Chief Medical Editor’s Page

By Andrew S. Morgenstern, OD, FAAO

“The Worst Part About These Eye Doctor Jokes is That They Just Keep Getting Cornea And Cornea.” - Somebody, but not me

My father is an optometrist; my uncle is an optometrist. As a child, I had lens blanks and tinting equipment in my basement and Brock strings on my doorknobs. Saturday mornings, I went with my dad to his office and hung out there while he saw patients. I have been around the eye care profession my entire life, and I think I have seen it all. Almost all of eye care has evolved medically, surgically, and technologically; however, there is one thing that I can identify that has remained stuck in place for hundreds of years: our approach to myopia.

Per the American Academy of Ophthalmology Museum of Vision, we know that glasses were believed to be invented somewhere in Italy between 1268 and 1289. The inventor is unknown (but I’m guessing it was the first Luxottica frame). The printing press was invented in 1452 and in rushed the availability of books. This, of course, led to mass production of glasses so people could read those books. Naturally, an eye exam was required to determine the prescription. Since then, children and adults have presented for eye exams year after year. In every language, everywhere around the world, these patients have asked the same question: “Has my vision gotten worse since last exam?” The answer? “Yes.” What did we do? We gave these patients a stronger pair of glasses and sent them on their way—only to have them return in 1 to 2 years for the next increase in their prescription.

Let me get this straight:

• patient comes in for exam with glasses;

• asks if eyes got worse;

• doctor says yes, gives patient stronger glasses;

• does not address cause of worsening vision; and

• repeat for everyone for next 800 years (even though we can likely stop the progession of myopia or slow it down).

My father and me, my first time in the chair, 1971.

We know that myopia is at virtual epidemic levels in pediatric populations. We know that increased screen time, near work, and likely the lack of outdoor time makes myopia worse. We know that certain ethnic groups are at higher risk than others. We know that we can control it with atropine and/or multifocal (hard and soft) contact lenses. We know that the FDA hosted a myopia workshop in September to address the need to control myopia. We know the parameters of treatment the workshop recommended. We know the experts involved. We know that we can slow it down or stop it, and we know that if we don’t, higher levels of myopia lead to increased retinal and optic nerve disease.

Therefore, as eye care providers, why are we addressing the most common refractive condition in the eye (myopia) by watching it get worse and doing nothing about it? (Add cricket noises here). Why at the end of an exam, when a parent asks us if their child’s vision has gotten worse, we just give them more of the same palliative treatment that does nothing to slow down or halt the progression of the most common refractive condition of the eye?

Folks, it’s time to make myopia control a priority in the United States as it has been made abroad. This is a nonsurgical, very well researched, incredibly low-risk approach to helping millions of kids whose vision is getting worse every day. n

Dr. Morgenstern is the medical director of Treehouse Eyes (treehouseeyes.com), Myopia Control for Kids, in Bethesda, Maryland.

Andrew S. Morgenstern, OD, FAAO

Chief Medical Editor