When asked about their five senses, people usually respond that their eyesight is the mode of perception they value (and fear losing) the most. However, very few of us have any real understanding of how eyes work or what vision problems can affect eye health.
Myopia occurs when the cornea (clear cover on the front of the eye) is steeply curved or when the eyeball grows too much, elongating from front to back. While there are theories about what causes the eye to elongate, no one really knows what triggers this growth. However, the result is nearsightedness, which means that faraway objects look blurry while things nearby appear perfectly clear and in-focus.
Unfortunately, in addition to blurred vision, myopia is often a gateway to serious blinding diseases. With one million new cases occurring each week, vision scientists are warning that there is no safe amount of myopia because each minus (-) diopter in a lens prescription doubles the risk of developing serious ocular problems.
The elongation of the eye puts stress on its inner parts thereby inviting other maladies that used to be attributed to the scourge of old age. Nowadays, cataracts, retinal detachments, glaucoma and macular myopathies* are striking earlier in life, dramatically disabling millions of young people in their teens, twenties and beyond.
[*What do these words mean? A cataract is a clouding of the crystalline lens inside the eye and, although surgically correctable, it is the principal cause of blindness in the world. A retinal detachment is an emergency situation in which the retina pulls away from its normal position and, if untreated, risks permanent vision loss. Glaucoma, which damages the optic nerve, is the leading cause of irreversible blindness worldwide. Macular myopathy describes any pathological condition to the area of the center of the retina that is associated with highly sensitive, accurate vision.]
Considering the rise in pre-mature incidences of myopia related diseases, estimates indicate that by 2050, half the world’s population will be myopic – with up to one billion children at high risk of permanent blindness.
At the heart of our story is an international group of vision scientists – physicians, inventors, psychologists, sociologists, and epidemiologists – whose research over the last 40 years has advanced even the most basic knowledge of eye science. This coterie of colleagues first came together under the auspices of the Wallman Vision Laboratory at City College-CUNY and have been collaborating on myopia research since the early 1970s. Led by neurobiologist Josh Wallman, their pioneering discoveries challenged long-held assumptions about how the eye functions, grows and adapts.
Josh’s greatest genius came from his love of putting people together from different walks of life – doing so because he relished considering opinions from a variety of angles. Thus, his lab located on the upper reaches of Manhattan became a gathering place for researchers, artists, writers, inventors, students and professionals of many backgrounds, cultures and disciplines. Sadly, Josh succumbed to cancer in 2012 yet, around the world, his brilliance lives on in the continuation of ideas, projects and experiments that he encouraged and supported. Because filmmaker, Jane Weiner has the privilege of being a part of Wallman Vision Lab’s circle of friends, many of the vision scientists participating in this project are people she’s known for quite a long time.
Working in close association with this group for several years, we’ve developed an ambitious, multi-platform project wherein we retrace the path of early experiments: Discoveries of retinal and neurobiological interactions, and physical mechanisms of ‘how we see what we see‘ that have fostered dynamic breakthroughs in understanding not only what could be causing the worldwide Myopia Epidemic but also in identifying new remedies to help bring it under control.
“I wish someone would make a film that really shows what it’s like when I first open my eyes in the morning all that’s there are blobs of light and color. My prescription is -13.0 diopters so, without my glasses, I don’t see much of anything at all…!”
LOSING SIGHT opens in darkness with the sounds of a maternity ward, suddenly we see a point-of-view shot of lights overhead as a newborn baby squints at first sightings of her new world. Looking up and around, she struggles to adjust to the brightness and to see…
Babies are born farsighted with eyeballs too small to handle the internal optics. Through infancy and childhood, the eyeball grows, elongating until it reaches the precise point of perfect vision, normally in time to enter first grade at school. What triggers it to continue growing on into myopia is still unknown and solving this mystery, especially in the midst of an epidemic, is the urgent goal of energetic scientific research.
Watching children around the world – at home, in nursery school, interacting with others, playing alone with toys – we track the evolution of a child’s eyesight over early years of life, from a hazy monochrome at birth into a sharply defined, colorful world of perfect vision at about 6 years old. Understanding how an eye matures is key to comprehending the nature of myopia.
With accumulating years and as eyes age, we observe how our vision changes and what visual aberrations presage complications as ocular diseases set in.
“As my retina detached, I watched the first sparks fly, like arcs of lightning, shooting through my sight then, an oil slick of black started down and to the left, creeping toward the center of my vision. I couldn’t fathom what was happening but my eye was coming apart..!”
Insights from professionals interwoven with testimonials from individuals living with progressive myopia – as well as those facing the blinding maladies associated with nearsightedness – give audiences firsthand witness to the real-life challenges on both sides of the conundrum.
“We’re now seeing huge increases in the numbers of younger patients with eye diseases normally associated with middle- or old-age… Here, in Hong Kong, more and more teen-agers are arriving at hospital emergency rooms with detached retinas…”
In a commercial port city in China, we spend a day with the Liu family. Like most of their classmates, both six-year-old Jun and twelve-year-old Qiang wear glasses. Neither sees much natural light, burdened as they are with classes and extracurricular activities that tend to take place indoors. When the boys arrive home, well past sunset, they have another hour or two of homework before being allowed to touch their electronic gadgets. This way of life is hardly an exception in countries where the prevalence of myopia has grown to worrisome proportions – and, in terms of education, in cultures that tend to put competitive academics high on the achievement list for their children.
“The best evidence of this comes from Singapore where parents now start getting their kids into special early tutoring to be sure they know the alphabet and can count before entering kindergarten. So, they’re beginning schooling at age 3 or 4.”
Despite theories that a couple hours daily in sunshine might delay the onset of myopia, parents with ambitious goals for their children sometimes feel that playing outside wastes precious study-time.
But many people don’t realize the dangers of nearsightedness simply because they’ve never been told by health professionals that they and/or their myopic children are at considerable risk for developing maladies that lead to permanent vision loss.
“A child’s eyes should be tested early and tracked regularly while they’re developing because eye elongation is more difficult to control after the process has set in. And, should the child become myopic, parents need to be advised of future complications, which are sure to come.”
In a crowded shopping mall brightly lit with Christmas decorations, we find Linda walking with her white cane. Diagnosed with glaucoma at the age of 21, she shares her poignant story about confronting this debilitating condition, which more than likely will progress to complete blindness. After enduring five years daily regimes of a variety of eye drops along with surgical treatments, Linda is no longer allowed to drive. She questions why her glaucoma was not noticed earlier, “I am quite nearsighted so, of course, my vision was checked yearly since I was 10. But I never got a full, complete eye examination until my late teens.”
“With all we now know about signals telling eyes to elongate, just giving a myopic child his first pair of eyeglasses then returning annually for checkups and increasingly stronger lenses, is bordering on professional negligence.”
Outfitted in a wetsuit, Charles takes a few minutes to perform eye exercises before taking his board into the surf. Starting when he was 12, he’s been doing this routine for the last few years, firmly believing that it helps him to see better. He’s anxious that his vision will keep him from his dream to become an astronaut. While anecdotal stories abound of the value of such regimes, its worth is difficult to assess because empirical evidence is nearly impossible to gather. Nevertheless, the twice-a-day, 5-minute exercise ritual, instituted 50 years ago by China’s Minister of Education, is still required of all Chinese schoolchildren today. However, many vision experts are of the opinion that such exercises do nothing for myopia.
“Many people falsely believe that shortsightedness is ‘treated’ by having laser surgery — which is marketed as treatment for myopia… You can, of course, see better but you still have a too-long eye that puts you at risk for other maladies — and, your too-long eye will never become short again because eye stretching is one-way traffic, it’s an irreversible process.”
To-date, there is no outright cure for nearsightedness but as vision science moves forward – many are finding and identifying different strategies to slow and control myopia’s progression – and, we are coming closer to understanding what conditions, physiological and/or environmental, can cause the eye to elongate more than it should in the first place.
Myopia, or nearsightedness, is the most common refractive error of the eye.
Worldwide, myopia has become a major vision-threatening disorder, especially targeting young children growing up better-educated in urban communities. Ocular stress (from near vision activities such as concentrated, intensive, and sustained reading) has long been thought to be responsible for its development. And, in societies where doing well in school is greatly valued, both the prevalence and degree of myopia seem to be directly correlated with the amount of time spent in strenuous, full-time education.
Today, myopia in kids has burgeoned into an out-of-control epidemic – tripling in the USA in the last 30 years. Currently approximately half the populations of both America and Europe are myopic. In 1960’s China – only 20 percent of the population was nearsighted – now, while the rate among schoolchildren in rural China is as low as 5%, its prevalence among 17-year olds in Beijing is 74%. In Taiwan, Hong Kong and Japan 86% of young people in are myopic. Whereas estimates among Singaporean youth are as high as 90%.
What’s causing this recent, staggering uptick in the worldwide Myopia Epidemic?
The steep rise in myopia has set off loud alarm bells among vision professionals. Yet, most people consider being nearsighted a relatively minor nuisance easily corrected with a pair of glasses. But experts’ concerns are heighten with mounting evidence that conventional single-vision lenses, which are traditionally prescribed for myopia may be a driving factor.
“Optical characteristics within the eye seem to be telling it when to elongate. Eye glasses typically used to correct nearsightedness cause light rays to converge on the macula at the back/center area of the retina. But, with single-vision lenses, this same in-coming light doesn’t land properly on the peripheral parts of the retina. Responding to this, the eyeball keeps lengthening to compensate – making the myopia worse.”
LOSING SIGHT explores the whys and wherefores of this ‘silent’ epidemic that remains largely outside common public knowledge.
Reviewing what is known about myopia, we investigate reasons for its rise and how scientists are working to resolve unanswered questions into the mechanisms that drive eye growth.
Although spikes in myopia have been documented in particular pockets of populations throughout past centuries, the origins of the current epidemic can be traced back to shortly after the end of WWII. What’s new this time is that the span and magnitude of the present-day crisis has sparked a massive world-wide response from researchers, practitioners and industry who have joined together to tackle the mysteries of this phenomenon.
While no one fully understands what exactly triggers eye to grow, several contributing factors are clearly evident: Genetics is definitely one component of myopia but, across the globe, it represents only a small fraction (10-14%) of the story.
“If you look in evolutionary terms at simple societies who are still living as we might have lived ten thousand years ago – there’s a tiny percentage of myopia so we can surmise that, in a natural environment, humans are not a genetically myopic race.”
Studies of groups of indigenous peoples who spend most of their daily lives outdoors (Inuits and Amazonians, inhabitants of rural Romanian villages, Pacific islanders) reveal that as soon as classroom education and other elements of modern society become the norm, the rates of myopia rise – sometimes, as quickly as in one generation.
Consequently, researchers are looking back to changes in environmental factors brought on by modern living, societal stresses, artificial lighting, dietary compromises, physical exercise, competitive education, books contra computers, time spent indoors versus outside, etc…
In most cases, myopia stops progressing when students finish school, although this may not be until adulthood for those pursing higher education, particularly law or medicine.
Why should we care?
Once stretched, the myopic eye forever retains its elongated shape along with continuing physiological stress, which hastens the onset of associated blinding diseases. Therefore, goal of vision specialists is to find a way to slow down and, hopefully, halt this process as early as possible in a child’s life.
Some go so far as to assert that children should be forbidden from playing with electronic gadgets and that it would be better if parents didn’t press toddlers into learning to read before first grade.
After decades of research on the Myopia Epidemic being largely ignored by major media, studies published in Lancet finally caught the attention of the popular press with the suggestion that spending two-hours-per-day outdoors might provide an intriguingly simple solution: Sunshine, they said, was the answer.
It remains unclear how light impacts myopia but among the hypotheses is that, when stimulated by blue light (460-500 nm.) the retina releases dopamine, which acts as an inhibitor for eye growth. Also, in brighter light pupils become smaller, allowing a greater depth of field and less image blur.
“Today many believe that bright light can be preventative for childhood myopia but we must not forget that there’s a part of the blue spectrum that’s really harmful to retinal cells. It’s controversial because when we speak about blue light, it’s not just one blue. You have parts of the blue spectrum that are very useful especially to regulate your circadian cycle. But different wavelengths have different impacts and we’re still trying to find out which ones hurt and which ones help.”
However, other vision scientists push back on the Sunshine Theory, asserting instead that the benefit of time spent outdoors comes not just from light intensity but that the act of looking out at a distance protects the eye because the point-of-focus is constantly moving back and forth – from near to far. That is to say, when outside our eyes shift perspective – we look out into the open and view three-dimensional objects from afar – as opposed to the close, fixed-distance concentration of near work.
“With new technologies, we’re able measure whether the images we see themselves and their distance from our eyes – indoors or outdoors – in urban environments or on the written page – actually do have differences in terms of how the image is made up, which can tell the eye to grow longer…
“The eye is responding to what it sees. So, we need to understand what’s exactly in the image that the eye is capturing which tells it whether to grow or not to grow. And to do that, we need to understand everything about that image.”
Essentially we’ve reached a nexus where Vision Science meets technical innovation: With advances in pharmaceuticals and lens design, inventive methodologies are now being applied to scientific discoveries made by associates of Wallman Vision Lab nearly half-a-century ago. These breakthroughs are giving practitioners new and innovative remedies to help to stem-the-tide of an ever-growing global epidemic.
In their effort not to overwhelm viewers with abstract concepts and difficult words, we take a cue from Peter Friedman and Jean-François Brunet’s visually entertaining film, Death By Design (1995) wherein scientists explain the complexities of cellular behaviors in everyday language, never once uttering ‘Apoptosis’ – the scientific term central to the story. [https://www.youtube.com/watch?v=4NytzTLnyKM]
Artistically, our intention is to increase public awareness of this ‘invisible’ vision crisis by giving audiences a kinetic, visceral sense of what it means to be optically challenged. Using state-of-the-art digital imagery, we simulate how vision develops in children, the characteristics of myopia, and early signs of visual anomalies that may be signaling the onset of associated diseases.
Hence, point-of-view visual representations of ‘how we see what we see‘ is an important component of our storytelling. Although we all use common words to describe visual acuity, brightness and colors, human vision is very personal and highly subjective and nearly impossible to replicate on the screen.
Because this filmmaker, herself a myope is coping with fragile retinas, cataracts and glaucoma, she has a pretty clear conception of what these kinds visual aberrations look like from the inside. Her cinematographic challenge is finding ways to accurately depict how nearsighted and otherwise visually challenged people see and experience the world.
The way human vision works is neither static nor flat: Our eyes ‘accommodate’ in 3-dimensions – zooming in and out through a multitude of fields of focus – all the while constantly and rapidly accommodating or ‘pulling focus’ inside the eye – as we look at someone’s face, observe an object, scan a room, or lift up suddenly from our phone so as not to bump into someone on the sidewalk.
By layering digital imaging, we’ve found creative ways to simulate how we view our world as well as various aspects of how people experience vision that’s been compromised by myopic refractive errors, cataracts, glaucoma, macular myopathies and/or retinal detachment.
A Multi-Platform Documentary Project
With millions of young people unwittingly marching towards blindness, our objective is to reach as wide a general audience as possible on multiple media and educational platforms. To do this, we’ve created a project with a strong visual and editorial line while building an integrated international distribution model with: 1) A creative, feature-length documentary film; 2) a 52-min version for TV and classroom screenings; 3) five x short episodes (2-3 mins each) designed for the internet and doctors’ waiting rooms; 4) a 12-hour Audio book and; a 20-min traveling science-education museum exhibition (produced & budgeted separately).
A Brewster Pond Production