Jay Neitz, PhD, Professor in the Department of Ophthalmology at the University of Washington School of Medicine talks about myopia.
Interview conducted by Ivanhoe Broadcast News in July 2018.
You said that cases of myopia are increasing, why is that?
Dr. Neitz: Myopia has been increasing a huge amount since the time when basically people started to watch television. And there’s still some argument about it but the correlation is huge that as more and more people are spending time with screens in front of their eyes. Televisions, computers, lap tops, but even more emphasis in certain areas of the world on academics, you know people are spending more time with books in front of their face. And there’s a huge correlation between those things and so we are pretty sure that this drastic increase, I mean it’s really an epidemic increase in incidence of nearsightedness caused by to too much time spent with things in front of your face.
Is it eye strain or what is it?
Dr. Neitz: These are all things that have been very mysterious to people so it hasn’t been an obvious solution to that. Here’s some things that we know. We know that in order for you to have perfect vision that the back of your eye has to be at exactly the right distance away from the front of your eye in order for the optics of your eye to perform a perfect image. And Mother Nature has found a way to make that happen and that is that is every little kid is born farsighted. And that means that their eye is a little too short. And in normal development your eye is supposed to grow longer and longer until it gets to the place where the images formed by your optics are in perfect focus. And what happens is that fails and causes myopia, the eye grows too long and then we have to wear special glasses to focus things on your retina. But the reason it’s growing too long is that normally the eye has to use cues from images that we’re taking in through our lifetime in order to know how to make the eye grow long enough. And the images are very different when you’re spending all the times with things in front of your face than they are if back in the days when humans lived mostly outdoors and things were far away. We changed our visual environment to one that confuses the eye to think that it needs to grow when it really is long enough.
You said it usually starts showing up third grade, eight, nine years old.
Dr. Neitz: Yeah, exactly. So your eye is supposed to get to the right length so your vision is perfect at about the time you get through adolescents or a little bit later. Most people’s eye won’t grow anymore after they’re in their early twenties. But when people are going to be myopic their eye is already longer than it’s supposed to be when they’re twenty when they’re eight or nine years old. And then it usually continues to grow and your eyes get worse and worse and eventually there are mechanisms. I have myopia and somewhere after my twenties even though my eyes got worse and worse it did stop and that’s what happens with everybody.
Tell us a little bit about what you’re doing about it with the glasses and the trial.
Dr. Neitz: We’re supper interested in trying to prevent myopia. A lot of people say well you can just wear glasses or contacts or you have Lasik. But part of what the huge worry is that particularly people that have severe myopia like I do and that’s also increasing that you know not only more people have myopia but a lot of people have worse myopia. Their eye, this growing eye too long actually puts people at risk for lots of other things that go on and actually cause people to go blind in later years. So people that have high myopia are at risk for glaucoma and retinal detachment and retinal degeneration. So this is a huge problem that putting a band aid on it basically by having people wear glasses but it’s really, really important that we can stop the progression. And so basically we have invented glasses that are designed to make images on the retina more like images would normally fall when people are not reading or having things close to their eyes. So it’s supposed to kind of simulate more like what it is if you’re playing outside all day long. A solution to the whole myopia epidemic would be that don’t allow people to read or have a computer or watch TV. But people are using computers to socialize, they use them to educate themselves. They use them to entertain themselves and play computer games. And nobody wants to give all that up. We have to find a solution where people continue to that but we have these glasses that are designed to reduce the harm caused by these kinds of things.
How do they work?
Dr. Neitz: If you have perfect vision what it means is that when you look off in the distance that things are very perfectly clear. But in order for us to be able to see at all distances our eyes are actually able to change their focus. When you look off in the distance you should see things perfectly and when they get closer then you should be able to focus on things closer and closer. So if people can’t see things closer they’re farsighted and that’s what little kids are when their eye is too short so things are really clear far away. And what happens is that they’re even clear far away when they begin to accommodate the things that are closer. And so like right now I’m talking to you but you only are a little tiny part of the image on my retina. The whole entire rest of the world is also on my retina. And really that’s what our eyeball is paying attention to. And in the natural world all those things are far away. And if as I accommodate so I can see you clearly if still things far away are still very clear then my eyeball says, wait a minute I must be farsighted because those things that are far away are still clear and so I need to grow. Now what happens is that when you read a book or put a big TV screen it’s now filling your whole visual field but yet you’re focused on the things that are close but out here in the periphery those things are also clearly in focus because they’re not far away. And that’s basically your brain or your eyeball really says, wait a minute, things are in focus out here in the periphery and it’s used to thinking that they’re far away. I must be farsighted I need to grow. What these glasses do is they make things progressively more blurry in the periphery. And it tricks the eye to think that even when you’re looking at a TV screen or a book or something it thinks, oh everything is cool because I’m focused close but things that are in my periphery are blurry I must not need to grow anymore and that’s how they work.
What’s happened so far, what are your results?
Dr. Neitz: This is such a radical idea there were a number of steps we had to go through. One thing you have to have things approved by the Institutional Review Board that says you’re going to let us put glasses on kids. And so the first thing that we did is we made some glasses that had regular lens in one eye and they had the special lens, a first version of special lens, in the other eye. And then we had people wear these, kids wear these glasses. And all these kids already were screened so they were already progressing with their myopia. Then we followed them for three months and we have special a instrument that can measure changes in people’s vision very accurately. And then the kids could re-enroll and switch their eyes. And what that trial showed in a period of three months that the special lens actually completely and totally stopped the abnormal growth of the eye. That was a great result. And we were pretty excited about that. It turns out that the glasses, our first version, there were things that weren’t quite a marketable thing. It was kind of a test version. And you never know does it have something to do with the fact that you have it on two different eyes. And so our next trial we did a very similar thing only we had groups of kids, one group that wore the special glasses on both eyes and another group that had wore just regular glasses. And we did it, we wanted to see what happens in the longer term so we did it for six months. And in that case very much the same result between the kids that were wearing the glasses their eyes grew much less about seventy percent less. So it didn’t completely stop it. And then still these were prototypes, and so we spent a number of years trying to develop something that could really be more of a commercial product. And some of the limitations you have to have a pair of glasses that kids can wear and they’ll take the wear and tear and wear them for a long time. And we wanted to make sure they were tolerable and safe. So we’ve been working on the design for quite a while kind of tweaking it and improving it. And we now have what we think is our final kind of commercial product design and we’re testing that right now on a group of children. And so you’ll talk to somebody later and that’s one of the kids that’s been trying this glasses.
So it’s in that final stage. The growth was seventy percent less than your control group?
Dr. Neitz: Yep, that’s exactly right. And we hope that the current version is even a little bit better. I mean we’d like to stop it completely. Ultimately the goal is to get it so that we catch it before kids need glasses and can slow it down. So that you could wear glasses through high school and once you get them to twenty you could throw them away and have normal vision. That would be our ultimate goal.
There’s probably not an answer to this but how long kids would wear these corrective glasses?
Dr. Neitz: It depends on how bad their nearsightedness is. But until they’re through college really.
How about Olivia, how is she doing?
Dr. Neitz: She’s maybe been wearing the glasses about a month and it takes a little getting used to but I think she’s doing great.
I know you don’t need FDA approval but you’re seeking FDA approval.
Dr. Neitz: Exactly.
What would the potential time line be to get it out in the market?
Dr. Neitz: These glasses could be marketed without FDA approval. But there’s a lot of things that are marketed that are supposed to do miraculous things that are not real. And if you have FDA approval and you can label it and say these are effective in preventing myopia then everybody can feel rest assured that this is the real thing. I mean there are hair brushes you can buy on Amazon with red lights in it that make your hair grow well. We don’t want it to be like that.
How many kids are in the current trial?
Dr. Neitz: I think there is about a dozen.
Is this the last trial before you start the documentation, the paperwork?
Dr. Neitz: No this is the last trial before we do our pivotal trial. Our pivotal trial will be actually a hundred and eighty kids. By twenty fifty there’s supposed to be five billion people on earth that have myopia. We want to have glasses that could be fit to five billion people. And so if you have something that’s going to be a produce that’s going to go on lots of people you have to make sure that there isn’t some kind of small group of people that have a problem or something. So we need a big group. And we’re scheduled to start that pivotal trial in the next months. But we wanted to make sure that we had really finalized the design of the glasses.
So the trial kids will be around Olivia’s age?
Dr. Neitz: Yeah, yep. Our big trial six to fourteen.
Is enrollment still open?
Dr. Neitz: For our current trial we call it a tolerability and durability trial just to make sure that you know we’re not going to run in to any surprises. And yeah we’re still enrolling kids just to make sure.
In the big trial?
Dr. Neitz: In the little trial.
The little trial and then you’ll start enrolling?
Dr. Neitz: The big we haven’t started enrolling.
And do they have to live here?
Dr. Neitz: No. There are sites all over the United States.
If someone was interested in getting their child in the trial how would they do that?
Dr. Neitz: I can find that out.
What else I haven’t asked that you think is important to get in the story?
Dr. Neitz: No I think we did it.
END OF INTERVIEW
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