Dr. Shefali Miglani:
Good morning. My name is Dr. Shefali Miglani and I am an optometrist with my own private practice in New Jersey called Monroe eyecare. I’m also the chief medical officer of Hoot Myopia Care. Hoot is a parent education platform that helps optometrists enable parents to learn about myopia progression and to do something about it for their children. Today, I’m speaking with Dr. Yoram Friedman of fellow optometrist and myopia management specialists running his practice right here in beautiful Bound Brook, New Jersey called Family Vision Center. Dr. Friedman has recently joined our growing community of myopia management specialists here at Hoot Myopia Care. Dr. Friedman. Hello and welcome to Hoot.
Dr. Yoram Friedman:
Good afternoon. Thanks for having me
Dr. Shefali Miglani:
Of course. So, for parents who don’t know anything about myopia. Can you please tell us, tell them about it?
Dr. Yoram Friedman:
Sure. Uh, so, uh, myopia is, uh, is the technical term for near-sightedness. It’s when a person can see clearly up close, but they have difficulty seeing things far away. Um, and it’s a condition that involves a mismatch between the curvature of the cornea and the size of the eye. And, um, and it’s a condition that is becoming increasingly common.
Dr. Shefali Miglani:
Right. So now that you told us a little bit about what myopia is, um, why should the parents care about it?
Dr. Yoram Friedman:
Sure. So, um, there are, there are both cosmetic lifestyles and, uh, eye health reasons to care about increasing near-sightedness. So of course we’re all kind of familiar with a person who, uh, develops increasing near-sightedness and, and, and, uh, and so they develop a greater need for, uh, glasses, uh, and, and the glasses may end up becoming thick and, and, uh, and heavy and uncomfortable. And, and, uh, and you know, a lot of parents are concerned that their child may be needing Coke bottle glasses when they’re, when they’re, when they’re teenagers. Um, and, and also, uh, in terms of lifestyle, a person who has a relatively low prescription is going to be far less dependent on their correction than someone who has a higher prescription. So the person with a higher prescription, uh, may not be able to go in the kitchen in the middle of the night or the restroom without having to reach for their glasses or their contact lenses.
Dr. Yoram Friedman:
But beyond that, um, we see, um, a number of different eye diseases that become far more common for people who are highly near-sighted. Um, you know, it’s an extreme case, but, but, but it’s one, uh, kind of changed my perspective on the issue is a couple of years ago, I had a patient who, um, he’s a minus 20 Myope, which is, uh, is high prescription. And, um, and his daughter was one of my first ortho K patients. But, um, maybe about three or four years ago, I started noticing that his retina was becoming, uh, wrinkled and I referred him to a retina specialist and he delayed a while, but in the end, ended up needing retinal surgery and, uh, and it, and the surgery went poorly and, and he is now a minus 20 myope in one eye and he’s essentially blind in the eye that had these problems.
Dr. Yoram Friedman:
And I spoke with the retinal surgeon afterward. And, uh, the surgeon explained to me that, um, surgery that, that, that eye problems aren’t just more common in high myopes, but the surgery is far more delicate and tricky when a person’s, uh, the retina is so thin a person who’s highly myopic, the retina becomes increasingly thin and like cellophane paper. And so it’s harder to when, when a patient needs those kinds of treatments, it becomes much riskier. So, you know, that was something that kind of changed my attitude. I, I, I’ve always had the attitude that obviously, you know, parents are gonna do what they wanna do and, and, you know, uh, but, um, but I encourage them to take a little bit more of a proactive approach, uh, you know, knowing. I’m saying in general, now that I, myself have a greater understanding of, of, of the, of the risks that are, that come along with having really high myopia, you know, I, I’m more strongly encouraging parents to be proactive.
Dr. Shefali Miglani:
Okay. So can you, um, sort of concisely tell the parents what risk myopia has progressing myopia has when the child is, grows up to be an adult, like what are three or four common things that you and I see in our practice that is, you know, can be vision threatening forever.
Dr. Yoram Friedman:
Sure. So, going back to the idea that myopia nearsightedness is this mismatch between the curvature of the eye and the science of the eye. The most common thing in progressive myopia is that the eyeball is getting physically larger as it gets physically larger, the retina gets stretched thinner. And so the, the most common and concerning thing, uh, later in life are holes and tears in the retina, they become higher, the more highly myopic and adult is the higher, the risk for developing those problems, which can, in some cases be blinding. That’s not the only thing. Um, I mean, uh, high, highly myopic patients are, are, are at higher risk for glaucoma, um, you know, and, and some other conditions, but, but the holes and tears and retinal detachments are for sure, um, you know, the most serious thing that, that, that are directly related to increasing myopia.
Dr. Shefali Miglani:
Right. And, and you, and I also see that myopic patients, um, you know, they can also have glaucoma, which is, you know, so, so a lot of the glaucoma patients that we have to tend to be myopic, so that’s definitely a risk factor.
Dr. Yoram Friedman:
Sure. And I’ll call it an ankle. Glaucoma is more difficult to evaluate when we look at a myopic fundance, and we have to evaluate, you know, the appearance of a person’s optic nerve is so much trickier in those high myopes
Dr. Yoram Friedman:
Exactly. Exactly. So, you know, to control myopia the best you can do is, to start addressing it when the child is young and not let it go to wherever the genetics has programmed them to be, you know, so genetics don’t have to rule. We have to, we can do something about it. Let me, um, let me ask you, so have you seen the impact of more near work, online schooling, greater use of devices in your practice?
Dr. Yoram Friedman:
For sure. For sure. Um, you know, what, what a, what a time to be an optometrist with this pandemic, and we’re seeing it’s, it’s like, it’s like a controlled experiment. Okay. Let’s have a year. I mean, of course our society has for a long time now been heading down this road where we’re, we’re all becoming clerks. I, you know, I like to tell patients that we’ve known for 150 years, that clerk’s become near-sighted in a way that farmers don’t, like, that’s not a news flash that’s been known for a long time, but, but we’re all becoming clerks. I mean, even farmers are staring at their cell phones half the day. And, um, but with this pandemic, I mean that, like, that, like put all this near work stuff on steroids. And I think we’re all seeing, uh, increasing myopia at noticeably greater levels in this last year than what we had seen previously, for sure.
Dr. Shefali Miglani:
I mean, it’s become to an epidemic level where, uh, you know, we need all, all, all hands on deck to control this progressive disease. Um, all right. So, um, now walk us through what the parents should be thinking about now that their kids should be returning back to school.
Dr. Yoram Friedman:
Well, I think the first thing is, um, uh, you know, kids should get regular yearly eye exams. Uh, cause we don’t know if that’s the only, that’s the first, first way to know if there’s an issue I’m not here, there are still lots of kids whose eyes are perfectly healthy and who aren’t near-sighted and that’s great. And we’d like to know that too.
Dr. Shefali MiglanI:
What, what are some of the symptoms that they should be watching for, uh, the parents, uh, and the kids let’s educate our, our population, patient population of the symptoms that they may be, that they may be experiencing when they returned back to school.
Dr. Yoram Friedman:
So for sure any, any kid who’s having difficulty seeing the board, any, any kid who’s, uh, squinting, you know, while they’re, while they’re, uh, watching TV, uh, you know, th those are, those are things to be on the lookout for, um, you know, but I’m not sure that I like to leave this issue up to a question of symptoms, uh, you know, uh, um, kids, uh, find ways to manage, uh, with vision. That’s not, uh, not so great. And, uh, and so if we rely on them to provide symptoms, uh, we’re going to miss the boat a lot of times. So I, you know, I, I think, um, I think just getting them in for a routine eye exam is the very first step. Yeah, for sure. For sure. It’s more urgent. If, if they’re reporting difficulty, seeing things they’re not seeing as well on their glasses, as they used to complaining of headaches.
Dr. Shefali Miglani:
Are not doing well in school, even, you know, a lot of the learning is visual and that’s that, that warrants a complete eye health checkup with you. For sure. Yeah. Yeah. So, uh, when you diagnose these kids in your office with myopia, uh, what are some of your go-to therapies for myopia management? What do you talk to the parents about? What do you say?
Dr. Yoram Friedman:
So, uh, I generally like to let parents know that there are really, uh, two, two issues. One is we want their children to be able to see really well, you know, uh, they need to be able to see everything they need to see. And, um, and then we also want to prevent near-sightedness from getting worse year after year. And there are some treatments that address both of those issues at the same time. And, uh, and, and, and there are other other treatments that will only dress one and not the other. So for instance, a lot of times parents, uh, you know, want to know, okay, with a pair of glasses, my child’s going to be seeing clearly, and that’s true as far as it goes, you know, but, um, but you know, glasses don’t do anything to prevent the prescription from getting worse year after year,
Dr. Shefali Miglani:
Right. In fact, that’s the problem.
Dr. Yoram Friedman:
Yeah. Um, you know, regular contact lenses might free a child from glasses, but they also don’t prevent a prescription from getting worse year after year. So we have, we have three, um, we have three, um, treatment modalities that we work with at our office that, uh, that can be used to, uh, for which I’m aware of good evidence, that they prevent a prescription from getting worse year after year. And those include, um, low dose atropine eye drops, a multifocal, uh, daytime contact lens wear, and orthokeratology or ortho K.
Dr. Shefali Miglani:
What is the most popular, um, treatment, uh, avenue that you take with, or has been, you know, in your, in your office popular?
Dr. Yoram Friedman:
Um, ortho K has been, by far, more popular than the other. Um, well, um, you know, the eyedrops, for one thing, don’t, don’t help a child to see. Yeah. Okay. Uh, and so, um, uh, and then a lot of the parents who, um, who opt, who are concerned about myopia control for their children, their children might be a little bit young to be going to school, wearing contact lenses that, you know, they, they, they want whatever the method of this issue, they want it to be done under their roof in their home. And the ortho K takes place really under the supervision of the parents. So mom and dad are in charge, but, you know, you send your child to school with, with, uh, with a multifocal contact lens that they’re wearing during the day, the child needs to be responsible enough to, to handle it, to take it out, if it needs to be taken out, put it back in, you know, hand-washing case, the, you know, the whole nine yards.
Dr. Shefali Miglani:
Yeah. So the ortho K allows, uh, what, what’s the advantage that ortho K has for the kids?
Dr. Yoram Friedman:
Okay, as a contact lens, that’s only born during nighttime hours, right? So they’re worn at home. They, they get, they get put, I have some parents where the parents want to be the ones putting the lens on the child’s eyes. They want to be the ones putting it on and taking it off. They don’t, you know, they, they don’t want to leave that to their children. Right. That’s okay. You know, I mean, uh, but even, even for those parents who want the child to be doing it, they are often comforted by the knowledge that, okay, this is only being worn in my house under my care and supervision. If there’s a problem, you know, I have Dr. Freeman’s cell phone number, I’ll call them up, you know, but it’s not, I’m not delegating it to the school nurse.
Dr. Shefali Miglani:
And isn’t it great that when they go to school, they actually do. They don’t have to wear their glasses. They’re corrected for myopia after that night. So it’s, it’s wonderful. Not having any daytime wear I wear to be responsible for. So that’s great. So let’s wrap up, um, you know, well, well, you know, before we wrap up, give me one piece of advice that you’d like to tell the parents before they send their kids to school.
Dr. Yoram Friedman:
Well, I know that there are some parents out there and an increasing number of parents out there, every parent is going to be different, but there are some parents who are really worried about this, right? Just keep them up at night. Maybe, maybe, maybe dad was a minus eight and he had LASIK and minus, and mom is a minus 11. And she worked in, and they do not want their children to, uh, to develop these high levels of near-sightedness from which, you know, they have personal experience of how it impacts their lives. Um, I want those patients to know that, that, that there, that there are really good proven treatments out there, you know, it’s, you know, it’s not new, it’s not experimental. Um, it’s been FDA, ortho K has been FDA approved since 2003. It’s, it’s been around. We’ve been, you know, we have a lot of very happy patients who, whose myopia has been very well controlled for, you know, I, me personally, I’ve been doing this for 12 years, so, you know.
Dr. Shefali Miglani:
That’s great. So very good. So that’s a very good, uh, piece of advice. Uh, you know, I, I’m sure that our audience has learned a lot about it. So, uh, let’s wrap up. Uh, today we spoke to Dr. Friedman, Phillip fellow optometrists, and, um, owner of Family Vision Center, and now proud Hoot Myopia Care specialist. Thank you doctor for your time today. Hope to see you soon.
Dr. Yoram Friedman:
Thank you so much. I really appreciate your time.
Dr. Shefali Miglani:
Good morning. My name is Dr. Shefali Miglani and I am an optometrist with my own private practice in New Jersey called Monroe eyecare. I’m also the chief medical officer of Hoot Myopia Care. Hoot is a parent education platform that helps optometrists enable parents to learn about myopia progression and to do something about it for their children. Today, I’m speaking with Dr. Yoram Friedman of fellow optometrist and myopia management specialists running his practice right here in beautiful Bound Brook, New Jersey called Family Vision Center. Dr. Friedman has recently joined our growing community of myopia management specialists here at Hoot Myopia Care. Dr. Friedman. Hello and welcome to Hoot.
Dr. Yoram Friedman:
Good afternoon. Thanks for having me
Dr. Shefali Miglani:
Of course. So, for parents who don’t know anything about myopia. Can you please tell us, tell them about it?
Dr. Yoram Friedman:
Sure. Uh, so, uh, myopia is, uh, is the technical term for near-sightedness. It’s when a person can see clearly up close, but they have difficulty seeing things far away. Um, and it’s a condition that involves a mismatch between the curvature of the cornea and the size of the eye. And, um, and it’s a condition that is becoming increasingly common.
Dr. Shefali Miglani:
Right. So now that you told us a little bit about what myopia is, um, why should the parents care about it?
Dr. Yoram Friedman:
Sure. So, um, there are, there are both cosmetic lifestyles and, uh, eye health reasons to care about increasing near-sightedness. So of course we’re all kind of familiar with a person who, uh, develops increasing near-sightedness and, and, and, uh, and so they develop a greater need for, uh, glasses, uh, and, and the glasses may end up becoming thick and, and, uh, and heavy and uncomfortable. And, and, uh, and you know, a lot of parents are concerned that their child may be needing Coke bottle glasses when they’re, when they’re, when they’re teenagers. Um, and, and also, uh, in terms of lifestyle, a person who has a relatively low prescription is going to be far less dependent on their correction than someone who has a higher prescription. So the person with a higher prescription, uh, may not be able to go in the kitchen in the middle of the night or the restroom without having to reach for their glasses or their contact lenses.
Dr. Yoram Friedman:
But beyond that, um, we see, um, a number of different eye diseases that become far more common for people who are highly near-sighted. Um, you know, it’s an extreme case, but, but, but it’s one, uh, kind of changed my perspective on the issue is a couple of years ago, I had a patient who, um, he’s a minus 20 Myope, which is, uh, is high prescription. And, um, and his daughter was one of my first ortho K patients. But, um, maybe about three or four years ago, I started noticing that his retina was becoming, uh, wrinkled and I referred him to a retina specialist and he delayed a while, but in the end, ended up needing retinal surgery and, uh, and it, and the surgery went poorly and, and he is now a minus 20 myope in one eye and he’s essentially blind in the eye that had these problems.
Dr. Yoram Friedman:
And I spoke with the retinal surgeon afterward. And, uh, the surgeon explained to me that, um, surgery that, that, that eye problems aren’t just more common in high myopes, but the surgery is far more delicate and tricky when a person’s, uh, the retina is so thin a person who’s highly myopic, the retina becomes increasingly thin and like cellophane paper. And so it’s harder to when, when a patient needs those kinds of treatments, it becomes much riskier. So, you know, that was something that kind of changed my attitude. I, I, I’ve always had the attitude that obviously, you know, parents are gonna do what they wanna do and, and, you know, uh, but, um, but I encourage them to take a little bit more of a proactive approach, uh, you know, knowing. I’m saying in general, now that I, myself have a greater understanding of, of, of the, of the risks that are, that come along with having really high myopia, you know, I, I’m more strongly encouraging parents to be proactive.
Dr. Shefali Miglani:
Okay. So can you, um, sort of concisely tell the parents what risk myopia has progressing myopia has when the child is, grows up to be an adult, like what are three or four common things that you and I see in our practice that is, you know, can be vision threatening forever.
Dr. Yoram Friedman:
Sure. So, going back to the idea that myopia nearsightedness is this mismatch between the curvature of the eye and the science of the eye. The most common thing in progressive myopia is that the eyeball is getting physically larger as it gets physically larger, the retina gets stretched thinner. And so the, the most common and concerning thing, uh, later in life are holes and tears in the retina, they become higher, the more highly myopic and adult is the higher, the risk for developing those problems, which can, in some cases be blinding. That’s not the only thing. Um, I mean, uh, high, highly myopic patients are, are, are at higher risk for glaucoma, um, you know, and, and some other conditions, but, but the holes and tears and retinal detachments are for sure, um, you know, the most serious thing that, that, that are directly related to increasing myopia.
Dr. Shefali Miglani:
Right. And, and you, and I also see that myopic patients, um, you know, they can also have glaucoma, which is, you know, so, so a lot of the glaucoma patients that we have to tend to be myopic, so that’s definitely a risk factor.
Dr. Yoram Friedman:
Sure. And I’ll call it an ankle. Glaucoma is more difficult to evaluate when we look at a myopic fundance, and we have to evaluate, you know, the appearance of a person’s optic nerve is so much trickier in those high myopes
Dr. Yoram Friedman:
Exactly. Exactly. So, you know, to control myopia the best you can do is, to start addressing it when the child is young and not let it go to wherever the genetics has programmed them to be, you know, so genetics don’t have to rule. We have to, we can do something about it. Let me, um, let me ask you, so have you seen the impact of more near work, online schooling, greater use of devices in your practice?
Dr. Yoram Friedman:
For sure. For sure. Um, you know, what, what a, what a time to be an optometrist with this pandemic, and we’re seeing it’s, it’s like, it’s like a controlled experiment. Okay. Let’s have a year. I mean, of course our society has for a long time now been heading down this road where we’re, we’re all becoming clerks. I, you know, I like to tell patients that we’ve known for 150 years, that clerk’s become near-sighted in a way that farmers don’t, like, that’s not a news flash that’s been known for a long time, but, but we’re all becoming clerks. I mean, even farmers are staring at their cell phones half the day. And, um, but with this pandemic, I mean that, like, that, like put all this near work stuff on steroids. And I think we’re all seeing, uh, increasing myopia at noticeably greater levels in this last year than what we had seen previously, for sure.
Dr. Shefali Miglani:
I mean, it’s become to an epidemic level where, uh, you know, we need all, all, all hands on deck to control this progressive disease. Um, all right. So, um, now walk us through what the parents should be thinking about now that their kids should be returning back to school.
Dr. Yoram Friedman:
Well, I think the first thing is, um, uh, you know, kids should get regular yearly eye exams. Uh, cause we don’t know if that’s the only, that’s the first, first way to know if there’s an issue I’m not here, there are still lots of kids whose eyes are perfectly healthy and who aren’t near-sighted and that’s great. And we’d like to know that too.
Dr. Shefali MiglanI:
What, what are some of the symptoms that they should be watching for, uh, the parents, uh, and the kids let’s educate our, our population, patient population of the symptoms that they may be, that they may be experiencing when they returned back to school.
Dr. Yoram Friedman:
So for sure any, any kid who’s having difficulty seeing the board, any, any kid who’s, uh, squinting, you know, while they’re, while they’re, uh, watching TV, uh, you know, th those are, those are things to be on the lookout for, um, you know, but I’m not sure that I like to leave this issue up to a question of symptoms, uh, you know, uh, um, kids, uh, find ways to manage, uh, with vision. That’s not, uh, not so great. And, uh, and so if we rely on them to provide symptoms, uh, we’re going to miss the boat a lot of times. So I, you know, I, I think, um, I think just getting them in for a routine eye exam is the very first step. Yeah, for sure. For sure. It’s more urgent. If, if they’re reporting difficulty, seeing things they’re not seeing as well on their glasses, as they used to complaining of headaches.
Dr. Shefali Miglani:
Are not doing well in school, even, you know, a lot of the learning is visual and that’s that, that warrants a complete eye health checkup with you. For sure. Yeah. Yeah. So, uh, when you diagnose these kids in your office with myopia, uh, what are some of your go-to therapies for myopia management? What do you talk to the parents about? What do you say?
Dr. Yoram Friedman:
So, uh, I generally like to let parents know that there are really, uh, two, two issues. One is we want their children to be able to see really well, you know, uh, they need to be able to see everything they need to see. And, um, and then we also want to prevent near-sightedness from getting worse year after year. And there are some treatments that address both of those issues at the same time. And, uh, and, and, and there are other other treatments that will only dress one and not the other. So for instance, a lot of times parents, uh, you know, want to know, okay, with a pair of glasses, my child’s going to be seeing clearly, and that’s true as far as it goes, you know, but, um, but you know, glasses don’t do anything to prevent the prescription from getting worse year after year,
Dr. Shefali Miglani:
Right. In fact, that’s the problem.
Dr. Yoram Friedman:
Yeah. Um, you know, regular contact lenses might free a child from glasses, but they also don’t prevent a prescription from getting worse year after year. So we have, we have three, um, we have three, um, treatment modalities that we work with at our office that, uh, that can be used to, uh, for which I’m aware of good evidence, that they prevent a prescription from getting worse year after year. And those include, um, low dose atropine eye drops, a multifocal, uh, daytime contact lens wear, and orthokeratology or ortho K.
Dr. Shefali Miglani:
What is the most popular, um, treatment, uh, avenue that you take with, or has been, you know, in your, in your office popular?
Dr. Yoram Friedman:
Um, ortho K has been, by far, more popular than the other. Um, well, um, you know, the eyedrops, for one thing, don’t, don’t help a child to see. Yeah. Okay. Uh, and so, um, uh, and then a lot of the parents who, um, who opt, who are concerned about myopia control for their children, their children might be a little bit young to be going to school, wearing contact lenses that, you know, they, they, they want whatever the method of this issue, they want it to be done under their roof in their home. And the ortho K takes place really under the supervision of the parents. So mom and dad are in charge, but, you know, you send your child to school with, with, uh, with a multifocal contact lens that they’re wearing during the day, the child needs to be responsible enough to, to handle it, to take it out, if it needs to be taken out, put it back in, you know, hand-washing case, the, you know, the whole nine yards.
Dr. Shefali Miglani:
Yeah. So the ortho K allows, uh, what, what’s the advantage that ortho K has for the kids?
Dr. Yoram Friedman:
Okay, as a contact lens, that’s only born during nighttime hours, right? So they’re worn at home. They, they get, they get put, I have some parents where the parents want to be the ones putting the lens on the child’s eyes. They want to be the ones putting it on and taking it off. They don’t, you know, they, they don’t want to leave that to their children. Right. That’s okay. You know, I mean, uh, but even, even for those parents who want the child to be doing it, they are often comforted by the knowledge that, okay, this is only being worn in my house under my care and supervision. If there’s a problem, you know, I have Dr. Freeman’s cell phone number, I’ll call them up, you know, but it’s not, I’m not delegating it to the school nurse.
Dr. Shefali Miglani:
And isn’t it great that when they go to school, they actually do. They don’t have to wear their glasses. They’re corrected for myopia after that night. So it’s, it’s wonderful. Not having any daytime wear I wear to be responsible for. So that’s great. So let’s wrap up, um, you know, well, well, you know, before we wrap up, give me one piece of advice that you’d like to tell the parents before they send their kids to school.
Dr. Yoram Friedman:
Well, I know that there are some parents out there and an increasing number of parents out there, every parent is going to be different, but there are some parents who are really worried about this, right? Just keep them up at night. Maybe, maybe, maybe dad was a minus eight and he had LASIK and minus, and mom is a minus 11. And she worked in, and they do not want their children to, uh, to develop these high levels of near-sightedness from which, you know, they have personal experience of how it impacts their lives. Um, I want those patients to know that, that, that there, that there are really good proven treatments out there, you know, it’s, you know, it’s not new, it’s not experimental. Um, it’s been FDA, ortho K has been FDA approved since 2003. It’s, it’s been around. We’ve been, you know, we have a lot of very happy patients who, whose myopia has been very well controlled for, you know, I, me personally, I’ve been doing this for 12 years, so, you know.
Dr. Shefali Miglani:
That’s great. So very good. So that’s a very good, uh, piece of advice. Uh, you know, I, I’m sure that our audience has learned a lot about it. So, uh, let’s wrap up. Uh, today we spoke to Dr. Friedman, Phillip fellow optometrists, and, um, owner of Family Vision Center, and now proud Hoot Myopia Care specialist. Thank you doctor for your time today. Hope to see you soon.
Dr. Yoram Friedman:
Thank you so much. I really appreciate your time.
