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Myopia: A Treatable Epidemic

December 30, 2019

 

Would it be OK with you if we made your life easier for less money?

We are in the middle of a myopia epidemic. One of 3 people in the world can’t see 20 feet in front of them or pass a drivers test without glasses. Most people don’t realize that when children are inside using smart phones rather than playing outside in the natural sunlight, nearsightedness worsens. The percentage is projected to increase to 50% of the world population by the year 2050. The other half of the population is farsighted, meaning they can see far away, but not up close, so you’ll see them at restaurants holding their menus out trying to figure out what to have for dinner. And 100% of people become presbyopic at about age 45, which makes reading glasses or bifocals necessary. So for those of you keeping score, 100% of people will need some sort of prosthetic device to see at some point in their lives. Isn’t it interesting that when someone can’t walk 20 feet, we offer them a solution such as a knee replacement, so that they don’t have to rely on prosthetics such as crutches and wheelchairs. But for people who can’t see 20 feet, we expect them to rely on prosthetics such as glasses and contacts for their entire lives!

For the first time in history we have the technology to fix something that affects such a large percentage of the world.

The old paradigm looks like this: glasses are first prescribed around age 7 to 10, on average. When kids are a little older, they can have contacts. They continue with these modalities until their 40s and 50s when the aging lens inside the eye requires them to use reading glasses or bifocals. They continue with those until their cataracts develop, and everyone gets cataracts if they live long enough. After cataract surgery, they still need bifocals. It has historically been considered acceptable for someone to be dependent on glasses nearly their entire lives.

It doesn’t have to continue this way. When myopia is first diagnosed, there are interventions that can slow and control its progression, such as the recenly approved bifocal contacts for children.

Lifestyle modifications such as decreased screen time and increased exposure to natural light may be beneficial.

So the new paradigm looks like this: when myopia is first diagnosed and glasses prescribed, ages 7 to 10, myopia control is started at the same time with bifocal,contacts to slow its progression. Once the eyes are done developing, in the late teens and early 20s, most are able to have a vision correction procedure. And because we slow down the progression, the treatment they need isn’t as significant. Vision correction can provide crisp clear vision until the aging lens needs to be replaced, typically in our 50s or older. after which, people can see far and near and never developed cataracts.

The individual benefits of vision correction are massive, and can be grouped into three categories: functional, safety, and financial.


Functional:

Athletes figured out the functional benefits years ago. Many top athletes such as Tiger Woods have had their vision corrected to improve their performance.

When first responders such as firefighters are in an emergency situation, the last thing they want to worry about is their vision. It’s a matter of life and death.

The same is true for the military. The US Armed Forces provide vision correction services for its active duty members, and it’s considered a major tactical advantage on the battlefield.

Safety:

The same groups have realized the safety benefits of the new paradigm compared to the old one. Consider that the lifetime risk of a contact lens associated infection increases by 10% per year of use. I mean, how many of us have slept in our contacts over the years? Compare that to the risk of infection from a vision correction procedure which is less than one in 10,000. There are risks that need to be considered and discussed, but they have to be compared to the alternatives. In the modern era the risk of vision loss from a contact lens associated infection exceeds that of a vision correction procedure.

Financial:

If a 20-year-old college student spends $950 per year (that’s the average in the United States) on glasses, contact lenses, and contact lens solutions, she or he will spend over $24,000 by the time they’re 45 years old.

Just on vision.

In contrast, if she has her vision fixed at age 20, she will save over $20,000 over the same time span. And have the safety and functional benefits for over 25 years.


So let’s take these numbers and think a little more broadly. In a city of 1 million people, roughly 330,000 suffer from myopia. If each of these people could save $15,000 by fixing their vision instead of paying the ongoing cost, the cumulative economic savings it’s over $5 billion. And that’s just for one midsized American city, and only for myopia. That’s not including the other 60% who can’t see the menu at the restaurant. If we take these numbers and apply them to the broader United States and beyond, the economic impact is staggering. And in an era of escalating healthcare cost, a solution that provides an improved quality of life and a savings for the individual and society, is simply too compelling to ignore. So let’s think even bigger, let’s think globally,. Of the worlds 7 1/2 billion, 6 billion live in the developing world. 75% of those age 18 to 45, the years of peak productivity do not have access to glasses or contacts. Lost production from this group, exceeds $250 billion every year. The psychological and social impact of not being able to contribute meaningfully to their community is perhaps even more significant. Glasses are a cheap solution, but they need to be maintained and replaced, which is difficult in the developing world. Contact lenses are an option but they require education, hygiene, close follow up. All of which are difficult. Imagine using vision correction to ease their burden, making them independent, productive members of their communities. Vision correction has been proven safe and effective for almost 30 years. It has the highest satisfaction rate of any procedure in the history of humanity.

So why are so many people stuck in the old paradigm, and what can we do to reframe the new one?

The answer is: it’s already happening. You see, we humans are not used to quick solutions that work, particularly when it comes to healthcare. We expect everything to be overly complicated, and expensive and ineffective. We fixate on the outliers, the people who didn’t have the experience they hoped to have. We say: “See, I told you it was too good to be true.” We ignore the overwhelmingly positive statistics, and the risk of contact lenses. We are also skeptical of things that are easy. I mean how often does someone of education and authority say to you, “would it be OK with you if we made your life easier for less money?” We assume such things don’t exist. But they do. For example, at the Tilganga Eye institute in Nepal, surgeons are being taught the most modern vision correction techniques in the world, and they treat tens of thousands of people each year. It’s just one small example of how we’re reducing a genetic defect on a mass scale. We are reframing the paradigm in a more effective and affordable way.

Glasses and contacts are a tried and true method of seeing clearly, and an excellent choice for many. But does anyone still think will be wearing glasses and contacts in the future? I mean look at the people on Star Trek: no one is wearing glasses. Historians are going to look back at our era and look back and marveled that we were willing to get up in the morning and put pieces of plastic in our eyes so we could function, when we could’ve had our problem fixed. Millennials in the United States have figured this out. 70% of them either are planning to have vision correction, or have already head it. Many of their parents had their eyes fixed years ago. So as the new paradigm replaces the old, vision correction becomes a right of passage. Similar to how braces are viewed by people who want straighter teeth. When the appropriate age is reached, the defect is corrected. When our knees prevent us from walking 20 feet, we get them fixed. When our eyes prevent us from seeing 20 feet, we get them fixed.


– Dr. Matthew Sharpe, MD