NEI focuses on time outdoors to prevent, slow myopia

Donald Mutti
Donald Mutti

A suspicion that near work may play a role in the development of myopia still lingers in the optometric community, but the benefits of time outdoors have been widely accepted, according to Donald Mutti, OD, PhD, a professor working in NEI-funded research at Ohio State University.

“Myopia is taken very seriously in the eye care community,” Mutti told Primary Care Optometry News in an interview.

Cheri Wiggs, PhD, a program director at the NIH, believes more can be done to increase the public’s understanding of the widespread issue, and the impact could occur at the school level.

Cheri Wiggs
Cheri Wiggs

“We know that infants are getting their hearing tested,” she said in an interview. “That was a public health effort that went well, to make sure hearing screenings happened early on. Perhaps making sure vision screenings take place at that level would be helpful so we can ensure that every child can see the classroom blackboard.”

In the U.S., 42% of Americans are nearsighted, with the incidence increasing, while in Asia 80% are myopic, Wiggs added.

“I was stunned that, even in the U.S., so many kids have uncorrected refractive error and the cascade of events that can occur as a result, like impacting school performance,” she said.

In high myopia, where the eye has stretched further, there is an increased risk for retinal detachment, glaucoma and cataract at an early age, according to Wiggs.

She explained that the good news is that myopia is easily diagnosed and treatments are available.

“Glasses, contact lenses and refractive surgery can all bring back your vision to normal again, and that’s a big success story for public health,” Wiggs said.

The NEI and NHI fund a wide variety of projects related to myopia, such as obtaining the best estimates of the prevalence of refractive errors in the population in general and in specific populations where these numbers have not been obtained before, Mutti said.

Other research explores risk factors for the onset of myopia and rate of progression as well as understanding the consequences of refractive error, whether from an economic angle or impacting children’s learning.

“Basic science laboratories are attempting to untangle the cascade of events that translate the quality of the retinal image into the regulation of the rate of growth of the eye, to treatments aimed at slowing the rate of progression of myopia,” Mutti said.

In Wigg’s program, much of the research focuses on discovery science in the biochemical pathways that regulate eye growth. She said researchers are trying to sort out how emmetropization works when it performs correctly and, in myopia, what happens when it goes awry.

“Once we really understand what the issues are we can start using that information and translate it into therapies,” she said.

“One of the most important discoveries to come from NEI-funded research on myopia in the last 10 years is that our attention should shift away from the centuries-old assumption that myopia arises from or is made worse by excessive reading and other forms of close work,” Mutti said.

Research shows that this is not true, he noted.

“Attention is shifting toward the protective effect of time outdoors lowering the risk of onset of myopia,” Mutti said. “Importantly, this protective effect is its own independent effect and not simply the result of children reading less when they are outdoors.”

NEI-funded research using animal models showed that the benefit from time outdoors is likely from a light-driven release of greater amounts of dopamine from the retina, which, in turn, inhibit the rate of elongation of the eye, Mutti explained. Unfortunately, this protective effect does not seem to benefit children who are already myopic.

“We can diagnose it, we have treatment at work, but it would be better if we could prevent, slow or stop the progression,” Wiggs said. “We are in a good place in diagnosis and correction, but we’d like to understand it more fully to prevent or stop progression.” – by Abigail Sutton

Disclosures: Mutti reports that he has research contracts with Johnson & Johnson Vision Care and that he is a principle investigator of the Ohio State University clinical site for an NEI grant for a randomized clinical trial of multifocal soft contact lenses for myopia control. Wiggs is employed by the NIH.

Donald Mutti
Donald Mutti

A suspicion that near work may play a role in the development of myopia still lingers in the optometric community, but the benefits of time outdoors have been widely accepted, according to Donald Mutti, OD, PhD, a professor working in NEI-funded research at Ohio State University.

“Myopia is taken very seriously in the eye care community,” Mutti told Primary Care Optometry News in an interview.

Cheri Wiggs, PhD, a program director at the NIH, believes more can be done to increase the public’s understanding of the widespread issue, and the impact could occur at the school level.

Cheri Wiggs
Cheri Wiggs

“We know that infants are getting their hearing tested,” she said in an interview. “That was a public health effort that went well, to make sure hearing screenings happened early on. Perhaps making sure vision screenings take place at that level would be helpful so we can ensure that every child can see the classroom blackboard.”

In the U.S., 42% of Americans are nearsighted, with the incidence increasing, while in Asia 80% are myopic, Wiggs added.

“I was stunned that, even in the U.S., so many kids have uncorrected refractive error and the cascade of events that can occur as a result, like impacting school performance,” she said.

In high myopia, where the eye has stretched further, there is an increased risk for retinal detachment, glaucoma and cataract at an early age, according to Wiggs.

She explained that the good news is that myopia is easily diagnosed and treatments are available.

“Glasses, contact lenses and refractive surgery can all bring back your vision to normal again, and that’s a big success story for public health,” Wiggs said.

The NEI and NHI fund a wide variety of projects related to myopia, such as obtaining the best estimates of the prevalence of refractive errors in the population in general and in specific populations where these numbers have not been obtained before, Mutti said.

Other research explores risk factors for the onset of myopia and rate of progression as well as understanding the consequences of refractive error, whether from an economic angle or impacting children’s learning.

“Basic science laboratories are attempting to untangle the cascade of events that translate the quality of the retinal image into the regulation of the rate of growth of the eye, to treatments aimed at slowing the rate of progression of myopia,” Mutti said.

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In Wigg’s program, much of the research focuses on discovery science in the biochemical pathways that regulate eye growth. She said researchers are trying to sort out how emmetropization works when it performs correctly and, in myopia, what happens when it goes awry.

“Once we really understand what the issues are we can start using that information and translate it into therapies,” she said.

“One of the most important discoveries to come from NEI-funded research on myopia in the last 10 years is that our attention should shift away from the centuries-old assumption that myopia arises from or is made worse by excessive reading and other forms of close work,” Mutti said.

Research shows that this is not true, he noted.

“Attention is shifting toward the protective effect of time outdoors lowering the risk of onset of myopia,” Mutti said. “Importantly, this protective effect is its own independent effect and not simply the result of children reading less when they are outdoors.”

NEI-funded research using animal models showed that the benefit from time outdoors is likely from a light-driven release of greater amounts of dopamine from the retina, which, in turn, inhibit the rate of elongation of the eye, Mutti explained. Unfortunately, this protective effect does not seem to benefit children who are already myopic.

“We can diagnose it, we have treatment at work, but it would be better if we could prevent, slow or stop the progression,” Wiggs said. “We are in a good place in diagnosis and correction, but we’d like to understand it more fully to prevent or stop progression.” – by Abigail Sutton

Disclosures: Mutti reports that he has research contracts with Johnson & Johnson Vision Care and that he is a principle investigator of the Ohio State University clinical site for an NEI grant for a randomized clinical trial of multifocal soft contact lenses for myopia control. Wiggs is employed by the NIH.