Slowing Myopia - OrthoK Case Notes

Fitting children with hard contact lenses which they will wear while sleeping at night may seem like a big undertaking, but the outcomes
continue to impress us. From the first morning these children see massive improvements in their vision - one of the most rewarding
aspects to this work.
When we met Jack* he was 6 years old, an outdoors boy who loved to read, struggling to see the whiteboard at school. Jack’s Mum is
highly short-sighted (-9.00D myopic), and his dad is moderately short-sighted (-2.50D myopic). Jack’s first prescription in December
2015 was -1.00D.
Jack also had poor visual efficiency, a risk factor for becoming more myopic. The first step was a behavioural optometry assessment
and vision therapy to improve his binocular vision. This was successful, but his distance vision remained blurred.

At the end of 2016 Jack got his first pair of glasses. To start he only wore his glasses a couple of times a week at school. Over a 6
month period, Jack’s vision got worse, by -0.50D. If he continued at this rate, by 18 years old his prescription could track towards -
11.00D increasing the risk of serious future eye problems (retinal detachment, glaucoma and maculopathy).
This year we have fitted Jack with custom made Ortho K contact lenses to wear while sleeping. This gives him clear vision the next day
once he takes out his contacts. Importantly, wearing these contact lenses can significantly slow down his myopia progression.
When we checked Jack after his first night wearing his contacts, he commented “I can see great” and his vision was 6/6 (equivalent to
20/20). He managed to take out his lenses solo on the second morning. There are more firsts; he was able to see his parents in the
back row of assembly when he won an award at school. His family report “we are so impressed with these lenses, Jack is really excited
to be able to see clearly and positive about the process.”
Jack will have follow-up checks every 6 months to monitor his vision. So far, after 2 months of treatment his vision has not changed at
all.
*name changed for privacy

MiSight® Daily Contact Lenses for Myopia Control

We now have MiSight® Daily Contact Lenses as another option for myopia control. This year at the British Contact Lens Association
(BCLA) meeting some promising results were announced from a three-year study for MiSight®. The results indicate MiSight® dual-
focus contact lenses which have alternating visual correction and treatment zones - are effective in slowing myopia progression in
children by 59%. CooperVision, MiSight® manufacturer, reported data from its Clinical  Contact Lens Study showing these lenses
slowed myopia and eye elongation. 

The prevalence of myopia is projected to increase from approximately two billion people worldwide in 2010 to an alarming five billion
people in 2050, bringing with it both short  and long-term health challenges. “Myopia’s growth has been dizzying and now affects the
vast majority of young adults in some countries, especially in East Asia,” said Arthur Back, from CooperVision. “Not only does it create
blurred vision, but also increases the likelihood of serious and blinding eye conditions later in life.
“Early intervention by parents, in partnership with optometrists, is essential for the short and long-term health and well being of their
children.”

The prospective, multi centre, double masked, randomised study enrolled 144 myopic children aged 8-12 years from Singapore,
Canada, England and Portugal. MiSight® was well accepted by the children who continued their daily activities such as school work,
reading, playing outside and computer use while wearing the lenses.  
Parents of participants gave a very positive response, noting that before the study, many were concerned about their children wearing
contacts.  After their children had worn MiSight® 1 day contact lenses for three years, almost 9 out of 10 parents rated their children
‘extremely happy’ with the overall experience. Children could mostly manage their lens wear independently.

Book Online

Recycling Contact Lens Packaging

Disposable contact lenses are brilliant in terms of breathability and hygiene. But like so many other items in our daily lives they come in plastic packaging. Many people have asked about options for recycling contact lens packaging - good news, now you can do so and it is very easy.
If you have Ascend, Biofinity, MiSight or Proclear contact lenses, the blisters are classified #5/PP Plastic. This is a designation shared by a wide range of medical and food packaging. The cartons and cardboard packing are classified as recyclable paper and can also go in your regular household collections. The small piece of foil topping is the only part of packaging which should be discarded. One more step to help protect our environment.

McDonald Adams Science Scholarship Rodney College

Sally Adams was at Rodney College prizegiving to present our annual McDonald Adams Science Scholarship. The winner this year was Lachlan Campbell. Lachlan plans to attend the University of Auckland, studying towards a Bachelor of Engineering with Honours. At this stage he thinks he may do Mechatronics or Engineering Science.

Sally Adams presenting Lachlan Campbell with his Scholarship

McDonald Adams Science Scholarship - Mahurangi College

Hannah Dunn was this year's recipient of our McDonald Adams Science Scholarship. She is off to the University of Auckland to study Bachelor of Science, majoring in chemistry. Her long term goal is to advance into post graduate study in Forensic science. 

Claire McDonald presenting Hannah Dunn her Science Scholarship

Omega-3 for Dry Eye - Helping you make tears

Omega-3s are essential fatty acids. "Essential" means their inclusion in your diet is essential for good health. Omega-3s cannot be produced by the body. The two best sources of omega-3s are dark oily cold-water fish, and flax seed. As a population New Zealanders are omega-3 deficient and have the lowest omega-3 dietary intake in the world.

Omega-6s are another group of essential fatty acids which we get through eating beef dairy, vegetable cooking oils, and vegetable shortenings (i.e. biscuits, potato chips etc). The ideal ratio of omega-3s to omega-6s is 1:2. For kiwis that ratio has been estimated to be as low as 1:10.

Omega-3s are helpful for dry eye in these four ways:

Decrease inflammations (signs of inflamation are redness, irritation, scratchy eyes)

• Decrease cell death (called apoptosis)
• Stimulate tear secretion
• Improve meibomian gland oil secretion (these are the vital oils which create better tear film)

The take home is omega-3s are very beneficial in dry eye treatment. Try them and see. We have two omega-3 supplements; Thera Tears, and Lacritec. Both are designed specifically for dry eyes. Anecdotally we find people taking these omega-3s notice a difference within 3-4 weeks of using these supplements.

There is a lot of cool science driving these benefits, if you are interested in more details please read on!

Omega-3s decrease inflammation. Once eaten, omega-3s are elongated by enzymes to produce anti-inflammatory compounds: prostaglandin E3 (PGE3) and anti-inflammatory leukotriene B5 (LTB5). 

There is an abundance of clinical evidence that taking omega-3s decreases inflammation seen in joints in rheumatoid arthritis and in dermatitis. These anti-inflammatory effects help explain why omega-3s have been helpful for people symptoms of meibomian gland dysfunction and blepharitis.

Omega-3s decrease apoptosis (programmed cell death) through suppressing TNF-a. TNF-a increases programmed cell death in the lacrimal gland, where aqueous tears are produced. This contributes to the decrease in tear production, and increase in tear film osmolarity that drives dry-eye ocular surface disease.   

Restasis® (not yet available in NZ), is a drug administered as an eye drop (it is toxic systemically) also inhibits TNF-a production.  Applied as a drop, it achieves good concentrations on the eye surface but is not thought to reach the orbital lacrimal gland in humans.  Omega-3s, taken by mouth, reach the lacrimal gland by the blood supply and the ocular surface via meibomian gland secretions. 

Omega-3's stimulate tear secretion. There are more positive effects of suppressing pro-inflammatory cytokines. We now know the pro-inflammatory cytokines TNF-a , IL-1a , and IL-1b, impair tear secretion in lacrimal gland disease-based dry eye by inhibiting the release of neurotransmitters from neural synapses, and interfering with the secretory response of lacrimal gland acinar cells to stimulation.  This is probably the main mechanism by which tear secretion decreases in dry eye. 

The importance of this was illustrated in work showing when TNF-a gene expression is blocked by gene therapy in an animal model, autoimmune lacrimal gland disease can be reversed, and tear secretion restored. The relevance of this animal model is supported by epidemiological data that indicates that the risk for dry eye decreases with increased dietary intake of omega-3s, as well as an additional study that finds that Sjögren's patients have a lower dietary intake of omega-3s, including EPA and DHA, than age-matched controls.

While EPA is central in blocking the gene expression of pro-inflammatory cytokines, DHA may help in a complementary way.  Neural synapses contain among the highest concentration of DHA in the body and research has shown that dietary supplementation with DHA restores neural DHA levels and improves age-related declines in synapse function. DHA may reduce the ability of pro-inflammatory cytokines in the lacrimal gland to inhibit signal transduction at the synapse.  Lending credence to this hypothesis is the finding that severity of dry eye in Sjögren's patients has been found to be inversely proportional to membrane and serum levels of DHA.

Omega-3s affect the lacrimal gland in another way.  EPA and DHA and alpha-linolenic acid (ALA) from flaxseed oil competitively inhibit conversion of omega-6s to arachidonic acid (AA), promoting the conversion of DGLA to prostaglandin E1 (PGE1).  PGE1 also has anti-inflammatory properties and, in addition, acts on the receptors, increasing cyclic AMP (cAMP). PGE1 and cAMP have been shown to stimulate aqueous tear secretion.

Omega 3's, and the meibomian gland oils. Meibomian glands use essential fatty acids to synthesise oil (meibomian gland secretions). Dietary intake of omega-3s in general, and EPA and DHA in particular, have been shown to affect the polar lipid profiles of meibum as observed by HPLC. THinning and clearing of meibomian gland secretions has been observed with omega-3 supplementation.

There have been some attempts to treat dry eye with the omega-6 essential fatty acid gamma linolenic acid (GLA) found in black currant seed oil, evening primrose oil and borage oil. There are two published studies that concluded GLA was not effective for dry eye. 

Omega-3 supplements provide a foundation for a broad spectrum of dry eye treatment regimens by decreasing inflammation, and improving the oil and water layers of the tear film. We have two supplements available; Lacritec and Thera Tears. Ask us if these could help you.