护眼的十一大疑惑

这段时间比较忙。上个月的Zoom 分享，现在才整理出来了。很多家长对孩子近视很担心。这里做了一些解说和解惑。 我们以前10岁才近视，现在孩子6岁就近视了。一年长75度到一百度，到成人了，那不变成1000度？在那个度数，视网膜会更脆弱，容易脱落，也不能做激光手术了。 那近视发展，可以停止吗？

近视其实有三个原因，妈妈怀孕期营养影响/难产， 看近的小字和符号多/眼睛压力多，或者双眼不协调/视功能失调。

双眼视功能失调可以是因为集中不够，调节不够或两眼微小动作不同步。如果不治疗好，近视会快加深很多。双眼视功能失调可以做视觉训练矫正, 减少近视发展。视觉训练目前还可以做脑震荡眼脑康复治疗， 视觉上的学习障碍，和提高运动员的速度和反应能力 （耳聪目明）。视觉训练在美国开始，现在在广州中三眼科医院有提供。在美国可以在COVD.org  上找，Boston Children’s Hospital 也开始做了。在加拿大可以在 visiontherapycanada.com 上找。视觉训练通常由进修做眼脑发展和复建的视光眼科医生 (Developmental and Rehabilitative Optometrist) 和他的视觉训练员做。

如果近视是只是由用眼多的压力造成的，那视觉训练就不够效果。 要一直做下去才好。 这种情况，可以做OK 镜，效果会好很多。做OK 镜前，要找做眼脑发展和复建的视光眼科医生详细检查，确认没有双眼视功能失调才有效果。

下面是在家长群里的问题收集和我的回答：

Q1. 青少年带隐形眼镜有什么危害吗？如果佩戴怎么选择？

Dr. Liang, 我以前是常说隐形眼镜没什莫伤害，这主要是我的病人没有什么感染的情况。其实在青少年来说，普通白天戴的隐形是比成人的感染多一些。在中国，也比北美的情况严重些。在北美，风险是1-2%而已。我每个病人都要做个Contact Lens Fitting, 新手要做个 contact lens teach, 教会他们好的，规范的佩戴和清洁习惯，就减少了很多感染和不适。Contact lens fitting 是由视光医生做的，挑的隐形就比较适合孩子，以后再每年检查的就基本很少感染。OK 镜来说，是比较透气的，是晚上睡觉的时候戴的。洗的干净和规范，就减少很多感染。

Q2. 青少年戴远视眼镜，需要防止近视吗？远视眼如何注意保护眼睛，维持正常视力？

Dr. Liang, 近视的人眼睛比较长，看到的都投影在眼睛视网膜的前面。 远视的人眼睛比较短，看到的都投影在视网膜的后面。和近视是相反的。远视的孩子需要每年验眼检查。 他们有些像有老花的人那样，看近的，会不清楚，或者逃避看书。做验眼检查就可以看到他们的眼睛视功能会不会也受到影响了。

Q3. OK镜的最佳佩戴年龄，激光手术针对近视者是一劳永逸的吗？术后会有什么副作用？20岁的女孩是佩戴OK镜适合还是激光手术更适合？

Dr. Liang, OK 镜6岁就可以戴了，到成人也可以戴。如果眼睛度数有稳定下来两年了，可以考虑做激光视力矫正手术。副作用包括眼干和晚上会有光圈。早点找个视光眼科医生手术前的评估，可以减少很多风险。做完手术，每年验眼可以减少副作用的影响。到40岁了，老花了，还是要戴眼镜的。

Q4. North York 孩子17岁，视力左眼0.1、右眼1.0，是否最好要配戴眼镜。如果不戴眼镜，是否反而不能训练0.1左眼？

Dr. Liang, 这个视力看来双眼度数应该相差很大。这个情况该检查一下弱的那个眼睛有没有眼睛的病， 还有看看有没有弱视。就好是配戴日抛的隐形，然后看眼脑发展的视光医生(developmental and rehabilitative Optometrist)做视觉训练 (vision therapy)。如果有弱视了，视觉训练可以矫正回来。

Q5. 看电脑时，带蓝光眼镜对视力有保护作用吗？

Dr. Liang, 防蓝光眼镜对视力的保护不大，可能有1-2%的作用。你可以自己调低电脑的光线，减少蓝光。个人定制的防疲劳的镜片对视力的保护比防蓝光眼镜好10倍。视觉训练对视力的保护比防蓝光眼镜好90倍，这些方案可以做，在眼脑发展的视光医生那做就好。

Q6. 在家上网课时，选择投影仪会比看电视、电脑对视力要好吧？

Dr. Liang, 如果家里有条件的，是的，投影仪远一些，减少对眼睛的影响。投影仪和电视一样远的话，那电视会清晰一些。越近，对眼睛的压力越大。以前我们奶奶爷爷辈的，也是因为做针线活，读书，近的活，影响了眼睛了，不然没是没有近视的。（能帮讲解一下投影仪、电视、电脑、iPad 和手机这几种电子对视力的影响吗？ see above. 如上。）

Q7. OK镜使用多久后需要更换？如果到期不换会有什么后果？哪些品牌的护理液和润滑液是适用于多数OK镜的？

Dr. Liang, OK 镜通常一年一换。它是有磨损的，虽然肉眼看不见，但还会在。今年疫情期，变数很大。因为在家看电脑，上网课的多了，眼睛近视涨快多了，有些眼睛会因度数改变要多换一些。 不换会影响控制近视的效果，白戴了。 洗镜片的药水，要双氧水好一些。品牌的问题，请问视光眼科医生，你去诊所做OK镜的话，都会和你说的。最重要的，还是护理镜片的教育和好的习惯。这些，做OK镜的医生可以和孩子复习。

Q8. 孩子17岁，佩戴近视眼镜五年了，这两年度数维持在270度左右，原本每年检查一次视力，今年因为疫情没有检，请问需要每年一检和每年更换眼镜吗？

Dr. Liang, 安省视光眼科医生协会建议一年找视光医生做一次眼睛全面检查。疫情期用电脑多，眼睛变数更多，我建议更要检查。检查后，医生会视情况建议镜片或镜框的更换。验眼时请务必带上眼镜。

9. 眼部如何做训练 ?

Dr. Liang, 视觉训练是在美国开始。视觉训练用脑科的原理，和物理治疗的原理，来提高脑眼协调，和双眼协调。大脑80%的容量都和视觉有关。视觉训练其中包括， 提高大脑对眼睛的控制，提高眼睛回馈给大脑的信息，提高眼睛这个感官和大脑的沟通。譬喻，有些人是用右眼多的，有些人是用左眼多的。有些人看书两个眼睛可能是不同步的，一个比另一个快，就容易造成看书跳字，或跳行。到了需要看很多书的时候，这些人就吃亏了。视觉训练就可以平衡双眼的速度，跟踪，跳跃，调节，集中和分散，打开外围视野的感应 （眼观四面）。视觉训练还可以和听觉，触觉一起调和，提高反应能力和眼手协调 （提高眼睛和大脑的灵敏度）。由眼睛引起的学习时精神不集中，弱视和斜视的人，和脑创伤的人的都能通过视觉训练康复回来。

10. 高中孩子-NorthYork, OK镜清洗能详细说明一下吗？配眼镜时技师说早上取下来直接放在双氧水里泡6小时后可以直接佩戴，取戴时可以用自来水，凉白开或是生理盐水冲洗一下吗，哪种水冲洗更合适？

Dr. Liang, OK镜，我建议找视光眼科医生配（contact lens fitting)，减少感染，效果也好很多。 在安省，第一次配戴的时候，医生助手会详细教你怎样戴，和建立好的护眼习惯。在加拿大，视光眼科医生(Optometrist) 是可以看眼病和开药的，过敏了，感染了，都可以开药治疗。配镜师(Optician)是不能/不会看病开药的。视光眼科医生学过眼睛病理学，治疗过眼睛感染，是不建议你用自来水洗隐形眼镜片的。如果用双氧水里泡6小时后，可以直接佩戴，不要用自来水。

11. 对于干眼症有什么眼药水和方法可以缓解，人工泪液可以长时间使用吗？

Dr. Liang, 眼睛感觉干的，安省视光协会建议看眼科视光医生做个详细的全面眼睛检查，找出真正的原因来治疗。眼睛干有多种原因，譬如药物，习惯，环境，荷尔蒙，双眼不协调，或做的隐形，眼镜不适合。有防腐剂的眼药水会更刺激眼睛的，用没防腐剂的好一些。如果眼药水有防腐剂的，一天不要用超过四次。 如果用了两个星期眼药水都没好回来，建议你去看眼科视光医生好好检查。

微信：yanl2014
油管: DrLiang Optometrist

梁艳玲医生毕业于滑铁卢大学,在七年内从滑铁卢大学拿到了生命科学和视光眼医科双学位。期间，她去了美国的中部的白内障和激光视力矫正中心实习，作为交换生到香港理工视光系实习，和到广州中山眼科中心实习。她有十多年视光眼科经验。她曾是加拿大视光医生牌照,临床考试的考牌官。她也曾是安省视光医生协会董事会成员。她还是Seneca College 和 Georgian College Optician (配镜师） program的实习课程导师。她不只是做一般的验眼配镜，梁艳玲医生毕业后还参加最新的临床视光课程培训, 成为眼脑发展和复健的眼科视光医生，给双眼不协调的孩子，眼睛影响的学习障碍，和有脑创伤的人做眼科视觉训练。梁医生工作以外还做义工, 给本地的狮子会义举筹款，做公益活动。梁医生说粤语和国语,和英语。想看其他护眼资料，请订阅梁医生的Youtube油管号，DrLiang Optometrist，有中文字幕。

//

Myopia progression, can it be stopped?

During my younger years, I was myopic near 10 years old. Kids are getting myopic around 6 years old now. If their vision changes -0.75 per year, it would easily reach -10.00 by adulthood. With that prescription, there are more risk with retinal detachment and would be harder to do LASIK refractive surgery. So can myopia be controlled?

There are actually three causes of myopia, by birth/nutrition, near work stress with small prints/symbols, and poor eye coordination. Poor eye hand coordination can be caused by poor convergence, poor accommodation and poor eye movements. If not corrected, myopia can get worse faster.  All eye coordination functions can be improved with vision therapy. Vision thearpy is also used for concussion, learning related vision disorders, amblyopia/strabismus and athletic sports performance, NHL player, Olympians and racing.  

Vision therapy is widely used in North America, especially in the USA. It’s available in many private developmental and rehabilitative Optometrist’ clinics. These specialty-trained Optometrists can be found on www.covd.org in USA, and www.visiontherapycanada.com. Vision therapy is also found in Boston children’s hospital, and now ZhongShan Ophthalmic hospital in Guangzhou, China.

If myopia is due to near point stress, vision therapy would not be very effective. You would have to continue at all times for it to work. In this case, then orthokeratology is the best option. It’s effective for the right candidate, and it’s great for sports. With orthokeratology, myopia progression is slowed by 40-50%.

Last month, I did a zoom meeting with local parents about myopia and eye health protection. Here are some of the topics we covered, most are around myopia. Parents are concerned that their kids are having myopia earlier.

Q1: What’s the danger of kids wearing contacts? How to choose a lens properly？ 

Dr. Liang: I used to say there is almost no risk with an OK lens. But some that came to me from having done with someone else did have a poor effect on eye movements, and sometimes more risk of red eyes and infections.  Contact lenses do have a small risk of infection, it’s about 1-2%. To get the right contact lenses, you need to see an Optometrist for an eye exam, and do a contact lens fitting for the proper size, power, and vision that you need for either work or play. The Optometrist would also train you properly for infection prevention. It starts with proper insertion, removal and cleaning. Good habits would reduce infection.  

Q2: For Kids who are farsighted, should they be concerned for myopia? How do farsighted people protect their eyes and keep good vision?

Dr. Liang: Farsighted eyes have their images projected to the back of the retina, it’s the opposite of nearsighted, where the image is projected onto the front of the retina.  They need to be checked at least once a year. Eye coordination needs to be checked, to make sure there is no effect on reading and writing. similar to those who have presbyopia.

Q3, What’s the best age for an OK lens? Is LASIK the best treatment for nearsightedness? What’s the side effect? For 20 years olds, is it better to do an OK lens or to do LASIK?

Dr. Liang: The use of an OK lens can start at age 6. Up till adult life. If the eye is stable for more than two years, then they can consider LASIK. LASIK is also not for everyone. It may cause dry eyes and halos at night for driving. Checking the eyes yearly after the surgery can reduce the side effects on you. You would still need reading glasses at age 40. It’s good to see an Optometrist for a personal assessment to see if they are a good candidate for LASIK. There are many factors involved.

Q4, a young adult in North York is 17 years old, one eye sees 20/200, one eye sees 20/20, should he wear glasses? If he doesn’t wear glasses, is it hard to train the eye with the worse vision.

Dr. Liang: It appears that the two eyes may have very different prescriptions. It’s best to check the eyes to rule out any eye diseases and amblyopia. These children are best served with daily disposable contact lenses and would need to do vision therapy to prevent the eyes getting more different. It can reduce their passion for reading and learning if the eyes are poorly coordinated. Please see a developmental Optometrist. A properly fitted contacts and vision therapy would help them use both eyes together. 

Q5, For computer use, do blue light blocking lenses have protection on vision?

Dr. Liang: Blue light blocking lenses don’t have too much effect, maybe only 1-2% reduction on eye fatigue. You can reduce the blue light yourself by lowering the brightness on display and screens.  Anti-fatigue lenses have 10x more effect than blue light blocking lenses. And vision therapy has 90x more effect than blue light blocking lenses for near work stress and fatigue. You can see a developmental Optometrist for a personalized pair of anti-fatigue lense’s for better eye protection.

Q6, When doing online courses, is it better for the eyes to use a projector than to watch TV or use the computer?

Dr. Liang: If possible, yes, projectors work better than near point computers or screens. It’s worse when it’s closer to your eyes. As our eyes are more relaxed from looking at far, from the hunting and gathering days. But for school work and future workforce, they would still need to use the computer. It’s better to train them in vision therapy, and give me good working habits to work with technology for today and the future. 

Q7, How often does one need to change the OK lens? What are the effects if not changing it frequently. Which brands work better for the OK lenses. 

Dr. Liang: OK lenses usually should change yearly. As their micro changes on the lenses that cannot be seen by the naked eye. However, this year, there is covid and some eyes change faster, so some eyes need to change more frequently. Our office uses a special RGP lens cleaning solution and non preservative hydrogen peroxide to clean. Use with care, ask the doctor as you proceed with the OK lens, as it can cause a chemical burn if used improperly.

Q8: My child is 17 years old. He’s been wearing glasses for five years. The last two years are around -2.75ds. We tend to check once yearly. This year, we didn’t check due to COVID, should it be checked yearly? Should glasses be updated yearly?

Dr. Liang: Eye exams should be done at least once a year for children.The doctor would make proper recommendations to change the lenses if deemed necessary. Please bring your glasses when you bring your children in to check their eyes.

Q9, How does one do vision therapy?

Dr. Liang, Vision therapy incorporates a series of exercises such as physiotherapy, to help the eyes move better separately, and then together from far to near, and from side to side. We were never taught how to use our eyes to see, but vision is what we do, not what happens to us. For example, some people use the right eye more than the left. Some people jump around with their eyes when they read or correct their essays. (I used to do that.) It includes training in pursuits, saccades, accommodation, vergences, opening peripheral awareness, integrating with other senses such as hearing, and touch, for better reaction time and eye hand coordination. You would get the training from the developmental Optometrist office once a week, and do 20 minutes of exercise at home every day. 

Q10, High school child in North York, Can you clarify how to clean OK lens? Optician said you should be able to put it into your eyes after using Hydrogen peroxide for 6 hours. Or you can use tap water, cold boiled water, or saline to wash. Which one should be best for washing. 

OrthoK is best done with an Optometrist, as the child need to be checked for eye infections or allergy in the eyes. I have seen many cases of red eyes from those who came to me after having lenses done with an Optician in Markham. Usually the Optometrist and Optometric staff would go through all the infection control with the student at the initial fit of the contact lenses, and the Optometrist would monitor frequently for risk of infections and allergies. But by all means, please do not use water at all. If you use hydrogen peroxide, it’s clean after 6 hours. You can just put the lens into the eyes, or use a type of eye drop before putting it onto the eye. 

Q11, For dry eyes, what kind of eye drops would work for relief?

Those with dry eyes should see an optometrist for an eye exam for relief. The cause of dry eye can be from medications, habits, environment, hormones, or poor eye coordination, or poorly made glasses.  It’s better to find out the real cause and fix it. Eye drops with preservative should not be used for more than 4x a day. Eye drops with no preservative can be used for longer. If you tried the eye drops for two week, and you are not getting better, you should go see the Optometrist for better care. Halloween is around the corner, please see an Optometrist if you want contact lens for Halloween. 

Reference:
Contact Lenses
https://contactlensupdate.com/2018/10/26/contact-lens-wearer-demographics-and-risk-behaviors-for-contact-lens-related-eye-infections/
20/20 Isn’t Everything
https://www.optom.on.ca/OAO/Patients/Library/20_20_isn_t_everything.aspx