August 22, 2025 • 38 mins
In this episode of The Eye-Q Podcast, I speak with Dr. Rupa Wong about the essentials of pediatric eye health. We cover amblyopia (“lazy eye”), the myopia epidemic, and groundbreaking treatments like low-dose atropine drops, specialized contact lenses, and even VR headsets. We also dive into screen time rules every parent should know and why early diagnosis makes all the difference for lifelong vision.
Dr. Rupa Wong is a board-certified pediatric ophthalmologist, wife, mom to 3 kids, entrepreneur, and the managing partner of Honolulu Eye Clinic for the past 16 years. She has been featured on the Best Doctors Lists since 2010. She also serves as Clinical Associate Professor at the University of Hawaii School of Medicine. She is the co-founder of Pinnacle, an innovative medical education company. She is active on several committees of the American Academy of Ophthalmology and the American Association of Pediatric Ophthalmology & Strabismus. In addition, she serves on the Board of Directors of Make-A-Wish Hawaii and Big Brothers Big Sisters Hawaii.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
When we are thinking of a lazy eye, we're thinking of an eye
that doesn't see well, thinking of an amblyopia and a patient
thinking of strabismus. And so that's where the
confusion often get a lot of questions.
Why isn't surgery recommended for amblyopia?
There's no surgery to grow the nerves, grow the visual system.
What they mean is they're getting confused between
business and amblyopia. There definitely is your
(00:21):
business for misalignment of thycross.
In isotropia, the eye can wanderout.
Exotropia can even be verticallymisaligned.
There's definitely surgery for that.
But for amblyopia, the decreasedvision in the eye, there is not.
We've got to do either the patching, the eye drop, or one
of these virtual reality headsets.
Welcome to the IQ podcast. I'm Doctor Ronnie Bannock.
(00:44):
Here to help. You boost your IQ with powerful
insights that connect your eyes,your brain, and your whole body
Wellness. This episode was.
Recorded during the Eye Health Summit, where the world's
leading experts shared breakthrough insights in vision
and holistic eye care. I'm thrilled to invite Doctor
Rupa Wong to join us for this session.
(01:06):
Doctor Wong is a. Board certified pediatric.
Ophthalmologist based in beautiful Hawaii, Doctor Wong is
passionate about educating families.
On how to protect. And nurture children's vision,
ensuring that they thrive both in and out of the classroom.
Doctor Wong not only runs a successful ophthalmic practice
with her husband, who also has to be an ophthalmologist in
(01:28):
Honolulu, but she also shares her expertise widely on social
media. Reaching thousands of people.
Around the world with practical eye care tips and advice.
Thank you so much, Doctor Wong, for joining us.
Thanks so much for having me here today, Doctor Bannock.
Absolutely. So let's start from the
beginning. Why is it so important to think
(01:49):
about vision during this period of life, during childhood?
What goes on during these critical years?
This that's exactly what it is. It is a critical period for
children and mainly because their brains are still
developing and most people know that kids are learning, they're
growing, they're wreaking developmental milestones.
(02:10):
But your vision and your eyes asas a neuroophthalmologist is
just an extension of their brain.
So the plasticity extends to thevisual system as well.
So when we are talking about kids, we've got a very critical
period of about 13 years from birth to 13 years when their
brain and their visual system are still developing.
(02:32):
All of these things that we are doing, the environmental
lifestyle modifications, everything we do has a profound
impact on kids and that's why it's so important to start early
with some really great habits and to make sure that you're
doing the appropriate care that's requested by your eye
doctor. Yeah, I think what that point is
so important that you made aboutthis ten, this 13 year period,
(02:56):
right from birth to 13 years is really there's a window of
opportunity. And I think oftentimes,
unfortunately some kids, they their issues don't get picked up
during that time and it's very hard for us to try to improve
their vision back to what they could have had if they had been
diagnosed earlier. So Doctor Wang is a pediatric
ophthalmologist. What are some of the most common
(03:17):
vision concerns that parents come to you with?
What are some of the questions that they ask you?
There are so many questions and the most common things that we
see are needing glasses or having something called
amblyopia, which is when the vision is decreased in one or
both eyes, but it's not because of a functional reason or a
(03:38):
misalignment of the eyes. And then now really I'm getting
so many questions about near sightedness because that is a
growing trend unfortunately in kids in the US as well as across
the world. They predict by 20, fifty, 50%
of the global population is going to be near sighted.
So I'm getting a lot of questions about how to prevent
(03:59):
near sightedness in kids. Often times the parents
themselves are near sighted. They don't want that for their
children. And thankfully for the first
time, we've actually got answers.
We've got treatment strategies for them before we really
didn't. So those are the most common
questions that I get. I want to go back to the very
first condition that you mentioned, which is amblyopia.
(04:23):
Can you explain a little bit more about what this term means?
You mentioned that it doesn't have to do with something
functional. So what?
What is the cause of amblyopia? So a lot of people will call
amblyopia a lazy eye, and then there's often confusion between
what is amblyopia and what is strabismus.
So this is such an important distinction because the
(04:43):
treatments are really different.Amblyopia is when the vision
doesn't develop fully in one eyeand it has to go back to that
plasticity period of the brain. And there are a couple different
reasons to have this issue with the vision and one eye.
It can sometimes be bilateral, but more often than not it's in
one eye. So the first and the most common
(05:05):
reason is unequal glasses prescription between the two
eyes. So if one eye doesn't need any
glasses, sees perfect 20 / 20, and one eye is more near sign or
more farsighted or has astigmatism, what the brain does
is it shuts off the eye. It doesn't see, it doesn't like
the vision in that eye. And brains of children can do
(05:27):
that. Brains of adults cannot do that.
So it starts to shut off the vision connections between the
eye and the brain. So when you're actually looking
at the brain of those kinds of patients, we're noticing it's
not as much arborization, that'swhat we call it, just those
connections. Connections are not as robust.
So unequal glasses prescription is one reason, strabismus, it's
(05:50):
alignment of the eye when the eye is either wandering in or
wandering out because not utilizing the part of the eye
that's really required for excellent vision.
So that can cause the vision to decrease, doesn't necessarily
mean it has to. I have a lot of patients with
cross eyes that have perfect 20 / 20 vision in each eye.
(06:12):
Sometimes if it's one eye that'spreferentially crossed or
wandering out, that's going to cause the vision to decrease.
And then the third reason to getamblyopia is if there's
something depriving the eye of vision.
So if there's a cataract or a droopy lid or tumor that's
obstructing the light from entering the eye, and then I go
(06:33):
in and I fix the cataract or I fix the droopy eyelid, but the
vision doesn't recover. And that's because for so many
years, that part of the brain has not been received visual
input in the brain. Just shut that eye off.
Thankfully there are treatments for amblyopia and we can get
into those if you've got the time.
Yeah, absolutely. Let's talk about some of those
(06:55):
treatments. You mentioned one, which is if
there's something blocking vision that the treatment would
be to remove that blockage. What are some of the other
treatments that are out there? So the treatment would be to
remove the blockage, but that's just that's actually the easy
part. I always tell my patients,
parents, me doing cataract surgery on your child, that
might not sound easy, but that'sthe easy part because then the
(07:16):
hard part falls to the parents. And the treatments then are to
address that amblyopia because I've removed the obstruction,
but I haven't fixed the amblyopia.
That unfortunately is up to the parents.
So there's a couple different ways force the brain to use the
weaker seeing eye and the gold standard kind of that we've used
(07:36):
for many years, decades was a patch.
And it cannot be a pirate patch that you buy from the drug
store. It has to be a special either
sticky patch or patch that goes over the glasses so that it
completely blocks the light of the better seeing eye.
That's called patching treatment.
And usually eye doctors are going to recommend that you do
it anywhere from one to about 6 hours a day.
(07:59):
We don't need to do full time patching treatment anymore.
What that does is it penalizes the better seeing eye.
So you're not using the better eye and your brain is forced to
use the worst seeing eye and that actually improves the
vision. Of course, children don't like
that patch. Oftentimes I put a patch on and
I have perfect 2020 vision and it is hard to navigate.
(08:20):
But another treatment option is a dilating drop.
And So what that does is you putthat again in the better seeing
eye, it makes the pupil large, which is more of a side effect
because what we're really interested in is the paralysis
of the focusing muscles of the eye.
And that fits the child from reading up close in the better
(08:41):
seeing eye. So again, the brain's forced to
use the worst eye. The reason a lot of kids don't
love that drop is because it makes them really light
sensitive and it stays a long time.
So they've got difficulty in school.
So I don't usually use that as my first line of treatment
because it affects them for a full 24 hours, can't be titrated
(09:03):
the way a patch can. And then now it's really
exciting because we actually have virtual reality headsets
that are FDA approved to treat amblyopia.
One of those is called Luminopia.
It looks like almost like an Oculus headset.
This is something called dicoptic masking.
And what that does is it doesn'tcompletely block the vision in
(09:24):
the one eye, but it Grays out portions more on the better eye,
less on the worse eye. And so your brain's forced to
fuse and forced still to use worsening eyes.
We've seen a lot of success and the trials actually looked at
kids who had failed patching treatment and then done the
Luminopia. So that's it's a very.
(09:46):
Exciting. That is so.
Fascinating to use our technology to help solve this
age-old problem of how do we force the we're seeing eye to
improve. And so with these like for
example, the device you mentioned, Apache, you wear it
for a certain number of hours a day.
How is the device used? Is that used like the child
would be? Playing a video game you.
Wearing the device for a certainperiod of time during the day.
(10:09):
So they've got the headset on and it has 1000 hours of
programming that's already downloaded into the device.
When you connect to the Wi-Fi, then it knows because I have the
doctor has sent in the prescription for which eye needs
to be more occluded. They just watch TVI like this
because #1 It's a distance target and I'm sure we're going
(10:30):
to get near sightedness, but I'malways really conscious about up
close screens. I don't like them.
I want to minimize them. But it's a distance target like
TV or movies, so it's not going to induce sightedness.
And usually we do it about the FDA style studies looked at one
hour a day. Sometimes I'll recommend 2 hours
(10:51):
a day knowing they're going to get about one hour a day.
And the neat thing is as a doctor, I can log in and chart
my patients compliance. I can see 99% compliance.
They did all of the prescribed treatment that I recommended.
When I see them for follow up with a patch or an eye drop,
it's just really dependent on the parents telling me and
(11:12):
remembering and it's not as accurate.
So we've got a really nice measurement too, of how much the
child is actually doing the. Prescribed treatment for?
I'm really so fascinated by thisdevice.
What's the youngest age that thedevice is approved for?
It's approved for ages four to seven years old off label.
(11:32):
I use it, of course in older kids and they are currently
looking at the trials for older children as well.
Honestly, off label. I've also used it in adults
because we talked about that critical period right for.
So when I was in training 2025 years ago, we used to think, oh,
if you've got poor vision one eye and you didn't wear your
patch when you were young and you're our age, you're 48 now,
(11:55):
sorry, you can't do anything about that worse vision.
But interestingly, we are knowing, we're realizing now
that critical period, that plasticity, it still exists in
adults, it's harder, but you canstill make vision changes.
And in fact, I had a 43 year oldpatient that used this headset
and caught a line of improvementand better control of her
(12:18):
misalignment of her eye as well.So that's anecdotal.
It's not in a published study, but it's there's a lot of
benefit there. And I think there's a lot that
we're still discovering about the way that the brain works and
the plasticity of the visual system in children and.
Yeah, no, it's a really excitingtime in our field.
I wanted to clarify for our audience is use some terms,
(12:40):
embryopia, strabismus, that can oftentimes happen in children,
but a lot of people hear the term lazy eye and it's very
colloquial. I have lazy eye or so and so had
lazy eye as a child. What does that mean and how does
that relate to those other termsthat you used?
So it's interesting because I think it means different things
based on who you talk to, which is why most of us
(13:02):
ophthalmologists do not prefer to use that.
Plus it's got a pejorative senseto it.
Lazy, I don't love that term for, but I think a lot of times
when and a patient comes to me and says they have a lazy, what
they mean is an eye that's wandering the ophthalmologists,
when we are thinking of a lazy eye, we're thinking of an eye
that doesn't see well, thinking of amblyopia and a patient's
(13:23):
thinking of strabismus. And so that's where the
confusion often get a lot of questions.
Why isn't surgery recommended for amblyopia?
There's no surgery to grow the nerves, grow the visual system.
What they mean is they're getting confused between
business and amblyopia. There definitely is strabismus
for misalignment of thy cross. In isotropia, the eye can wander
out. Exotropia can even be vertically
(13:45):
misaligned. There's definitely surgery for
that. But for amblyopia, the decreased
vision in the eye, there is not.We've got to do either the
patching, the eye drop, or one of these virtual reality
headsets. Yeah, thank you for clarifying
that. I think these terms get
sometimes just tossed around loosely.
And it's really important when it comes to eye care to try to
use the correct terminology because different things can
(14:08):
need widely different causes anddifferent treatments.
So we really need to focus in onand choose the right words.
Thank you so much for all you'veshared.
I'm going to come back to some of those other things you
mentioned, but we're going to take a very short break and
we'll hear from one of our sponsors and we'll be right.
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(16:56):
So earlier, we were talking about the various concerns that
can arise in childhood, what that have to do with vision, and
Doctor Wong mentioned screens. Doctor Wong, I would love to
hear your take on this. I know you're a mom as well.
You're a mom of three. And I'm a mom too.
And I see my daughter on her on her phone all day long or on her
computer. What what do you tell your
patients? And also, what do you do in your
(17:17):
own home as a mother and an ophthalmologist?
What are your recommendations? This is something that
unfortunately we're facing now that really they had no place 20
years ago. And it's just this added layer
of parenting, unfortunately, because it can affect the visual
system of children, the neurologic, the brain
development, so many different aspects.
(17:40):
So I am a very big advocate of monitoring screen time.
And the reason is it's near work.
And what we mean by near work isanything you do up close.
Most of the time kids are using screens as devices, whether
phones or tablets, iPads, computers, laptops.
And when you are working at a very short distance, they have
(18:02):
shown in studies that amount of time can be linked to near
sightedness. Now, that's not the only way to
get nearsighted. There are a lot of other reasons
to get nearsighted. But if that is the one near work
that I can reduce because I still want my kids to read a
book, I still want them to do their homework, I'm going to
eliminate the recreational screen time.
(18:23):
And there are guidelines by the American Academy of Pediatrics
and the American Association of Pediatric Ophthalmology and
Store Business, both of which I belong to.
And they have very strict guidelines about when they
recommend screen time for children.
So for babies, the American Academy of Pediatrics says
absolutely no screen time under the age of 18 months.
(18:46):
My other association that pediatric ophthalmologists say
under the age of two years. So there's a little bit of
difference there. But overall, they say no screen
time except for video chatting, meaning FaceTime with the.
Grandparents or yes with. The grandparents, but no screen
time, even educational content and people don't like to hear
that. They love their Miss Rachel.
(19:07):
I get it, she's wonderful. She helps with language
development, but not under the age of 2.
And the reason that for the exception for the face timing
and the video chatting is because there is back and forth,
it's interactive from a neurologic perspective, there's
more for the child to interact with as opposed to just
passively consuming television. Now television is also screens
(19:30):
and thankfully that's a distanceobject, but still it's in the
screen time recommendations fromage 2 to 5.
Both organizations agree just one hour of screen time should
be the norm, so nothing more than that.
Even educational content, just one hour a day of screen time.
And then past the age of five, they recommend a screen time
(19:52):
agreement with your child. So I have one available.
I think you're going to be linking to it in show notes.
It's a free fillable resource for any parent.
I've done this with my three kids.
And the nice thing about a screen time agreement?
It's not just rules that you arehanding down to your children.
My kids are 1113 and 15. They don't take rules anymore.
They want to be a part of the discussion and it should be a
(20:15):
collaborative discussion. So in that agreement, we discuss
screen free areas in our house and screen free times as well.
So for us personally, absolutelyno screens in the bedroom.
So they are not allowed to have their phones, tablets in their
bedrooms. Sorry for the privacy sake, but
Nope. Because there is so much out
(20:35):
there. There is if they're connected to
online, There is a lot that I'm worried about.
Millions of other people. I'm not worried about my child
pushing things out, but I'm worried about what type of
information they're consuming. We also have a rule that no
screens at meals. So whether we're at a restaurant
here at the dining table at home, and that goes for parents
(20:57):
too. No screens on the table, no
phone on the table, They are notusing their Apple Watch.
That is a time to learn to converse and to talk about our
day and to bond. So that's a very important one.
And then they don't charge theirphones in their bedrooms
overnight. When the phones have to come out
and they're charged. We have a docking station over
(21:18):
in our mud room where everybody plugs in their phones and going
with that, screens have to stop one hour before bedtime.
Now, unfortunately, now that my my 7th grader and my 10th
grader, they are doing homework,unfortunately right up until
they go to bed. But for recreational screen use
and gaming, that all stops at least in power.
(21:39):
Because there have been studies that have shown the blue light
from screens can decrease melatonin production, which is
going to suppress the circadian rhythms and cause more
grogginess in kids, less good sleep quality.
And that's not what I want. So those are the recommendations
I make. Doctor Wong, I have to applaud
you because as a parent, I know how hard it is to enforce screen
(22:02):
time guidelines. And to hear that you've been
able to do it with three kids across various ages, it's really
amazing. So please, I would encourage
people to download that assessment or the agreement, the
screen agreement that Doctor Wong is offering and use it and
share it with your family. So.
Let's talk a little bit. About you mentioned earlier
(22:23):
another major issue in the world, which is myopia.
It's really big become not just an epidemic, A pandemic right
across the world, myopia numbersare skyrocketing.
And it happens during childhood or during the early years, even
up until early adulthood. So what are your thoughts?
First of all, what's happening? Why is this happening and what
are your thoughts? About it.
(22:44):
So this is the perfect storm of a lot of things, the rocks and
screens, right? I know in our house the minimum
age to get a phone is 13. That's just that's my house.
But each kid is different. So I think honestly, for my
daughter who's 11, she's probably going to get her phone
a little bit later. I worry a lot about the
psychological effects. Specifically for her.
(23:04):
She has a lot of fear of missingout.
I know she'll have some social anxiety with that so I'm
probably going to delay that forher.
Know that there were kids in herclass in 4th grade that had
phones. Kids are spending a lot more
time up close and again, it's the same as reading.
Nothing has been shown that screens phones are worse than
reading. But kids are on their phones
(23:26):
just like adults for more hours consecutively without breaks.
Then they are doing the reading and the homework.
So we're seeing a lot more near work.
We're seeing kids don't get outside as much.
I'm lucky I'm in Hawaii so my kids are outdoors all the time.
But there's been proven benefitsof outdoor time on decreasing
(23:47):
the risk of near sightedness andkids so.
I remember reading that there were some studies out of I think
Singapore and Taiwan, if not, ifI'm not mistaken, where so many
different hours a day. Yeah.
Yeah. Two hours a day outdoors reduce
their progression of myopia. Absolutely.
So that's the recommendation that studies were done in China,
(24:07):
Taiwan, Australia, Denmark, Israel, all different
ethnicities. They've even studied it in the
Eskimo population in Alaska because they've seen a rise in
near sightedness in the inner population up there and they
tracked it back to again near work last time outdoors.
So isn't that interesting? So we're seeing.
Those two things really make this perfect storm.
(24:30):
In places like Singapore, 80% kids are near sighted because
they're also doing a lot of tutoring, a lot of extra
studying outside. And it's really interesting
because in China, they have limited certain video games.
You can't do them at certain times of the day.
As a public health initiative. They took the school doors at
(24:54):
during recess. So kids are forced to go outside
and won't stay inside and study.So they're really taking it very
seriously because it's much worse in Asian countries and but
we're starting to see it here inthe US So I'm really excited to
see hopefully if we can start tomake some inroads in some public
health initiatives to address itas well.
It's so important, yeah. So let's say you have a child
(25:16):
who starts off maybe at the age of 7 or 8 having a little bit of
myopia, and you've been following them, and their myopia
keeps increasing every six months, every year.
Their power keeps going up. What are some options now for
myopia management in these kids?So it's, it's really amazing.
We've got a couple different options.
Some are FDA approved, some are not, but they've been around for
(25:39):
a while. So one of the first is low dose
atropine. Atropine is a dilating drop.
It dilates your pupil for about a week at a time.
But when they dilute it down, dilute the concentration.
Usually when you go to the pharmacy, you buy it for
atropine 1% they found in studies coming out of Singapore
and Taiwan. If you decrease that
(26:00):
concentration 0.01 or 0.02 or even 0.05%, you can help
decrease the progression of nearsightedness.
So what does that mean when every year when kids go into
their eye doctor, you probably notice the prescription gets
worse and worse. If you wear glasses, you
probably notice that about yourself when you were young,
(26:22):
and now we have a way to stabilize it.
Why do we care? It's not I don't care how thick
the glasses are. What I care is that the eye is
also elongating. That's what it means to be
nearsighted. The eye is longer than the
average. Each millimeter that the eye is
longer, you increase the risk ofvision threatening consequences
(26:43):
like retinal detachment, myopic maculopathy, cataracts,
glaucoma. That's what I'm trying to
prevent. I want to reduce the blindness
associated with near sightednessdown the road.
And we can do that with the eye drop.
It's just once a day nightly. And I actually recommend really
following kids and even if they look like they're about to
(27:04):
become near sighted. All three of my children are on
low dose atrophenic. None of them wears glasses yet,
but I was able to do some extra testing in the office and I saw
that all three of them were going to follow in my husband's
place. So I started them
prophylactically on low dose atropine and now studies have
actually shown that's that's effective as well.
The second type of treatment is a dual acting contact lens.
(27:26):
It's a daily disposable peripheral contact lens that has
different rings of power so thatit helps stabilize the near
sightedness. And this actually is FDA
approved in ages 8 to 12. So the brand name is called My
Site. It's made by a company called
Cooper Vision and it helps decrease the near sightedness.
(27:48):
It stabilizes it. So this is a really good option.
Sometimes I will use the first two in combination.
The atrophy unfortunately is notFDA approved for kids, but it's
found for 100 years. I found a journal article in the
Journal of Pediatrics from the 1930s that talked about seeing
near sightedness. It said atropine eye drop and
get outside. By the way, the atropine, I
(28:12):
wanted to go back to what you said in the very beginning of
our talk about when you were treating, treating amblyopia,
You said people could put drops in their child's eyes to treat
amblyopia. That's the same drop correct as
Atropine. That is.
It's the same, but it's the stronger.
Concentration. Percent which you can buy just
fill it at your local drug store.
(28:33):
This type of low dose atropine has to be for now specially made
in a compounding pharmacies verydifferent usually has to be
refrigerated. It has to be tossed after one to
three months. So it's a different type of eye
drop. So there's actually a pharmacist
make your solution of low dose atropine.
There's also glasses that are available outside of the United
(28:55):
States and Canada and Europe andin Asia, two different types of
glasses that are different than the regular glasses that we all
wear. It's not just the single vision
glasses that traditionally are given to children because they
found that actually might worsenthe near sightedness.
These special glasses have a honeycomb type pattern.
You can't notice them. But again, what it does is it
(29:16):
really projects the image properly on the curved retina,
whereas a regular single vision pair of glasses projects the
image on a straight line. In a straight path, your eyeball
is curved. So that's a factor that might
make the eyeball grow even more and might make you more near
sighted. So those glasses are available
outside of the US? Some.
(29:37):
Things that may be available. In the US, at some point, do you
think that they. Are currently trying to do
trials. The problem is going to be at
least five years. OK, got it.
Where we. See them, you can get the off
brand version. I have a manufacturer that will
make it same type of lens as oneof the branded versions, but you
(29:58):
cannot get in the US at least one of the branded versions.
So you have to go to Canada or go to Europe to get them.
But also the data looks really good on those specific types of
glasses for again, slowing nearsightness.
So I think treatment for someonethat's nearsighted could be just
one of those three. It could be a combination if
there's a strong family, the history of retinal detachments.
(30:19):
It might be a high myopia means anything above -6 because that
carries with it those added risks that I talked about before
of retinal detachments and myopic maculopathy.
Got it. I wanted to ask.
You about another treatment thatI sometimes hear about for
myopia which is ortho keratology.
What are your thoughts about that and what is the evidence
show? So ortho keratology is a hard
(30:43):
contact lens that you sleep in. What they found was this was a
contact lens and it's you. It basically shapes the cornea.
It mushes the front part of youreye while your sleep.
Flattens it down a little bit. And adults then in the morning,
so initially this was for adults, would remove the contact
lens and their near sightedness would be temporarily cured.
(31:05):
They wouldn't need glasses or contact lenses during the day to
see and they would keep putting this contact lens in at night.
And then what they found was that in the younger patients it
seemed to slow the progression of near as well.
I the data does show that it is a good method of treatment.
However, most pediatric ophthalmologist, we don't love
(31:26):
it because we don't like tellinganyone to sleep in a contact
lens has increased the risk of infection up to 8 times.
And my corneal colleagues like my husband will sometimes see
these corneal opacities not necessarily vision affecting,
but they will see them in kids that are wearing ortho
keratology. I think if you're doing ortho
(31:47):
keratology under the care of an optometrist who is really on top
of things, I will. There's somebody in our
community and he's fantastic. He is really educating the
parents as to what to look out for.
If there is an infection, they get in to see him right away.
The parents are really a part ofthat kind of just ensuring that
(32:08):
something terrible is not occurring in a child.
There are a lot of stories, unfortunately, in the
ophthalmology community of terrible infections, even one at
Stanford where they were admitted to the ICU because of
these awful bilateral infections.
So once you see that and there are other options available,
that's why usually as an ophthalmologist, I don't
(32:28):
prescribe it personally and I don't really talk about it all
that much. But if you look at the data does
show that it works and that the risk of infection was about 1.7%
if I'm not mistaken. So not terrible.
But there's a risk nevertheless.There's a risk and with the eye
drops, there's really very minimal risk of infection that
my site contact lens is a daily disposable, meaning you're
(32:50):
throwing it away at the end of the day, which is always the
healthiest for the eyes. It's always what I recommend for
my tween and teen patients is I like that, that kind of a
contact lens. So, but it isn't.
Also with Ortho K, it's like theequivalent is having to wear a
retainer at night, right? You have to wear the retainer
during the night and then you take it off.
But if you stop wearing yet, your teeth are going to go back
(33:10):
to whatever they were at before the shape, the formation that
they were at before. So the same holds true for the
cornea, right? If you stop wearing your Ortho K
contact lenses, your cornea willrevert back to the shape that it
had before. Absolutely, Absolutely.
Yeah, Doctor Wong, we are nearing the end of our talk and
it's just been such a pleasure learning so much from you.
I'm going to definitely be looking up some of these newer
(33:33):
treatments that you've describedfor kids eye health.
But I one other very common question that parents have is
how often do I need to take my child to the eye doctor?
When should they get their firstexam?
And then after that first exam, how often should they be seen?
So can you give us some guidanceon that?
So our Association of Pediatric ophthalmology, we really partner
(33:54):
and rely on the pediatricians tobe the medical home.
Since we're both physicians, we want you first to go to your
pediatrician. If you have concerns about your
child's eyes, they should be doing a vision screening in the
office. Now, if there is a family
history of eye crossing, if there's a family history of near
sightedness, absolutely make that appointment when you desire
(34:17):
with your pediatric ophthalmologist.
But the American Association of Peed's ophthalmology and
Business, we do not recommend routine comprehensive eye exams
for children. And the reason is when you come
in, we have to put those dilating drops in kids eyes.
Those drops takes 30 minutes. They are not.
They can be a traumatic event, especially for younger kids.
And a lot of the times everything is normal.
(34:40):
There's not much that we need tobe concerned about.
So we don't want to overburden the system.
A lot of pediatric ophthalmologists in the country,
there are a lot of optometrists there.
There they will differ in what they say, but from a pediatric
ophthalmology perspective, we really think that only come in
when you are concerned about something specific.
(35:00):
If there's a family history, if there's a personal history,
absolutely bring them in at any time.
I examine babies in the neonatalintensive care unit, so there's
no age that's too young to be examined by us in the eye
clinic. Absolutely not.
There should be a reason. There should be a.
Reason. There should be a reason now
again, a sibling with near sightedness at the age of three,
(35:23):
I will tell the parents, yes, bring in your other kids maybe
even earlier than that age. Then I can just pick up on it as
fast as can. But if you're worried too that
the pediatrician is not doing a proper job of screening the
vision. Obviously we want to make sure
that kids are getting picked up that vision issues that we
talked about amblyopia or classes that they're getting
(35:44):
discovered early enough where wecan make a difference.
But there are no guidelines thatsay you need to come in by X
amount of months or years. That's not usually the
recommendation. Well, thank you for clarifying
that because I know that's a concern a lot of parents have.
And yes, they get their kids eyes tested at the
pediatrician's office or perhapsin school.
They have eye screenings. But really, if you see that your
(36:07):
child's having some kind of issue, they're squinting,
they're rubbing their eyes a lot, there's indication that
they're bumping into things, Definitely get it checked out.
Again, Thank you, Doctor Juan, for this, Juan, for this
enlightening conversation. I'm sure that our audience has
learned so much from you. I just wanted to close with is
there any one particular myth orsome misconception people have
(36:29):
about kids eyes that you would love to clarify and clear up?
I think sometimes people think that when they see a child with
cross eyes that kids are going to outgrow it, that babies will
outgrow it. And that's a myth.
There's one very specific subtype of eye crossing that
gets better with age, but we're talking middle school age.
(36:52):
But it's something you absolutely want to see.
A pediatric ophthalmologist. Oftentimes we might need to give
glasses, but sometimes we need to go straight to surgery if
there's no need for glasses. So that myth that a baby will
outgrow their cross eyes. If the baby has cross eyes past
the age of 6 months then you really need to get that checked
out. That was such an important
(37:14):
point. Absolutely.
Again, thank you so much, DoctorWong, for sharing your wealth of
information. If anyone in our audience wanted
to learn more from you, use, maybe access some of your
resources, or perhaps even if they're in Hawaii, become a
patient. How can they find you?
So I am kind of everywhere out at the same name.
Doctor Rupa wong.com is my personal website.
(37:36):
Honolulu Eye Clinic is where I practice, which has our practice
website, but I'm on Instagram and TikTok and YouTube under
Doctor Rupa Wong. Facebook, for some reason that
name was taken. So I had to go with Rupa Wong,
MD. You can find me there and I'm
also on LinkedIn. So on all the places for I
health education, I have a bunchof freebies for parents about
(38:00):
how we do screen time in our homes.
Other things for just eye healthall along my personal website,
doctorrupawong.com. Wonderful.
And we will share all of those links in the notes below.
And I encourage all of you to follow Doctor Wong and her
social media platform. She is again a wealth of
information and she makes it very entertaining too, so it's a
joy to watch. Thank you all for tuning in and
(38:23):
I will see you during our next session together.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new
to help you boost your IQ. Leave us a review and.
Share the podcast with your. Family and friends stay
connected with me for more. Eye.
Opening insights on ihealth, nutrition and lifestyle.
(38:46):
Until next time, keep your vision clear and your IQ sharp.
When we are thinking of a lazy eye, we're thinking of an eye
that doesn't see well, thinking of an amblyopia and a patient
thinking of strabismus. And so that's where the
confusion often get a lot of questions.
Why isn't surgery recommended for amblyopia?
There's no surgery to grow the nerves, grow the visual system.
What they mean is they're getting confused between
business and amblyopia. There definitely is your
(00:21):
business for misalignment of thycross.
In isotropia, the eye can wanderout.
Exotropia can even be verticallymisaligned.
There's definitely surgery for that.
But for amblyopia, the decreasedvision in the eye, there is not.
We've got to do either the patching, the eye drop, or one
of these virtual reality headsets.
Welcome to the IQ podcast. I'm Doctor Ronnie Bannock.
(00:44):
Here to help. You boost your IQ with powerful
insights that connect your eyes,your brain, and your whole body
Wellness. This episode was.
Recorded during the Eye Health Summit, where the world's
leading experts shared breakthrough insights in vision
and holistic eye care. I'm thrilled to invite Doctor
Rupa Wong to join us for this session.
(01:06):
Doctor Wong is a. Board certified pediatric.
Ophthalmologist based in beautiful Hawaii, Doctor Wong is
passionate about educating families.
On how to protect. And nurture children's vision,
ensuring that they thrive both in and out of the classroom.
Doctor Wong not only runs a successful ophthalmic practice
with her husband, who also has to be an ophthalmologist in
(01:28):
Honolulu, but she also shares her expertise widely on social
media. Reaching thousands of people.
Around the world with practical eye care tips and advice.
Thank you so much, Doctor Wong, for joining us.
Thanks so much for having me here today, Doctor Bannock.
Absolutely. So let's start from the
beginning. Why is it so important to think
(01:49):
about vision during this period of life, during childhood?
What goes on during these critical years?
This that's exactly what it is. It is a critical period for
children and mainly because their brains are still
developing and most people know that kids are learning, they're
growing, they're wreaking developmental milestones.
(02:10):
But your vision and your eyes asas a neuroophthalmologist is
just an extension of their brain.
So the plasticity extends to thevisual system as well.
So when we are talking about kids, we've got a very critical
period of about 13 years from birth to 13 years when their
brain and their visual system are still developing.
(02:32):
All of these things that we are doing, the environmental
lifestyle modifications, everything we do has a profound
impact on kids and that's why it's so important to start early
with some really great habits and to make sure that you're
doing the appropriate care that's requested by your eye
doctor. Yeah, I think what that point is
so important that you made aboutthis ten, this 13 year period,
(02:56):
right from birth to 13 years is really there's a window of
opportunity. And I think oftentimes,
unfortunately some kids, they their issues don't get picked up
during that time and it's very hard for us to try to improve
their vision back to what they could have had if they had been
diagnosed earlier. So Doctor Wang is a pediatric
ophthalmologist. What are some of the most common
(03:17):
vision concerns that parents come to you with?
What are some of the questions that they ask you?
There are so many questions and the most common things that we
see are needing glasses or having something called
amblyopia, which is when the vision is decreased in one or
both eyes, but it's not because of a functional reason or a
(03:38):
misalignment of the eyes. And then now really I'm getting
so many questions about near sightedness because that is a
growing trend unfortunately in kids in the US as well as across
the world. They predict by 20, fifty, 50%
of the global population is going to be near sighted.
So I'm getting a lot of questions about how to prevent
(03:59):
near sightedness in kids. Often times the parents
themselves are near sighted. They don't want that for their
children. And thankfully for the first
time, we've actually got answers.
We've got treatment strategies for them before we really
didn't. So those are the most common
questions that I get. I want to go back to the very
first condition that you mentioned, which is amblyopia.
(04:23):
Can you explain a little bit more about what this term means?
You mentioned that it doesn't have to do with something
functional. So what?
What is the cause of amblyopia? So a lot of people will call
amblyopia a lazy eye, and then there's often confusion between
what is amblyopia and what is strabismus.
So this is such an important distinction because the
(04:43):
treatments are really different.Amblyopia is when the vision
doesn't develop fully in one eyeand it has to go back to that
plasticity period of the brain. And there are a couple different
reasons to have this issue with the vision and one eye.
It can sometimes be bilateral, but more often than not it's in
one eye. So the first and the most common
(05:05):
reason is unequal glasses prescription between the two
eyes. So if one eye doesn't need any
glasses, sees perfect 20 / 20, and one eye is more near sign or
more farsighted or has astigmatism, what the brain does
is it shuts off the eye. It doesn't see, it doesn't like
the vision in that eye. And brains of children can do
(05:27):
that. Brains of adults cannot do that.
So it starts to shut off the vision connections between the
eye and the brain. So when you're actually looking
at the brain of those kinds of patients, we're noticing it's
not as much arborization, that'swhat we call it, just those
connections. Connections are not as robust.
So unequal glasses prescription is one reason, strabismus, it's
(05:50):
alignment of the eye when the eye is either wandering in or
wandering out because not utilizing the part of the eye
that's really required for excellent vision.
So that can cause the vision to decrease, doesn't necessarily
mean it has to. I have a lot of patients with
cross eyes that have perfect 20 / 20 vision in each eye.
(06:12):
Sometimes if it's one eye that'spreferentially crossed or
wandering out, that's going to cause the vision to decrease.
And then the third reason to getamblyopia is if there's
something depriving the eye of vision.
So if there's a cataract or a droopy lid or tumor that's
obstructing the light from entering the eye, and then I go
(06:33):
in and I fix the cataract or I fix the droopy eyelid, but the
vision doesn't recover. And that's because for so many
years, that part of the brain has not been received visual
input in the brain. Just shut that eye off.
Thankfully there are treatments for amblyopia and we can get
into those if you've got the time.
Yeah, absolutely. Let's talk about some of those
(06:55):
treatments. You mentioned one, which is if
there's something blocking vision that the treatment would
be to remove that blockage. What are some of the other
treatments that are out there? So the treatment would be to
remove the blockage, but that's just that's actually the easy
part. I always tell my patients,
parents, me doing cataract surgery on your child, that
might not sound easy, but that'sthe easy part because then the
(07:16):
hard part falls to the parents. And the treatments then are to
address that amblyopia because I've removed the obstruction,
but I haven't fixed the amblyopia.
That unfortunately is up to the parents.
So there's a couple different ways force the brain to use the
weaker seeing eye and the gold standard kind of that we've used
(07:36):
for many years, decades was a patch.
And it cannot be a pirate patch that you buy from the drug
store. It has to be a special either
sticky patch or patch that goes over the glasses so that it
completely blocks the light of the better seeing eye.
That's called patching treatment.
And usually eye doctors are going to recommend that you do
it anywhere from one to about 6 hours a day.
(07:59):
We don't need to do full time patching treatment anymore.
What that does is it penalizes the better seeing eye.
So you're not using the better eye and your brain is forced to
use the worst seeing eye and that actually improves the
vision. Of course, children don't like
that patch. Oftentimes I put a patch on and
I have perfect 2020 vision and it is hard to navigate.
(08:20):
But another treatment option is a dilating drop.
And So what that does is you putthat again in the better seeing
eye, it makes the pupil large, which is more of a side effect
because what we're really interested in is the paralysis
of the focusing muscles of the eye.
And that fits the child from reading up close in the better
(08:41):
seeing eye. So again, the brain's forced to
use the worst eye. The reason a lot of kids don't
love that drop is because it makes them really light
sensitive and it stays a long time.
So they've got difficulty in school.
So I don't usually use that as my first line of treatment
because it affects them for a full 24 hours, can't be titrated
(09:03):
the way a patch can. And then now it's really
exciting because we actually have virtual reality headsets
that are FDA approved to treat amblyopia.
One of those is called Luminopia.
It looks like almost like an Oculus headset.
This is something called dicoptic masking.
And what that does is it doesn'tcompletely block the vision in
(09:24):
the one eye, but it Grays out portions more on the better eye,
less on the worse eye. And so your brain's forced to
fuse and forced still to use worsening eyes.
We've seen a lot of success and the trials actually looked at
kids who had failed patching treatment and then done the
Luminopia. So that's it's a very.
(09:46):
Exciting. That is so.
Fascinating to use our technology to help solve this
age-old problem of how do we force the we're seeing eye to
improve. And so with these like for
example, the device you mentioned, Apache, you wear it
for a certain number of hours a day.
How is the device used? Is that used like the child
would be? Playing a video game you.
Wearing the device for a certainperiod of time during the day.
(10:09):
So they've got the headset on and it has 1000 hours of
programming that's already downloaded into the device.
When you connect to the Wi-Fi, then it knows because I have the
doctor has sent in the prescription for which eye needs
to be more occluded. They just watch TVI like this
because #1 It's a distance target and I'm sure we're going
(10:30):
to get near sightedness, but I'malways really conscious about up
close screens. I don't like them.
I want to minimize them. But it's a distance target like
TV or movies, so it's not going to induce sightedness.
And usually we do it about the FDA style studies looked at one
hour a day. Sometimes I'll recommend 2 hours
(10:51):
a day knowing they're going to get about one hour a day.
And the neat thing is as a doctor, I can log in and chart
my patients compliance. I can see 99% compliance.
They did all of the prescribed treatment that I recommended.
When I see them for follow up with a patch or an eye drop,
it's just really dependent on the parents telling me and
(11:12):
remembering and it's not as accurate.
So we've got a really nice measurement too, of how much the
child is actually doing the. Prescribed treatment for?
I'm really so fascinated by thisdevice.
What's the youngest age that thedevice is approved for?
It's approved for ages four to seven years old off label.
(11:32):
I use it, of course in older kids and they are currently
looking at the trials for older children as well.
Honestly, off label. I've also used it in adults
because we talked about that critical period right for.
So when I was in training 2025 years ago, we used to think, oh,
if you've got poor vision one eye and you didn't wear your
patch when you were young and you're our age, you're 48 now,
(11:55):
sorry, you can't do anything about that worse vision.
But interestingly, we are knowing, we're realizing now
that critical period, that plasticity, it still exists in
adults, it's harder, but you canstill make vision changes.
And in fact, I had a 43 year oldpatient that used this headset
and caught a line of improvementand better control of her
(12:18):
misalignment of her eye as well.So that's anecdotal.
It's not in a published study, but it's there's a lot of
benefit there. And I think there's a lot that
we're still discovering about the way that the brain works and
the plasticity of the visual system in children and.
Yeah, no, it's a really excitingtime in our field.
I wanted to clarify for our audience is use some terms,
(12:40):
embryopia, strabismus, that can oftentimes happen in children,
but a lot of people hear the term lazy eye and it's very
colloquial. I have lazy eye or so and so had
lazy eye as a child. What does that mean and how does
that relate to those other termsthat you used?
So it's interesting because I think it means different things
based on who you talk to, which is why most of us
(13:02):
ophthalmologists do not prefer to use that.
Plus it's got a pejorative senseto it.
Lazy, I don't love that term for, but I think a lot of times
when and a patient comes to me and says they have a lazy, what
they mean is an eye that's wandering the ophthalmologists,
when we are thinking of a lazy eye, we're thinking of an eye
that doesn't see well, thinking of amblyopia and a patient's
(13:23):
thinking of strabismus. And so that's where the
confusion often get a lot of questions.
Why isn't surgery recommended for amblyopia?
There's no surgery to grow the nerves, grow the visual system.
What they mean is they're getting confused between
business and amblyopia. There definitely is strabismus
for misalignment of thy cross. In isotropia, the eye can wander
out. Exotropia can even be vertically
(13:45):
misaligned. There's definitely surgery for
that. But for amblyopia, the decreased
vision in the eye, there is not.We've got to do either the
patching, the eye drop, or one of these virtual reality
headsets. Yeah, thank you for clarifying
that. I think these terms get
sometimes just tossed around loosely.
And it's really important when it comes to eye care to try to
use the correct terminology because different things can
(14:08):
need widely different causes anddifferent treatments.
So we really need to focus in onand choose the right words.
Thank you so much for all you'veshared.
I'm going to come back to some of those other things you
mentioned, but we're going to take a very short break and
we'll hear from one of our sponsors and we'll be right.
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(16:56):
So earlier, we were talking about the various concerns that
can arise in childhood, what that have to do with vision, and
Doctor Wong mentioned screens. Doctor Wong, I would love to
hear your take on this. I know you're a mom as well.
You're a mom of three. And I'm a mom too.
And I see my daughter on her on her phone all day long or on her
computer. What what do you tell your
patients? And also, what do you do in your
(17:17):
own home as a mother and an ophthalmologist?
What are your recommendations? This is something that
unfortunately we're facing now that really they had no place 20
years ago. And it's just this added layer
of parenting, unfortunately, because it can affect the visual
system of children, the neurologic, the brain
development, so many different aspects.
(17:40):
So I am a very big advocate of monitoring screen time.
And the reason is it's near work.
And what we mean by near work isanything you do up close.
Most of the time kids are using screens as devices, whether
phones or tablets, iPads, computers, laptops.
And when you are working at a very short distance, they have
(18:02):
shown in studies that amount of time can be linked to near
sightedness. Now, that's not the only way to
get nearsighted. There are a lot of other reasons
to get nearsighted. But if that is the one near work
that I can reduce because I still want my kids to read a
book, I still want them to do their homework, I'm going to
eliminate the recreational screen time.
(18:23):
And there are guidelines by the American Academy of Pediatrics
and the American Association of Pediatric Ophthalmology and
Store Business, both of which I belong to.
And they have very strict guidelines about when they
recommend screen time for children.
So for babies, the American Academy of Pediatrics says
absolutely no screen time under the age of 18 months.
(18:46):
My other association that pediatric ophthalmologists say
under the age of two years. So there's a little bit of
difference there. But overall, they say no screen
time except for video chatting, meaning FaceTime with the.
Grandparents or yes with. The grandparents, but no screen
time, even educational content and people don't like to hear
that. They love their Miss Rachel.
(19:07):
I get it, she's wonderful. She helps with language
development, but not under the age of 2.
And the reason that for the exception for the face timing
and the video chatting is because there is back and forth,
it's interactive from a neurologic perspective, there's
more for the child to interact with as opposed to just
passively consuming television. Now television is also screens
(19:30):
and thankfully that's a distanceobject, but still it's in the
screen time recommendations fromage 2 to 5.
Both organizations agree just one hour of screen time should
be the norm, so nothing more than that.
Even educational content, just one hour a day of screen time.
And then past the age of five, they recommend a screen time
(19:52):
agreement with your child. So I have one available.
I think you're going to be linking to it in show notes.
It's a free fillable resource for any parent.
I've done this with my three kids.
And the nice thing about a screen time agreement?
It's not just rules that you arehanding down to your children.
My kids are 1113 and 15. They don't take rules anymore.
They want to be a part of the discussion and it should be a
(20:15):
collaborative discussion. So in that agreement, we discuss
screen free areas in our house and screen free times as well.
So for us personally, absolutelyno screens in the bedroom.
So they are not allowed to have their phones, tablets in their
bedrooms. Sorry for the privacy sake, but
Nope. Because there is so much out
(20:35):
there. There is if they're connected to
online, There is a lot that I'm worried about.
Millions of other people. I'm not worried about my child
pushing things out, but I'm worried about what type of
information they're consuming. We also have a rule that no
screens at meals. So whether we're at a restaurant
here at the dining table at home, and that goes for parents
(20:57):
too. No screens on the table, no
phone on the table, They are notusing their Apple Watch.
That is a time to learn to converse and to talk about our
day and to bond. So that's a very important one.
And then they don't charge theirphones in their bedrooms
overnight. When the phones have to come out
and they're charged. We have a docking station over
(21:18):
in our mud room where everybody plugs in their phones and going
with that, screens have to stop one hour before bedtime.
Now, unfortunately, now that my my 7th grader and my 10th
grader, they are doing homework,unfortunately right up until
they go to bed. But for recreational screen use
and gaming, that all stops at least in power.
(21:39):
Because there have been studies that have shown the blue light
from screens can decrease melatonin production, which is
going to suppress the circadian rhythms and cause more
grogginess in kids, less good sleep quality.
And that's not what I want. So those are the recommendations
I make. Doctor Wong, I have to applaud
you because as a parent, I know how hard it is to enforce screen
(22:02):
time guidelines. And to hear that you've been
able to do it with three kids across various ages, it's really
amazing. So please, I would encourage
people to download that assessment or the agreement, the
screen agreement that Doctor Wong is offering and use it and
share it with your family. So.
Let's talk a little bit. About you mentioned earlier
(22:23):
another major issue in the world, which is myopia.
It's really big become not just an epidemic, A pandemic right
across the world, myopia numbersare skyrocketing.
And it happens during childhood or during the early years, even
up until early adulthood. So what are your thoughts?
First of all, what's happening? Why is this happening and what
are your thoughts? About it.
(22:44):
So this is the perfect storm of a lot of things, the rocks and
screens, right? I know in our house the minimum
age to get a phone is 13. That's just that's my house.
But each kid is different. So I think honestly, for my
daughter who's 11, she's probably going to get her phone
a little bit later. I worry a lot about the
psychological effects. Specifically for her.
(23:04):
She has a lot of fear of missingout.
I know she'll have some social anxiety with that so I'm
probably going to delay that forher.
Know that there were kids in herclass in 4th grade that had
phones. Kids are spending a lot more
time up close and again, it's the same as reading.
Nothing has been shown that screens phones are worse than
reading. But kids are on their phones
(23:26):
just like adults for more hours consecutively without breaks.
Then they are doing the reading and the homework.
So we're seeing a lot more near work.
We're seeing kids don't get outside as much.
I'm lucky I'm in Hawaii so my kids are outdoors all the time.
But there's been proven benefitsof outdoor time on decreasing
(23:47):
the risk of near sightedness andkids so.
I remember reading that there were some studies out of I think
Singapore and Taiwan, if not, ifI'm not mistaken, where so many
different hours a day. Yeah.
Yeah. Two hours a day outdoors reduce
their progression of myopia. Absolutely.
So that's the recommendation that studies were done in China,
(24:07):
Taiwan, Australia, Denmark, Israel, all different
ethnicities. They've even studied it in the
Eskimo population in Alaska because they've seen a rise in
near sightedness in the inner population up there and they
tracked it back to again near work last time outdoors.
So isn't that interesting? So we're seeing.
Those two things really make this perfect storm.
(24:30):
In places like Singapore, 80% kids are near sighted because
they're also doing a lot of tutoring, a lot of extra
studying outside. And it's really interesting
because in China, they have limited certain video games.
You can't do them at certain times of the day.
As a public health initiative. They took the school doors at
(24:54):
during recess. So kids are forced to go outside
and won't stay inside and study.So they're really taking it very
seriously because it's much worse in Asian countries and but
we're starting to see it here inthe US So I'm really excited to
see hopefully if we can start tomake some inroads in some public
health initiatives to address itas well.
It's so important, yeah. So let's say you have a child
(25:16):
who starts off maybe at the age of 7 or 8 having a little bit of
myopia, and you've been following them, and their myopia
keeps increasing every six months, every year.
Their power keeps going up. What are some options now for
myopia management in these kids?So it's, it's really amazing.
We've got a couple different options.
Some are FDA approved, some are not, but they've been around for
(25:39):
a while. So one of the first is low dose
atropine. Atropine is a dilating drop.
It dilates your pupil for about a week at a time.
But when they dilute it down, dilute the concentration.
Usually when you go to the pharmacy, you buy it for
atropine 1% they found in studies coming out of Singapore
and Taiwan. If you decrease that
(26:00):
concentration 0.01 or 0.02 or even 0.05%, you can help
decrease the progression of nearsightedness.
So what does that mean when every year when kids go into
their eye doctor, you probably notice the prescription gets
worse and worse. If you wear glasses, you
probably notice that about yourself when you were young,
(26:22):
and now we have a way to stabilize it.
Why do we care? It's not I don't care how thick
the glasses are. What I care is that the eye is
also elongating. That's what it means to be
nearsighted. The eye is longer than the
average. Each millimeter that the eye is
longer, you increase the risk ofvision threatening consequences
(26:43):
like retinal detachment, myopic maculopathy, cataracts,
glaucoma. That's what I'm trying to
prevent. I want to reduce the blindness
associated with near sightednessdown the road.
And we can do that with the eye drop.
It's just once a day nightly. And I actually recommend really
following kids and even if they look like they're about to
(27:04):
become near sighted. All three of my children are on
low dose atrophenic. None of them wears glasses yet,
but I was able to do some extra testing in the office and I saw
that all three of them were going to follow in my husband's
place. So I started them
prophylactically on low dose atropine and now studies have
actually shown that's that's effective as well.
The second type of treatment is a dual acting contact lens.
(27:26):
It's a daily disposable peripheral contact lens that has
different rings of power so thatit helps stabilize the near
sightedness. And this actually is FDA
approved in ages 8 to 12. So the brand name is called My
Site. It's made by a company called
Cooper Vision and it helps decrease the near sightedness.
(27:48):
It stabilizes it. So this is a really good option.
Sometimes I will use the first two in combination.
The atrophy unfortunately is notFDA approved for kids, but it's
found for 100 years. I found a journal article in the
Journal of Pediatrics from the 1930s that talked about seeing
near sightedness. It said atropine eye drop and
get outside. By the way, the atropine, I
(28:12):
wanted to go back to what you said in the very beginning of
our talk about when you were treating, treating amblyopia,
You said people could put drops in their child's eyes to treat
amblyopia. That's the same drop correct as
Atropine. That is.
It's the same, but it's the stronger.
Concentration. Percent which you can buy just
fill it at your local drug store.
(28:33):
This type of low dose atropine has to be for now specially made
in a compounding pharmacies verydifferent usually has to be
refrigerated. It has to be tossed after one to
three months. So it's a different type of eye
drop. So there's actually a pharmacist
make your solution of low dose atropine.
There's also glasses that are available outside of the United
(28:55):
States and Canada and Europe andin Asia, two different types of
glasses that are different than the regular glasses that we all
wear. It's not just the single vision
glasses that traditionally are given to children because they
found that actually might worsenthe near sightedness.
These special glasses have a honeycomb type pattern.
You can't notice them. But again, what it does is it
(29:16):
really projects the image properly on the curved retina,
whereas a regular single vision pair of glasses projects the
image on a straight line. In a straight path, your eyeball
is curved. So that's a factor that might
make the eyeball grow even more and might make you more near
sighted. So those glasses are available
outside of the US? Some.
(29:37):
Things that may be available. In the US, at some point, do you
think that they. Are currently trying to do
trials. The problem is going to be at
least five years. OK, got it.
Where we. See them, you can get the off
brand version. I have a manufacturer that will
make it same type of lens as oneof the branded versions, but you
(29:58):
cannot get in the US at least one of the branded versions.
So you have to go to Canada or go to Europe to get them.
But also the data looks really good on those specific types of
glasses for again, slowing nearsightness.
So I think treatment for someonethat's nearsighted could be just
one of those three. It could be a combination if
there's a strong family, the history of retinal detachments.
(30:19):
It might be a high myopia means anything above -6 because that
carries with it those added risks that I talked about before
of retinal detachments and myopic maculopathy.
Got it. I wanted to ask.
You about another treatment thatI sometimes hear about for
myopia which is ortho keratology.
What are your thoughts about that and what is the evidence
show? So ortho keratology is a hard
(30:43):
contact lens that you sleep in. What they found was this was a
contact lens and it's you. It basically shapes the cornea.
It mushes the front part of youreye while your sleep.
Flattens it down a little bit. And adults then in the morning,
so initially this was for adults, would remove the contact
lens and their near sightedness would be temporarily cured.
(31:05):
They wouldn't need glasses or contact lenses during the day to
see and they would keep putting this contact lens in at night.
And then what they found was that in the younger patients it
seemed to slow the progression of near as well.
I the data does show that it is a good method of treatment.
However, most pediatric ophthalmologist, we don't love
(31:26):
it because we don't like tellinganyone to sleep in a contact
lens has increased the risk of infection up to 8 times.
And my corneal colleagues like my husband will sometimes see
these corneal opacities not necessarily vision affecting,
but they will see them in kids that are wearing ortho
keratology. I think if you're doing ortho
(31:47):
keratology under the care of an optometrist who is really on top
of things, I will. There's somebody in our
community and he's fantastic. He is really educating the
parents as to what to look out for.
If there is an infection, they get in to see him right away.
The parents are really a part ofthat kind of just ensuring that
(32:08):
something terrible is not occurring in a child.
There are a lot of stories, unfortunately, in the
ophthalmology community of terrible infections, even one at
Stanford where they were admitted to the ICU because of
these awful bilateral infections.
So once you see that and there are other options available,
that's why usually as an ophthalmologist, I don't
(32:28):
prescribe it personally and I don't really talk about it all
that much. But if you look at the data does
show that it works and that the risk of infection was about 1.7%
if I'm not mistaken. So not terrible.
But there's a risk nevertheless.There's a risk and with the eye
drops, there's really very minimal risk of infection that
my site contact lens is a daily disposable, meaning you're
(32:50):
throwing it away at the end of the day, which is always the
healthiest for the eyes. It's always what I recommend for
my tween and teen patients is I like that, that kind of a
contact lens. So, but it isn't.
Also with Ortho K, it's like theequivalent is having to wear a
retainer at night, right? You have to wear the retainer
during the night and then you take it off.
But if you stop wearing yet, your teeth are going to go back
(33:10):
to whatever they were at before the shape, the formation that
they were at before. So the same holds true for the
cornea, right? If you stop wearing your Ortho K
contact lenses, your cornea willrevert back to the shape that it
had before. Absolutely, Absolutely.
Yeah, Doctor Wong, we are nearing the end of our talk and
it's just been such a pleasure learning so much from you.
I'm going to definitely be looking up some of these newer
(33:33):
treatments that you've describedfor kids eye health.
But I one other very common question that parents have is
how often do I need to take my child to the eye doctor?
When should they get their firstexam?
And then after that first exam, how often should they be seen?
So can you give us some guidanceon that?
So our Association of Pediatric ophthalmology, we really partner
(33:54):
and rely on the pediatricians tobe the medical home.
Since we're both physicians, we want you first to go to your
pediatrician. If you have concerns about your
child's eyes, they should be doing a vision screening in the
office. Now, if there is a family
history of eye crossing, if there's a family history of near
sightedness, absolutely make that appointment when you desire
(34:17):
with your pediatric ophthalmologist.
But the American Association of Peed's ophthalmology and
Business, we do not recommend routine comprehensive eye exams
for children. And the reason is when you come
in, we have to put those dilating drops in kids eyes.
Those drops takes 30 minutes. They are not.
They can be a traumatic event, especially for younger kids.
And a lot of the times everything is normal.
(34:40):
There's not much that we need tobe concerned about.
So we don't want to overburden the system.
A lot of pediatric ophthalmologists in the country,
there are a lot of optometrists there.
There they will differ in what they say, but from a pediatric
ophthalmology perspective, we really think that only come in
when you are concerned about something specific.
(35:00):
If there's a family history, if there's a personal history,
absolutely bring them in at any time.
I examine babies in the neonatalintensive care unit, so there's
no age that's too young to be examined by us in the eye
clinic. Absolutely not.
There should be a reason. There should be a.
Reason. There should be a reason now
again, a sibling with near sightedness at the age of three,
(35:23):
I will tell the parents, yes, bring in your other kids maybe
even earlier than that age. Then I can just pick up on it as
fast as can. But if you're worried too that
the pediatrician is not doing a proper job of screening the
vision. Obviously we want to make sure
that kids are getting picked up that vision issues that we
talked about amblyopia or classes that they're getting
(35:44):
discovered early enough where wecan make a difference.
But there are no guidelines thatsay you need to come in by X
amount of months or years. That's not usually the
recommendation. Well, thank you for clarifying
that because I know that's a concern a lot of parents have.
And yes, they get their kids eyes tested at the
pediatrician's office or perhapsin school.
They have eye screenings. But really, if you see that your
(36:07):
child's having some kind of issue, they're squinting,
they're rubbing their eyes a lot, there's indication that
they're bumping into things, Definitely get it checked out.
Again, Thank you, Doctor Juan, for this, Juan, for this
enlightening conversation. I'm sure that our audience has
learned so much from you. I just wanted to close with is
there any one particular myth orsome misconception people have
(36:29):
about kids eyes that you would love to clarify and clear up?
I think sometimes people think that when they see a child with
cross eyes that kids are going to outgrow it, that babies will
outgrow it. And that's a myth.
There's one very specific subtype of eye crossing that
gets better with age, but we're talking middle school age.
(36:52):
But it's something you absolutely want to see.
A pediatric ophthalmologist. Oftentimes we might need to give
glasses, but sometimes we need to go straight to surgery if
there's no need for glasses. So that myth that a baby will
outgrow their cross eyes. If the baby has cross eyes past
the age of 6 months then you really need to get that checked
out. That was such an important
(37:14):
point. Absolutely.
Again, thank you so much, DoctorWong, for sharing your wealth of
information. If anyone in our audience wanted
to learn more from you, use, maybe access some of your
resources, or perhaps even if they're in Hawaii, become a
patient. How can they find you?
So I am kind of everywhere out at the same name.
Doctor Rupa wong.com is my personal website.
(37:36):
Honolulu Eye Clinic is where I practice, which has our practice
website, but I'm on Instagram and TikTok and YouTube under
Doctor Rupa Wong. Facebook, for some reason that
name was taken. So I had to go with Rupa Wong,
MD. You can find me there and I'm
also on LinkedIn. So on all the places for I
health education, I have a bunchof freebies for parents about
(38:00):
how we do screen time in our homes.
Other things for just eye healthall along my personal website,
doctorrupawong.com. Wonderful.
And we will share all of those links in the notes below.
And I encourage all of you to follow Doctor Wong and her
social media platform. She is again a wealth of
information and she makes it very entertaining too, so it's a
joy to watch. Thank you all for tuning in and
(38:23):
I will see you during our next session together.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new
to help you boost your IQ. Leave us a review and.
Share the podcast with your. Family and friends stay
connected with me for more. Eye.
Opening insights on ihealth, nutrition and lifestyle.
(38:46):
Until next time, keep your vision clear and your IQ sharp.
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