In February 2015 Paul and I volunteered a week at the Vietnam National Institute of Ophthalmology in Hanoi, teaching OrthoK fitting to the staff of the Refractive Department. The VNIO is a specialty eye hospital, employing about 500 staff and seeing around 2000 patients per day. I was also there in March 2014 teaching the fundamentals of rigid contact lens fitting, and was greeted with squeezy hugs from Minh Anh (Hanoi’s only qualified optometrist) and Dr Huong (Hanoi’s nicest and most cuddly ophthalmologist) whom I’d worked closely with in 2014 and had kept in touch with since. If you’re wondering why there’s only one qualified optometrist in Hanoi, and indeed only a total of three in a country of 90 million people, read on.
Hanoi had just entered a cold snap as we have arrived, so Minh Anh and Dr Huong brought scarves and extra layers for us today, because they’re so lovely. After three months of relentless 30+ degree heat in Brisbane, though, Paul and I were really enjoying mid-teens temperatures even though the locals were all rugged up! Each morning Paul or I gave lectures to the staff, and then were treated to a tasty lunch at a local street eatery, usually washed down with cinnamon tea. We would then see patients in the afternoon.
On this initial day, our first three patients are all 8 years of age, and all around -5.00. This is generally considered a high level of myopia (shortsightedness), meaning that anything further away than 20cm from their nose is blurred. The younger you are when you become myopic, generally the faster you progress (1) so parents looking to do something to slow down this worsening are wise for two reasons: higher levels of myopia are strongly associated with higher levels of eye diseases like glaucoma, macular degeneration and retinal detachment in adulthood (2) and because very high spectacle prescriptions have been shown to affect quality of life.(3)
Twin sisters came first – little M only got her last pair of glasses at the end of 2014 and has progressed two more steps of myopia in two months. Her mother said M’s first pair of glasses were only a year ago, and were less than half of the current strength. Her twin sister P has a similar story. After measurement including corneal topography, or mapping of the eye surface to select the best fitting lens, M&P then sat in the waiting room with trial OrthoK lenses on their eyes.
M was reclining in her Dad’s arms with her eyes closed enjoying a toasty winter’s day cuddle. Their mother discussed OrthoK with me through Minh Anh, reassured her daughters and took photos of the two overseas experts discussing trial lens selection with their eye doctors. Mum said she was only -1.00 and her husband is -4.00 – both girls have surpassed their parents’ myopia by only age 8.
Our third patient, a little boy of the same age who soon becomes nicknamed ‘Little Champ’, was lead out of the room with his eyes closed for a similar waiting room nap. We then brought M&P back in to check their lens fitting. M had a reduction in her myopia of nearly half in her 30 minute nap; P a little less. They were shown lens handling along with their mum and dad, and we planned to see them back in the morning. Paul and I gave M&P a koala toy to take home with them which they both seem quite taken with, although their unruffle-able demeanour wouldn’t give it away – they were entirely quiet and calm throughout having eye drops and contact lenses popped onto their eyes.
Around the world there is an increase in children of all ethnicities becoming myopic (4), and the reasons are multifactorial. Minimal time spent outside and high educational demands are key factors. I had an interesting conversation with one of the VNIO ophthalmologists at a dinner held in our honour later in the week. He said his children were myopic, and were getting worse, when they lived in an apartment with no significant outside view. Since they had moved to a higher apartment and could see further from the windows, their eyes had stopped worsening! While there’s probably a bit more to it such as the children getting older, where generally progression will slow down (1), there’s some truth to this observation!
Optometry isn’t a regulated profession in Vietnam, meaning that anyone can set up an optical shop with an automatic refraction machine (which takes an average reading of a spectacle prescription) and call themselves an optometrist or optician. Across the road from VNIO, the street is lined with these optical shops. Unfortunately for a lot of these myopic kids, this means that their glasses aren’t accurate, and whether they are over- or under-corrected, both can lead to worsening of myopia.(5,6)
Little Champ returned and his lenses look good for proceeding to an overnight trial. Mum was then instructed on lens handling and was struggling a bit, which gave Little Champ the giggles – no sight of tears or even a frowny face! While Dr Huong finished lens care discussions with his mum, Little Champ was folding up a paper plane out of a tissue I gave him earlier and flying it towards his toy koala. We saw him the next morning too.
Our three 5D myopic kids have done brilliantly after their first night in OrthoK. Twin girls M&P both crack smiles when their lenses are taken off, experiencing clearer vision with over half of their myopia being reduced in one night. Little Champ arrives at 9am and peeks in through the glass windowed door, looking a bit squinty as is normal on the first morning when the lenses are worn in for fitting assessment. He stands up in front of the microscope, rather than sitting down, because it’s at the perfect level for his 3 and a half feet of height. He’s been lucky enough to undergo even more overnight myopia reduction than our twin girls, and happily departs with all three due for follow up in another week
- Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith III EL, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci 2012;89:27-32.
- Flitcroft DI. The complex interactions of reintal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res 2012;31:622-60.
- Rose K, Harper R, Tromans C, Waterman C, Goldberg D, Haggerty C, Tullo A. Quality of life in myopia. Br J Ophthalmol 2000;84:1031-4.
- Dolgin E. The myopia boom. Nature 2015;519:276-8.
- Chung K, Mohidin N, O’Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vis Res 2002;42:2555-9.
- Gwiazda JE, Hyman L, Norton TT, Hussein ME, Marsh-Tootle W, Manny R, Wang Y, Everett D; COMET Group. Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children. Invest Ophthalmol Vis Sci. 2004 Jul;45:2143-51.