophthalmologist.
 
A retinal tear allows fluid to pass into the space under the retina, eventually causing the retina to detach from the back of the eye. If a retinal tear is found, it is usually treated with a laser to prevent a retinal detachment developing. The laser is used to make a ring of burns around the retinal tear. The burns heal to form a ‘weld' that seals the tear and prevents fluid passing through the tear and spreading under the retina. If there is a retinal detachment, it requires immediate surgery to repair it and prevent permanent vision loss.
 

ITS UP TO YOU!

The older you get, the more flashes and floaters you may see. They are usually harmless but may be a sign of an eye problem that needs care. Have your eyes examined regularly to be sure that your flashes and floaters are normal and to protect and preserve your vision.


HAVE A GOOD CRY

A teardrop running down the cheek is a symbol of sadness, but people may also "cry" while cutting an onion or trying to blink out an eyelash or a speck of dust. Researchers are investigating the various reasons that people cry, as well as the physiological, psychological and social effects of shedding tears. For the most part, tears help maintain healthy eyes, but they also have other roles to play. As the children's song says: "Its all right to cry; crying gets the sad out of you, crying gets the bad out of you."
 

Tears are more than salty water

When we cry a complex salty fluid full of protein, water, electrolytes, mucus and oil is released from the lacrimal gland in the upper, outer region of the eye. This fluid, better known as tears, then flows down the surface of the eye and runs down the cheeks. The body produces tears at a rate of about one to three microlitres per minute. Not all tears have the same composition - three types of tears exist, all with different purposes.
 
Basal tears are the tears that are constantly in the eyes, keeping them from drying out completely. They flow continuously from the lacrimal glands and drain through the nasal cavity. As we blink the basal tears clean and lubricate the eyes, keeping the eye surface smooth and helping us to see clearly. Basal tears have three layers: a thin mucus layer that sits directly on the eye, a watery layer in the middle and a thin oily layer on top that prevents the tears from evaporating.
 
Reflex tears serve to protect the eye from harsh irritants such as smoke, onions or a very strong, dusty wind. To accomplish this, the sensory nerves in the cornea communicate this irritation to the brain stem, which in turn sends hormones to the glands in the eyelids. These hormones cause the eyes to produce tears, effectively ridding the eyes of the irritating substance. Reflex tears are also made up of three layers, but they have a larger percentage of water than basal tears do, as well as higher levels of antibodies to prevent microorganisms from harming the eyes.
 
The third type of tears is emotional tears, which can be interpreted as a form of nonverbal communication. Starting in the brain where sadness, or sometimes happiness, is registered, the endocrine system is then triggered to release hormones to the ocular area, which causes tears to form and flow. Several chemicals have been found to be present in emotional tears, some of which include prolactin, adrenocortico hormones and an endorphin which reduces pain and improves mood. Because emotional tears help to remove chemicals that build up during stress, they are literally "crying out" harmful toxins, helping us to feel better after "a good cry".
 

Why do we cry?

The reasons for crying change as we grow from babies to adults. During the earliest weeks and months, crying is an essential communication tool, as babies cry to have their most basic needs fulfilled. If they are hungry, sleepy, gassy or dirty, they cry so that a caretaker can rectify the problem. As babies grow and mature, however, crying becomes a more sophisticated way of communicating specific and varying needs, so it becomes necessary to change the pitch, intensity and length of the cry. Babies are believed to change their crying goals sometime around the age of 10 months, crying to gain attention for other reasons.
 
After babyhood, researchers believe that girls and boys do equal amounts of crying until they reach the hormone-fraught adolescent years. As levels of testosterone increase in boys, their amount of crying decreases. The opposite is true for girls, whose estrogen levels begin to rise substantially during the early teenage years along with the frequency of crying. Gender studies throughout the world have all reached the same conclusion: women cry as much as four times as much as men do.
 

Crying in animals

According to some experts, only humans cry in response to emotional stress. Many animals certainly have feelings, make crying sounds in response to pain and stress, and routinely have tears to keep their eyes moist, but they do not shed tears in response to emotional stress.


NOT CHILD'S PLAY!

The visual system is the most complex sensory system in the body, and yet is the least mature system at birth. As the visual system develops, infants need to learn to make the change from simply responding to brightness or contrast towards developing effective functional vision and applying meaning to their visual world. This progress from the blurry world of light and dark to the sophisticated ability to handle complex visual tasks is enhanced through play. By thoughtful selection of toys and activities, parents can stimulate this process of visual development while integrating it with the fun of play.
 

GENERAL GUIDELINES WHEN CHOOSING TOYS

Walking into a toy shop can be overwhelming and quite daunting, particularly when it comes to selecting toys to facilitate development. There are certain guidelines to consider.
 
Toys Are Expensive - Cost is not everything! Inexpensive toys and games at the age and interest level of a child can be just as stimulating and effective in fostering visual development as sophisticated costly toys.
 
Age-appropriate Toys - Toys are made for every age group. By selecting something appropriate for the age of your child, you are making sure that, as well as providing fun, the toy will be right for a particular stage of development.
 
One Toy, Many Activities - Choose toys that can be used in a variety of ways, sparking the child's creativity and imagination. Some toys are designed to grow with a child and be used in different ways at different stages of development.
 
Toys Can Be Hazardous - Avoid toys that may pose a choking risk because of small parts that can detach or be chewed off easily. Ensure that there are no sharp or protruding edges. Be aware that the material or paint used for some toys can be toxic.
 
Washable Toys - Whatever material toys are made of, be it plastic, wood or different fabrics, it is always a good idea to ensure that they can be regularly washed without the risk of damaging them.
 
Sturdy Toys - As part of the fun of play, children throw, bang and generally mishandle their toys. Make sure they are not easily breakable.
 
Toys to Encourage Interaction - Many toys are ablaze with lights and sounds. These toys may entertain the child but don't necessarily foster interaction and learning. The more the toy does, the less the child has to do. Select toys that encourage the child to learn by performing an action to make a toy work.
 
Balloons - A party is not the same without balloons! Children love to play with them or watch them float nearby. Once they have burst, be sure to discard all the small rubber pieces, which may be a potential choking hazard.
 
Throw Away Plastic - Instead of the toy, children often prefer to play with the container in which it was packed. Cardboard boxes can provide hours of fun and imaginative play, but plastic bags and bubble wrap should be discarded as soon as the toy is unpacked because of the hazards they pose.
 

CHOOSING AGE- APPROPRIATE TOYS

The development of visual abilities is a gradual process. Because all children develop at their own pace, their developmental age does not necessarily align with their actual or chronological age. Children present with a variety of strengths and weaknesses, preferences and abilities, all of which need to be taken into account when choosing toys that will interest and stimulate them.
 
The First Six Months
 
Babies are able to see immediately after birth, but their vision is not yet clear. As vision gradually develops, the baby begins to react to objects of high contrast and to focus on faces and stare at them for a few seconds from as early as 2 - 3 weeks. At this very early stage the best stimulation is the human face so talk, smile and interact with your baby, as well as presenting toys with bright vibrant colours. At about 2 months the baby's ability to track objects with his eyes begins to emerge. He will be fascinated by leaves blowing in the breeze and by mobiles hanging above his cot, learning to focus and co-ordinate his eye movements as he watches their movement and gradually develops hand-eye co-ordination by reaching for the moving parts. Towards the end of the fourth month, depth perception and the ability to differentiate near and far objects starts to develop. By five months of age, he will recognise and react to familiar objects and faces. As he gains better control of his eye movements and learns to manipulate objects, give him brightly coloured toys of varying textures and toys that make sounds or light up as he grasps or squeezes them, creating an awareness of cause and effect.
 
Six to Twelve Months
 
During this period of development, present toys that can be stacked, fitted into each other and pulled apart, such as building blocks, nesting cups and stacking rings of different sizes. As well as improving hand-eye co-ordination they help to develop visual memory. Fun activities to increase visual memory include "peek-a-boo" and finding objects that have been hidden from view. It is never too early to start introducing books and reading to your baby. Choose cardboard or cloth books so that he can turn the pages himself and focus on pictures that attract his attention. At this stage pictures should depict bright familiar objects and pages should not be too full or busy, making it difficult for the child to visually select and focus on objects that interest him. As the child starts to learn about his world by crawling, and co-ordination between the eyes, the body and the environment develops, spatial perception emerges.
 
One to Two years
 
At this toddler stage the child becomes an explorer, wanting to see and touch everything that catches his attention. Visual skills continue to develop along with improved physical proficiency and dexterity. Activities such as finger painting, play dough and playing with sand and water are enjoyable learning experiences at this stage. The child enjoys bouncing, throwing, and chasing balls (and probably a few objects not meant for throwing!). Visual skills are linked with other important developmental skills, like balance. Children enjoy the movement of toys such as rocking horses which help to integrate balance and spatial perception. Hand-eye co-ordination, visual discrimination and eye teaming become more refined and can be encouraged with shape sorting toys, simple puzzles and interlocking building blocks such as Lego. Toys that reflect the world around them stimulate imaginative play and problem-solving.
 
Preschool
 
The preschool years are the time to sharpen pre-literacy skills, including the visual skills that are fundamental to learning to read and write. Cutting, painting, moulding with clay or play dough and threading beads strengthen fine motor abilities, while ball games develop gross physical co-ordination skills. While reading to your child, encourage him to look at the book and to match and identify shapes, colours and even letters, for example the letters of his name. As imaginative play becomes more sophisticated, provide opportunities for imitation of daily activities with toys such as household objects, cars and dress-up clothes.
 

SIGNS OF PROBLEMS

Even if you're doing everything you can to encourage your child to develop visual skills by the typical ages, you may notice signs that alert you to potential problems. If your baby is unable to focus or the eyes appear crossed by the age of four months, consult your doctor. Constant tearing or crusting around the eyes is not uncommon in the first few weeks, but if it persists it may be a sign of a blocked tear duct. Red or swollen eyes may indicate an infection. Seek medical advice to help you manage these concerns.
 
If your child has a functional vision problem, this may be detected at preschool or only once the child has started school and is having difficulty learning to read. Your optometrist will guide you towards the appropriate course of action.


THE POWER OF PERSPECTIVE

Blindness or loss of vision is ranked as one of the most common fears related to health. While for many people this is perceived as debilitating, there are people who are blind or partially sighted, either from birth, disease or trauma, who refuse to see this as an obstacle to living a full rich life. The extensive list of people who have turned this everyday struggle into success includes writers, musicians, artists, scientists, lawyers, chefs, sportspeople and adventurers, one of whom reached the summit of Everest as well as conquering the Seven Summits. Many of them have become activists and advocates for the rights of others with visual disabilities. YOUTH MONTH is an opportunity to reflect on some of their stories as an inspiration to young people.
 

BLIND SURFER

Derek Rabelo's father had always wanted his son to become a professional surfer, but it seemed that this was not to be as Derek was born with congenital glaucoma. After years of listening to waves crash on the shore of his home town in Brazil, Derek decided to pursue his own dream of becoming a big wave surfer. "I listen to the ocean and feel it. Every single part of the wave makes different noises, so I can decide which side of the wave I should surf towards. If you have a dream, you have to believe in yourself, and use your senses with passion and perseverance." Derek has shared his story with thousands of people around the world, inspiring young people to chase their dreams beyond the odds, push their limits to overcome fear and achieve what they never imagined possible.
 

BLIND PAINTER

John Bramblitt lost his vision when he was 30 years old due to complications from epilepsy. At first, John says he lost hope and was in a deep depression, but then he found an outlet in painting. Since John can't see colours, he has developed a process whereby he paints by touch. According to him, the colours feel different to him - white is thick and black is a little runny, so when he needs gray, he mixes the two until the texture is right. His art has received worldwide recognition, been sold in over twenty countries and he has received three Presidential Service Awards for his innovative art workshops.
 

BLIND ARCHITECT

Christopher Downey is an architect, planner, and consultant who lost his sight in 2008. How was it possible to keep working as an architect? He works with a blind computer scientist who has devised a way to print online maps through a tactile printer. Today, he is dedicated to creating more helpful and enriching environments for the blind and visually impaired, and he also helps in crafting design processes that are more responsive to the needs of blind people.
 

BLIND PHOTOGRAPHER

Some say she defied the odds, but blind Nigerian photographer Taiwo Lawal says she refused to see them and is showing the world that passion is stronger than obstacles. Prior to her photography training, Lawal learnt a few trades which included bead-making and bag-making. Her road to photography began with a chance meeting with a benefactor. Through his help and her photography instructor Lawal began photography lessons which she initially thought was impossible due to her lack of sight. Her instructor reports that teaching her was challenging but interesting. "One must be extremely patient. Training her is like two to three times longer than that of a sighted person. But I'm also learning from her. I didn't know how sharp her other senses were, and she always looks happy."
 

BLIND CRICKETER

Jackson Make, who was part of the South African squad in the Blind Cricket World Cup in 2014, has been described as "truly an inspiration to our younger players". Nominated by the KZN Cricket Union as the Blind Cricketer of the year in 2014, Jackson regards graduating with a Bachelor of Social Science degree as one of his greatest achievements. Make, who attended a school for the blind in the Free State, hopes to be an inspiration to other blind and partially-sighted students through his exploits on the cricket field as well as his academic pursuits.
 

BLIND AND SIGHTED CYCLIST PAIR

Inspirational and fearless women, Liezel van der Westhuizen and Cindy Jacobsz are the first South African all female blind and sighted pair to tandem cycle from Manali to Khardung La, India, covering a mean distance of 550km in 10 days at altitudes of up to 18330 feet. Not only did this courageous pair conquer the challenging route, but they did so while battling strong winds, rain, sleet and sub-zero temperatures, as well as being confronted by every imaginable technical problem. But they never gave up and achieved their goal with their heads held high. Passionate about philanthropy, they decided to use the event to raise funds for two medical charities - Operation Smile South Africa and OneSight.
 

BLIND MARATHON RUNNER

According to those who knew him well, Ian Jardine's stock phrase was "I see" - bittersweet since he could see nothing at all! In spite of his visual disability, Jardine entered the Comrades Marathon 14 times and completed it every time. The last 50 000 miles of his running were done with the help of friends who acted as guides, a difficult and admirable feat in itself, to accomplish over the distance of Comrades. Ian Jardine epitomised the heart and soul of this "ultimate human race", and an organisation catering for blind runners was named in his memory. Thanks to the inspiration of Ian Jardine many blind runners participate in the Comrades and find victory in their adversity.


SIX MONTHS IN

One moment you're hugging family and friends and setting impressive goals for the brand new year that's just minutes away. Next moment it's June and your list of resolutions, well... it's probably folded up somewhere but you're not sure where exactly.
 
Sound familiar?
 
We're officially halfway through 2019 and not all those big plans have quite worked out. We all had grand ideas before the clock struck midnight. So, how did it play out for you?
 
Maybe you were travelling to some exotic place for New Year, and you couldn't quite read the restaurant menu. (And yes, it was in English.) Those reading glasses suddenly weren't so effective, so you made the decision there and then. As soon as your plane touched down on home soil, you were going to make an appointment to get your eyes examined.
 
But maybe that wasn't you. Maybe you were on a beach somewhere in December complaining about your scratched old sunglasses. Maybe you grabbed a glass of champagne on New Year's Eve and made a decision to finally replace them. But then January came and went, and then February, and May...
 
Maybe you'd made a resolution to insure your glasses. To clean both sides of your contact lenses. To fix that loose temple on your glasses before it breaks off completely. And here we are, six months later. So, what do we do now?
 
Don't worry. I'm not here to nag you to do all the things you haven't got around to doing. (There could be other people in your life who'll do the nagging, but not me.) I'm just saying... isn't it strange that we ring in the new year with some bubbly and some really big plans? And then somehow, life gets in the way?
 
So now what? Well, some would say the best solution would be to stop making resolutions in the first place. Problem solved. And maybe that's the way to go.
 
On the other hand, the good news is six months are gone but we still have another six months to go. I know, that's the kind of glass-half-full thinking that belongs on an inspirational poster. But it's true - that champagne glass of hopes and goals still has six months' worth of bubbles in it.
 
If you start now you could be done by November, just in time to start thinking about the amazing things you'll achieve in 2020.
 
So happy mid-year, and good luck with that list. Maybe we don't drink toasts in June, and maybe we should. After all, you've come this far, and you've still got so many great things ahead. (So seriously, check that temple...)