Speaker:
Go for it. Okay, go for it.
Dr. King:
Oh, I’m adjusting my attitude.
Dr. Cha:
We need a masseuse that comes in here like once a month.
Speaker:
I know.
Dr. King:
Or a bartender. Hi. Welcome to Days of Our Eyes. I’m Dr. King.
Dr. Cha:
And I’m Dr. Cha.
Dr. King:
Today we’re gonna get back to basics. We’re gonna talk about hyperopia, myopia, presbyopia, all the opias. How’s that? All right. You know, as far as myopia and hyperopia and presbyopia, they all have nicknames. You know, nearsighted, farsighted, and 40 year old eyes.
Dr. Cha:
Mm-Hmm.
Dr. King:
Yeah. You’re politically correct.
Dr. Cha:
Dr. King:
What is it? What causes it? What can we do about it?
Dr. Cha:
Mm-Hmm
Dr. King:
Oh, by the way, he’s gonna tell you.
Dr. Cha:
Myopia. You might hear it when you, you know, you’re talking about like, maybe people have myopic perspectives or myopic viewpoints. Myopia is the more medical or scientific term for nearsightedness. So if you have a kind of a nearsighted perspective, you can’t see, you know, the far away, far away, you’re unable to see maybe the larger picture of what’s down the road, literally, too. So my myopes or people with myopia usually have a larger eyeball. So when we look at how refractive error or refractions in our eyes.
Dr. King:
Refracting means bending of light.
Dr. Cha:
Bending of light and how our our eyeball focuses images onto our eyes. People who have myopia can only really resolve or see things clearly when they’re close. Usually. It depends on how much myopia or how much nearsightedness you have. But it really comes down to anything past a certain distance. Out in the distance out far away things are blurry and hard to see. Usually it’s from the eyeball actually being a little bit too big. And that kind of goes into even another topic we’ve kind of teased before. Myopia control.
Dr. King:
Myopia control. Uhhuh,
Dr. King:
I always equate the eye to a camera. Okay. So your cornea is the front windshield of your eye that does 70% of the focusing for your eye, your lens inside your eye does around 30%. Now, there, somebody’s gonna say it’s 60 and 40, somebody’s gonna say 65, 35, okay, whatever.
Dr. Cha:
Mm-Hmm.
Dr. King:
Cornea does most, lens does a lot. And that focuses it back to the back of the eye called the retina. The retina’s, like the film and the camera, or the reception point, the front two parts have to focus the light right onto the retina. So when it focuses, it, it focuses the light in front of the retina. The other case could be maybe that cornea is extra curved. If you change the curvature of the cornea, you’re gonna change how fast the light comes to focus. Once again, it could end up in front of the retina. So I think that’s my analogy. So myopia is when the eye’s actually too strong or too long.
Dr. Cha:
Mm-Hmm.
Dr. King:
And the light focuses before it gets to its intended target. That’s why somebody with a myopic prescription, their glasses prescription or their contact lens prescription will be minus a minus one or a minus 1.25 or a minus four. We have to take power away to move that image back to the retina.
Dr. Cha:
That mean, so when you think of like a minus lens, you can even see it when people wear their glasses. If you think of, it’s like the opposite of magnifying glass, right? There’s too much power already into the eye. And so you’ll notice that literally the image that it’s presented to the eye is minified. It’s made smaller. So if you see a person with a high minus prescription, a lot of nearsightedness, literally their eyes kind of shrink behind it. Yeah. It actually motivates patients to get either special lenses, you know, they prefer their contact lenses or, you know, they want to explore different options like refractive surgery, like lasik, or even ICL inmplatable collamer lens
Dr. King:
Right? And people say, well, what causes it? Well, we don’t know a hundred percent, but we have found that in the digital age, since we’re, we’re, I, we’re all spending so much more time up close looking at screens, particularly, you know, students, we know that when, when babies are born, their visual system isn’t fully set up yet, that eye’s still growing a little bit, but thousands of a millimeter makes a difference. So that that visual system is still developing. Well, now we’re starting younger and younger ages looking up close. So there’s actually groundbreaking work being done by doctors all over the world is really phenomenal stuff. Stuff that I didn’t think we would be able to do about myopia management or myopia control. Trying to slow down the amount of myopia that develops in an eye.
Dr. Cha:
Mm-Hmm.
Dr. King:
Because what happens is later on in life, myopic eyes have a higher risk of certain diseases.
Dr. Cha:
Mm-Hmm.
Dr. King:
Such as retinal detachments or something called myopic degeneration. Most of us didn’t think we could do anything about that. But nowadays, if we can slow that down in childhood now we don’t have as nearsighted of an eye that’s gonna lower the risk of a lot of diseases. So that’s why we think it’s important to have an understanding about what myopia is, and maybe if we can manage it.
Dr. Cha:
So hyperopia, right?
Dr. King:
Mm-Hmm.
Dr. Cha:
It’s just, it’s just the opposite, I guess the inverse of myopia.
Dr. King:
Mm-Hmm.
Dr. Cha:
Myopia is nearsightedness, meaning that things up close are clear without really having to have some kind of correction whether glasses or contact lenses or surgery. And so, you know, another cool trick, if you’re nearsighted, you could take off whatever glasses that you have, and you could probably look at your phone pretty clearly
Dr. King:
Yeah. I don’t love the name farsightedness, because it, it in infer, or in infers…
Dr. Cha:
Implies?
Dr. King:
Implies. Thank you. Always mess up in infer and implies.
Dr. Cha:
The word.
Dr. King:
It implies that, well, you can see far away, but not close up, and that’s not the case.
Dr. Cha:
Mm-Hmm.
Dr. King:
Hyperopia, just like in myopia, the eyeballs too long, things focus in front of the retina. In hyperopia, the eyeball’s a little shorter, or the curvature of the cornea is a little flatter, and the image focuses behind the retina. Okay. So technically a hyperopic eye could see something all the way around the world behind it.
Dr. Cha:
Dr. King:
If you do the physics right, that’s all physics,
Dr. Cha:
The virtual image,
Dr. King:
Once again, go talk to the physics people for that.
Dr. Cha:
Dr. King:
But in hyperopia the eye, everything focuses it behind it. We have this cool little mechanism inside of our eye called our crystalline lens, and that lens is controlled by some muscles, and it’s flexible. So the lens can add some power to the eye to move that image up and put it right on the retina. So hyperopes in their younger years can still see everything. They might get some eye strain though, because when you’re focusing like that, when that accommodative mechanism, that’s what that lens focusing is called, is the accommodative mechanism. When that mechanism is on all the time, the eye is tensed up. It can cause fatigue headaches through here and here. A lot of the eye strain stuff that you hear about.
Dr. Cha:
Mm-Hmm.
Dr. King:
That’s why so many folks do a little reading power when they’re working on computers, because they could be just a little bit farsighted. And if you pick up that slack, it relaxes their eyes. So a hyper opes eyes are actually tensed up.
Dr. Cha:
Mm-Hmm.
Dr. King:
All the time.
Dr. Cha:
Mm-Hmm.
Dr. King:
That’s a bummer.
Dr. Cha:
Yeah. I mean, my, you were saying a myopic eye has too much power or is too strong. Mm-Hmm.
Dr. King:
Mm-Hmm.
Dr. Cha:
That’s the idea. Right. So it’s next to useless, so to speak, to correct nearsightedness because it already has too much power.
Dr. King:
That’s why a farsighted person’s prescription’s in plus
Dr. Cha:
Mm-Hmm.
Dr. King:
We have to add power. So they have a plus or a plus four mm-
Dr. Cha:
Hmm.
And you could tell like instead of it being minified, everything’s magnified.
Dr. King:
Mm-Hmm.
Dr. Cha:
Like those magnifying glasses or even coke bottle glasses kind of thing.
Dr. King:
Fish, fish bottle.
Dr. Cha:
There you go.
Dr. King:
Fish globe fish, what do you call it?
Dr. Cha:
Fish bowl.
Dr. King:
Fish bowl there. Oh my gosh.
Dr. Cha:
Dr. King:
We haven’t had lunch yet.
Dr. Cha:
There’s something called latent hyperopia.
Dr. King:
Mm-Hmm.
Dr. Cha:
Where patients or people will say, oh, I have 20/20 vision, I’m perfect.
Dr. King:
Mm-Hmm.
Dr. Cha:
I don’t, I don’t need glasses.
Dr. King:
You just might.
Dr. Cha:
Yeah.
Dr. King:
But…
Dr. Cha:
But a lot of times it’s actually what’s called latent hyperopia. Even, you know, it may be in a quick, you know, traditional eye exam. Oh, you don’t have any prescription. If you just kind of flash the lenses in front of the patient and what that, what that’s doing. Dr. King was talking about having your eyes tensed up. You know, you can, you can walk around, you know, tensed up and, you know, flex things in certain muscles, but then towards the end of the day, you’re gonna be tired. But also normal is, being tensed up all the time. So you don’t know what your normal, kind of relaxed state is. You don’t know if you’re compensating all the time. That’s why we always recommend getting a, a yearly or routine eye exam. Even though if you feel that you’re healthy, you’re seeing comfortably, they might be able, or we might be able to tease out something that you’ve been hiding or compensating your whole life. And maybe you’re kind of giving your, or you’re handicapping yourself by not, you know, exploring the possibility that yes, you’re still capable, you’re still healthy, but you might be able to function more comfortably and maybe even to another level with the right kind of correction in front of your eyes.
Dr. King:
I’ve seen that in students a lot.
Dr. Cha:
Mm-Hmm.
Dr. King:
You know, this, there can be students that are, you know, marked Yes. Not good at reading, learning disabled. They have certain stumbling blocks. Here they’re just struggling to focus. They’re working twice as hard to focus as the kids sitting next to ’em. Well, that puts ’em at a disadvantage. And sometimes we can even the playing field.
Dr. Cha:
Mm-Hmm.
Dr. King:
So one of the, one of the big ones is we, we kids can be farsighted and they can focus it out. They’re still gonna pass that screening that they do at school, but that’s not substituting an eye exam.
Dr. Cha:
Mm-Hmm.
Dr. King:
With a doctor to look for those circumstances that could impair learning. So hyperopes really do have a disadvantage when it comes to learning.
Dr. Cha:
Mm-Hmm.
Dr. King:
Whereas myopes are gonna say, I can’t see the board.
Dr. Cha:
Dr. King:
Mm-Hmm.
Dr. Cha:
You’re activating, you know, probably half a dozen other ones. Same with our eyes. When we flex those muscles to accommodate, it triggers all the other muscles and reflexes around our eyes. And that’s what causes the strain. It’s not just these small muscles inside the eye, but it’s activating everything else. And, you know, that amount of complexity just imagine goes into bending an arm. Another, another level of complexity is just to see clearly, especially for, you know, kids trying to learn at school. It’s always our privilege to be able to, you know, kind of tease out those problems and then present it to the parents. Especially like, hey, again, it’s not that your kid is, you know, less than, it’s just that they just need the right tools.
Dr. King:
Right.
Dr. Cha:
So that they can be enabled to fulfill their potential.
Dr. King:
Right.
Dr. Cha:
And we got number three.
Dr. King:
Speaking of the accommodative system.
Dr. Cha:
Oh right.
Dr. King:
That brings us to presbyopia right here. Presbyopia has to do with that accommodative system, that focusing system, the lens inside the eye. We always do this cuz for some reason I can’t talk about it without doing this.
Dr. Cha:
Dr. King:
Because the lens inside our eye naturally will change shape to adjust the focal distance. Because it’s a different, different strength to focus at 24 inches versus 16 versus 12 inches. It’s a different dioptric strength diopters are the units of measurement we use for vision. So the eye naturally adjusts. Well guess what? Nothing’s forever. The lens inside the eye continues to grow throughout our life. It adds layer upon layer like an onion. So it gets fatter and fatter. Well guess what? When I get fatter and fatter, I don’t move as well.
Dr. Cha:
Dr. King:
So if that lens gets fatter, it starts to stiffen up. It can’t focus as much when we’re 10 years old. We can focus right up to our nose by the time we’re twenties, it’s out here. Thirties, forties, that’s presbyopia. That mechanism is stiffening up. Now add hyperopia on top of that and you got a real mess.
Dr. Cha:
Mm-Hmm.
Dr. King:
Because you’ve been using this to see distance and up close. Now everything starts going.
Dr. Cha:
Mm-Hmm.
Dr. King:
So you see how everything works together. That’s, that’s what we’re getting at.
Dr. Cha:
Mm-Hmm.
Dr. King:
But presbyopia is a natural process.
Dr. Cha:
Mm-Hmm.
Dr. King:
And what we can do is use reading lenses, multifocals. There’s contact lenses that have that. We even have surgical procedures that we can put multifocal lenses in the eyes now.
Dr. Cha:
Mm-Hmm.
Dr. King:
It’s inevitable. You know, the definition of a good normal visual system is your focus for optical infinity. You can see far away. And then the accommodative system lets you adjust all the way into close up.
Dr. Cha:
Mature vision. I hear like certain cultures or languages have like a layman term for presbyopia. Cause I don’t think we really have like, like a synonym for presbyopia. We just have the medical term for it.
Dr. King:
Yeah. I don’t know why. You know, we have nearsighted farsighted, right. And 40 year old eyes.
Dr. Cha:
Yeah.
Dr. King:
I don’t know.
Dr. Cha:
It’s a little…
Dr. King:
And by the way, 40 isn’t the magic age. It can be anywhere 39 to 45. You know, there’s a range. It hits everybody at a different time.
Dr. Cha:
Mm-Hmm.
Dr. King:
But you’re right. We don’t have a term for that.
Dr. Cha:
Yeah. And you know, we should.
Dr. King:
Start that. Yeah. Let’s start mature vision.
Dr. Cha:
Mature vision. We should yeah. Put in a Merriam-Webster dictionary.
Dr. King:
Dr. Cha:
Be credited for it.
Dr. King:
We’re all doomed.
Dr. Cha:
Yeah. It’s not a disease, you know, it doesn’t mean you’re unhealthy, but just like gray hairs and wrinkles, you know, everybody eventually gets…
Dr. King:
Bite your tongue.
Dr. Cha:
Sorry.
Dr. King:
Sorry folks. I didn’t think we were gonna get into this controversial territory.
Dr. Cha:
Dr. King:
Gray hair, wrinkles and bifocals.
Dr. Cha:
Dr. King:
All right. You deal with those comments after this airs.
Dr. Cha:
It’s okay. I can deal with it.
Dr. King:
Drop your comments.
Dr. Cha:
And there is the one, you know, the one we don’t talk about because we don’t really treat it. There’s emmetropia Right.
Dr. King:
Oh Yeah.
Dr. Cha:
We got super lucky people that just have perfect vision.
Dr. King:
You are so perfect. Dang emmetropes.
Dr. Cha:
Yeah. You just have, you’re just a normal human being with emmetropia.
Dr. King:
That’s cuz we don’t have too many of those anymore.
Dr. Cha:
Yeah.
Dr. King:
The advent of the digital age.
Dr. Cha:
Mm-Hmm.
Dr. King:
Honestly, the one statistic is that as a population, the world is getting more nearsighted.
Dr. Cha:
Mm-Hmm.
Dr. King:
Because of the way we spend our time.
Dr. Cha:
Mm-Hmm.
Dr. King:
So that’s why we talk about so much of the other stuff.
Dr. Cha:
Mm-Hmm.
Dr. King:
Well there’s that.
Dr. Cha:
Dr. King:
Why don’t you close.
Dr. Cha:
Okay. I can close this. Yeah. Okay. Yeah.
Dr. King:
Take it away.
Dr. Cha:
Dr. King:
I’m Dr. King.
Dr. Cha:
Don’t forget to subscribe. Like. Comment. Flame us. We like that too.
Dr. King:
We do. Okay.