When asked about their five senses, people usually respond that their eyesight is the mode of perception they value and fear most of losing.
Why do you wear glasses? In fact, few of us are told much about the reason we’ve been prescribed corrective lenses or how vision problems can further affect eye health.
Myopia (nearsightedness or short-sightedness) commonly occurs when the eyeball grows too much, elongating from front to back. While there are theories about what causes the eye to elongate, no one yet knows exactly what triggers this growth. However, the result is that faraway objects look blurry while things nearby appear clear and in-focus.
Unfortunately, in addition to blurred vision, myopia is often a gateway to serious blinding diseases. Thusly, nearsightedness is divided into two groups: Physiological myopia refers to a refractive error of less than -6 diopters; while anyone with more than -6 diopters is considered to have pathological myopia. However, with one million new cases occurring each week, vision scientists are warning that there is no safe amount of myopia because each minus (-) diopter in a lens prescription doubles the risk of developing serious ocular problems.
The elongation of the eye puts stress on its inner parts thereby inviting other maladies that used to be mostly attributed to the scourge of old age. Nowadays, cataracts, retinal detachments, glaucoma and macular myopathies* are not only striking earlier in life dramatically disabling millions of young people but also present serious visual impairments later in life.
[*What do these words mean? A cataract is a clouding of the crystalline lens inside the eye and, although surgically correctable, it is the principal cause of blindness in the world. A retinal detachment is an emergency situation in which the retina pulls away from its normal position and, if not treated immediately, risks permanent vision loss. Glaucoma is called the ‘silent thief of sight’ because there are usually no symptoms in early stages of its progression while causing permanent damage the optic nerve. Yet, it is the leading cause of irreversible blindness worldwide. Very nearsighted people can also develop a condition called myopia-associated glaucoma-like optic neuropathy, which is the direct result of living for 20+ years with an over-stretched eye. Macular myopathies (such as macular degeneration) describe any pathological condition to the area of the back center of the retina, the region of most-accurate vision. A blinding condition specifically called myopic maculopathy is the accelerated aging of a myopic eye directly associated with the stretching and thinning of layers at the back of the eye. This malady tends to present itself after the age of 45 and, with it, comes a 70% risk of visual impairment by the time you reach your 70th birthday.]
“Using the analogy of a camera with its lens, which can be compared to eyeglasses and the film representing the retina at the back of the eye. If the film at the back of the camera becomes stretched or stops working for any reason, no matter how fancy a lens you put on the front, you’ll never be able to get a decent image out of it.”
Considering the rise in pre-mature incidences of myopia-related diseases, estimates indicate that by 2050, half the world’s population will be myopic – with up to one billion people at high risk of permanent blindness.
At the heart of our story is an international group of vision scientists – physicians, inventors, psychologists, sociologists, and epidemiologists – whose research over the last 40 years has advanced even the most basic knowledge of eye science. This coterie of colleagues first came together under the auspices of the Wallman Vision Laboratory at City College-CUNY and have been collaborating on research of eye movement and myopia since the early 1970s. Led by neurobiologist Josh Wallman, their pioneering discoveries challenged long-held assumptions about how eyes function, grow and adapt.
Josh’s greatest genius came from his love of putting people together from different walks of life – doing so because he relished considering opinions from a variety of angles. Thus, his lab located on the upper reaches of Manhattan became a gathering place for researchers, artists, writers, inventors, students and professionals of many backgrounds, cultures and disciplines. Sadly, Josh succumbed to cancer in 2012 yet, around the world, his brilliance lives on in the continuation of ideas, projects and experiments that he encouraged and supported. Because filmmaker, Jane Weiner has the privilege of being a part of Wallman Vision Lab’s circle of friends, many of the vision scientists participating in this project are people she’s known for quite a long time.
Working in close association with this group for several years, we’ve developed an ambitious, multi-platform project wherein we retrace the path of early experiments: Discoveries of retinal and neurobiological interactions and physical mechanisms of ‘how we see what we see‘ that have fostered dynamic breakthroughs in understanding not only what could be causing the worldwide Myopia Epidemic but also in identifying new remedies to help bring it under control.
LOSING SIGHT opens in darkness with the sounds of a maternity ward, suddenly we see a point-of-view shot of lights overhead as a newborn squints at first sightings of her new world. Looking up and around, she struggles to adjust to the brightness and to see…
Babies are born farsighted with eyeballs too small to handle the internal optics. Through infancy and childhood, the eyeball grows, elongating until it reaches the precise point of perfect vision, normally in time to enter first grade at school. What causes it to continue growing on into myopia is still unknown and solving this mystery, especially in the midst of an giant epidemic, is the urgent goal of energetic scientific research.
Watching children around the world – at home, in nursery school, interacting with others, playing alone with toys – we track the evolution of a child’s eyesight over early years of life, from a hazy monochrome at birth into a sharply defined, colorful world of perfect vision at around 6 years old.
If eyes continue to elongate past this point of perfect vision, it’s important to recognize visual aberrations that can presage impending ocular difficulties.
“As my retina detached, I watched the first sparks fly, like arcs of lightning, shooting through my sight then, an oil slick of black started down and to the left, creeping toward the center of my vision. I couldn’t fathom what was happening but my eye was coming apart..!”
“Retinal detachment, the most dreaded and common complications of myopia, occurs with considerable frequency…”
Insights from professionals interwoven with testimonials from individuals with maladies associated with myopia give firsthand witness to the real-life challenges on both sides of the conundrum.
“We’re now seeing huge increases in the numbers of younger patients with eye diseases normally associated with middle- or old-age… Here, in Hong Kong, more and more teen-agers are arriving at hospital emergency rooms with detached retinas…”
In a commercial port city in China, we spend a day with the Liu family. Like most of their classmates, both six-year-old Jun and twelve-year-old Qiang wear glasses. Spending long hours at school, neither sees much natural light. Arriving at home, well past sunset, they have another two hours of homework before being allowed to touch their electronic gadgets. This way of life is hardly an exception in countries where the prevalence of myopia in younger and younger children has grown to worrisome proportions.
“The best evidence of this comes from Singapore where parents now start getting their kids into special early tutoring to be sure they know the alphabet and can count before entering kindergarten. So, they’re beginning schooling at age 3 or 4.”
Notwithstanding theories that a couple hours daily in sunshine could delay the onset of myopia, parents with ambitious goals for their children sometimes feel that playing outside wastes precious study-time.
“A child’s eyes should be tested early and tracked regularly while they’re developing because eye elongation is more difficult to control after the process has set in. Moreover, should the child become myopic, parents need to be advised of future complications, which are sure to come.”
In a brightly lit Parisian shopping mall, Jeanne walks with a white cane. Diagnosed with glaucoma at the age of 21, she can see perfectly well when looking straight ahead but has lost perpherial vision. Thus, navigating pedestrian sidewalks, contending with scooters, cars or buses at street crossings anticipate personal hazard. She shares her poignant story about confronting this debilitating condition as it progresses toward blindness. After five years daily regimes of a variety of eye drops along with surgical treatments, Jeanne is no longer allowed to drive. She questions why her glaucoma was not noticed earlier, “I am quite nearsighted so, of course, my vision was checked yearly. But I didn’t have a complete eye examination until my late teens.”
“Glaucoma often is overlooked in younger patients even though myopes are at greater risk of developing it. Moreover, many people with glaucoma have ‘normal rage intraocular pressure’ but most optometrists only check eye pressure without doing a thorough eye exam. People with high myopia have a fragile eye structure, the optic nerve is also fragile making them prone to developing glaucoma.”
“With all we now know about signals telling eyes to elongate, just giving a myopic child his first pair of eyeglasses then returning annually for checkups and increasingly stronger lenses, is bordering on professional negligence.”
When she was 8 years old, after complaining that she could not see the blackboard, Siobhán was prescribed eyeglasses. As an Irish author, editor, publisher and translator, she says, “I’d always had eyesight problems because, afterall, I was -13 in one eye and -12 in the other. But, at around 39 years old, one day I discovered that I was really finding it difficult to read.
“I saw the world through the medium of print, that was my apprehension of the world, and suddenly that was completely taken away from me. I was diagnosed with myopic macular degeneration and that was devastating.
“So now, I can’t drive, I can’t recognize people’s faces… It’s very difficult socially, difficult at parties, difficult at meetings. I look as if I’m making eye contact with you but, in fact, I can’t make eye contact with people ’cause I cannot see their faces – and, all those things are a nuisance but not being able to read, that’s devastating.”
Outfitted in a wetsuit, Charles takes a few minutes to perform eye exercises before taking his board into the Pacific surf. At 16, he’s been doing this routine for the last few years, firmly believing that it helps him to see better. He’s anxious that his vision will keep him from his dream to become a pilot.
While anecdotal stories abound of the value of eye-exercise regimes, its worth is difficult to assess because empirical evidence is nearly impossible to gather. Nevertheless, the twice-a-day, 5-minute exercise ritual, instituted 50 years ago by China’s Minister of Education, is still required of all Chinese schoolchildren today. However, many vision experts are of the opinion that such exercises do nothing for myopia.
“Many people falsely believe that shortsightedness is ‘cured’ by laser surgery — which is marketed as treatment for myopia… You can, of course, see better but you still have a too-long eye that puts you at risk for other maladies — and, your too-long eye will never become short again because eye stretching is one-way traffic, it’s an irreversible process.”
To-date, there is no outright cure for nearsightedness but as vision science moves forward – finding different strategies to slow and control myopia’s progression – and, coming closer to an understanding of what conditions, physiological and environmental, can cause the eye to elongate more than it should in the first place.
Myopia is the most common refractive error of the eye.
Worldwide, myopia has become a major vision-threatening disorder, especially targeting young children growing up better-educated in urban communities. Ocular stress from near vision activities such as concentrated, sustained reading has long been thought to be responsible for its development. And, in societies where doing well in school is greatly valued, both the prevalence and degree of myopia seem to be directly correlated with the amount of time spent in strenuous, full-time education.
Today, myopia in kids has burgeoned into an out-of-control epidemic – tripling in the USA in the last 30 years. Currently approximately half the populations of both America and Europe are myopic. In 1960’s China – only 20 percent of the population was nearsighted – now, while the rate among schoolchildren in rural China is as low as 5%, its prevalence among 17-year olds in Beijing is 74%. In Taiwan, Hong Kong and Japan 86% of young people in are myopic. Whereas estimates among Singaporean youth are as high as 90%.
What’s causing the recent, staggering worldwide uptick in myopia? Many point to the ubiquitousness of computer screens but the statistics mentioned above were gathered long before the omnipresence of hand-held devices.
Most people consider being nearsighted a relatively minor nuisance easily corrected with a pair of glasses. However, concerns heighten with mounting evidence that conventional single-vision lenses traditionally prescribed for myopia might be a driving factor:
“Eyeglasses typically used to correct nearsightedness cause light rays to lengthen so as to converge at the back/center area of the retina. But these lenses don’t take into account the interior oval shape of the eye, therefore, this same in-coming light isn’t landing properly on the peripheral parts of the retina. Responding to this, the eyeball keeps lengthening – making the myopia worse.”
LOSING SIGHT explores the whys and wherefores of this ‘silent’ epidemic that remains largely outside common public knowledge.
While science is still trying to figure out what exactly triggers eye to grow, other contributing factors are clearly evident: Genetics is definitely one component of myopia but, across the globe, it represents only a small fraction (10-14%) of the story.
“If you look in evolutionary terms at simple societies who are still living as we might have lived ten thousand years ago – there’s a tiny percentage of myopia so we can surmise that, in a natural environment, humans are not a genetically myopic race.”
Studies of groups of indigenous peoples who spend most of their daily lives outdoors (Inuits and Amazonians, inhabitants of rural Romanian villages, Pacific islanders) reveal that as soon as classroom education and other elements of modern society become the norm, the rates of myopia rise – sometimes as quickly as in one generation.
Consequently researchers are looking back to changes in environmental factors introduced during the last century of modern living: Societal stresses, time spent indoors versus outside, artificial lighting, etc.
Why should we care?
Once stretched, the myopic eye forever retains its elongated shape along with its physiological stress, provoking the onset of blinding diseases that sometimes wait 20-30 years before showing themselves. Because the optimal time to begin to control eye elongation is when myopia is first discovered in a young person’s eye, today’s goal is to slow down and/or halt this process as early as possible in a child’s life. Vision experts compute that employing means that slow myopia even by 1 diopter would reduce the likelihood of developing myopic maculopathy by 40%.
The World Health Organization has stated that small children should be forbidden from playing with electronic gadgets and other professionals assert that it would be better if parents didn’t press toddlers into learning to read before first grade.
After decades of this epidemic being ignored by major news media, studies published five years ago in Lancet finally caught the attention of the popular press with the suggestion that spending two-hours-per-day outdoors might provide an intriguingly simple solution: Sunshine, they said, was the answer.
“Today many believe that bright light can be preventative for childhood myopia but we must not forget that there’s a part of the blue spectrum that’s really harmful to retinal cells. It’s controversial because when we speak about blue light, it’s not just one blue. But different wavelengths have different impacts and we’re still trying to find out which ones hurt and which ones help.”
Others suggest that the benefit of time spent outdoors comes not just from the intensity of sunlight but also that the act of looking out at a distance, which protects the eye because the point-of-focus is constantly moving back and forth – from near to far. This is to say that when outside our eyes shift perspective – we look out into the open and view far away objects – as opposed to the close, fixed-distance concentration of near work.
“With new technologies, we’re able measure whether the images we see themselves and their distance from our eyes – indoors or outdoors – in urban environments or on the written page – actually do have differences in terms of how the image is made up, which can tell the eye to grow longer…
“The eye is responding to what it sees. So, we need to understand what’s exactly in the image that the eye is capturing which tells it whether to grow or not to grow. And to do that, we need to understand everything about that image.”
With modern urban environments so massively well-lit, there’s less sense of day fading into night and children’s waking hours are made even longer by increased use of light emitting electronics, which disrupt sleep as well as biological rhythms.
“It is now clear that many aspects of retinal physiology are under the influence of our internal circadian clocks.”
How daily rhythms and sleep cycles may be related to myopia in children has been the focus of over 50 years of research. Recent elegant and intriguing experiments demonstrate what happens inside our bodies when certain blue spectrums of artificial light are blocked during the hours before bedtime.
“Could these circadian disruptions in modern societies also be contributing to the increasing prevalence of myopia? … Now, this seems a plausible hypothesis.”
Today we’re approaching a nexus where Vision Science meets technical innovation: With advances in pharmaceuticals and lens design, inventive methodologies are now being applied to discoveries made by associates of Wallman Vision Lab nearly half-a-century ago. These breakthroughs are giving practitioners new and innovative remedies to help to stem-the-tide of an ever-growing global epidemic.
Although our principal narrators are scientists, our intent is not to style this as a typical ‘science’ film. In order to not overwhelm viewers with arcane words customarily used in scientific jargon, our conversations with experts are deliberately tailored to be easy, straightforward and accessible to a wide general audiences, young and old.
In this way, we take a cue from Peter Friedman and Jean-François Brunet’s entertaining, award-winning film, Death By Design (1995) wherein scientists explain the complexities of cellular behaviors in everyday language, never once uttering ‘Apoptosis’ – the scientific term central to the story. [https://www.youtube.com/watch?v=4NytzTLnyKM]
Visually, our aim is to increase public awareness of this ‘invisible’ vision crisis by creating a visceral sense of what it means to be optically challenged.
“I wish someone would make a film that really shows what it’s like when I first open my eyes in the morning all that’s there are blobs of light and color. My prescription is -13.0 diopters so, without my glasses, I don’t see much of anything at all…”
Although we all use common words to describe visual acuity, brightness and colors, human vision is very personal and highly subjective and therefore technically challenging to replicate on the screen.
Our eyes ‘accommodate’ in 3-dimensions – zooming in and out through a multitude of fields of focus – all the while constantly and rapidly ‘pulling focus’ – as we look at someone’s face, scan a room, or lift up from our phone so as not to bump into someone on the sidewalk.
Because this filmmaker herself copes with myopia induced diseases, she is working with a variety of optical and computer image-layering techniques to re-create what visual aberrations look like from one’s own unique point-of-view.
A Multi-Platform Documentary Project
With millions of young people unwittingly marching towards blindness, our objective is to reach as a wide general audience on multiple media platforms. To do this, our project educates as well as entertains with a strong visual and editorial line for a fully-integrated international distribution model: 1) A visually creative, feature-length documentary essay; 2) a factual 52-min version for TV and classroom screenings; 3) five short episodes (2-3 mins each) designed for children and adolescents and; responding to popular demand, 4) an audio book/podcast.
A Brewster Pond Production