INTERVIEW WITH DR. SARAH ITO

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INTERVIEW WITH DR. SARAH ITO

Dr. Shefali Miglani:
Hello. My name is Dr. Shefali Miglani and I’m 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 their children. Today, I’m speaking with Dr. Sarah Ito, a fellow optometrist and myopia management specialist running her private practice in beautiful Santa Monica, California called Ocean Park Optometry. Dr. Ito has recently joined a growing community of myopia management specialists here at Hoot Myopia Care, Dr. ITO. Hello and welcome to Hoot.

Dr. Sarah Ito:
Thank you, Dr. Miglani. I’m so happy to be here.

Dr. Shefali Miglani:
What a pleasure. So, uh, tell us for the parents who don’t know anything about myopia. Can you please, uh, tell them what myopia is and why this is something they should care about?

Dr. Sarah Ito:
So myopia is a medical term for near-sightedness, and near-sightedness means that the vision is clear at near and blurry at the distance. So a high degree of myopia has a risk factor for blinding eye conditions. The higher it is, the higher the risk and children that are developing myopia quickly, you know, especially while COVID was sheltering at home, they’ve been in an indoor closed environment. So the prescriptions have been increasing at an alarming rate. Um, and some parents might think that myopia just means that they have to wear glasses, but it’s not just a matter of wearing glasses. It’s a global concern right now with published studies and there are methods to slow it down and, uh, keep it from getting worse.

Dr. Shefali Miglani:
Wonderful. Um, have you seen the impact of more near work, online schooling, greater use of devices in your practice with your patients?

Dr. Sarah Ito:
Yes. We have seen a big impact, uh, prior to the pandemic myopia progression was already a concern, uh, during the pandemic, almost everyone spent more time on digital devices and stayed indoors most of the time. So I’m seeing children returning with much worse vision today. Um, the children who had a clear vision before they’re nearsighted, and this, you know, a lot of them, it’s not attributed to genetics or normal growth, so it’s the environment causing this. Um, so it’s estimated 50% of the world will be near-sighted, but I feel like it’s going to happen sooner than what they expected. They said it would be by 2050, but I think it’s going to be sooner than that. If we don’t do anything.

Dr. Shefali Miglani:
I absolutely agree with you, Dr. Ito, uh, is Santa Monica not different? I mean, you guys have a lot of sunlight, uh, but youR kids don’t play outside in the beautiful weather. Um, how does that, uh, you know, is that different? What do you think?

Dr. Sarah Ito:
So we are in a beautiful beach city and we’re very fortunate to have the weather and the clean air, uh, but as a densely populated popular place to live. So around the homes, there’s not that much space for children to play.

Dr. Shefali Miglani:
Wow. That’s, uh, I didn’t think of that. All right. Now walk us through what parents should be thinking about as their kids return to school.

Dr. Sarah Ito:
So, um, the children at first, they learn to read, but then they read to learn, and reading relies heavily on vision. So they need to have clear vision and eye coordination skills to learn, without good vision reading suffers and learning suffers. So, uh, children should be having a comprehensive eye exam every year, regardless of any symptoms or anything suspicious. Um, because school screening alone isn’t enough.

Dr. Shefali MiglanI:
Right, right, right. And the kids are also doing homework on their computers. They’re on their devices, more than ever, what should parents be on the lookout for at home?

Dr. Sarah Ito:
So if possible, to reduce the screen time, um, you know, it’s a, it’s a part of learning today, so you can avoid it completely. But some of the things they can do are ergonomics. For example, having the computer not too close, um, and slightly down gaze because if they look straight or up at the computer, this can cause dry eyes. And that also causes blurry vision. Um, the screen of possible should not be against a wall if there’s open space around it, it’s easier for them to follow the 20, 20, 20 rule, which means they can look 20 feet away every 20 minutes for 20 seconds. Um, so if possible, it’s less eye strain to look at a piece of paper or read on a piece of paper than on a digital device, if they can substitute. Um, and if they’re having discomfort scrolling on the computer screen, getting eye strained that way there may be eye coordination issues as well.

Dr. Shefali Miglani:
What did some of the symptoms that kids come in with your practice with what did the symptoms that the parents should be, uh, looking for?

Dr. Sarah Ito:
So eye strain headaches, looking very close on the computer screen, rubbing their eyes, red eyes, um, avoiding reading.

Dr. Shefali Miglani:
And if the children have these symptoms, what should they do?

Dr. Sarah Ito:
So they should have a comprehensive eye exam because there are many different root causes that could be at play. Um, so to determine what the real cause is and to do something about it.

Dr. Shefali Miglani:
Yes. And, what are your go-to myopia management therapies in your practice?

Dr. Sarah Ito:
So we use three different methods, primarily the first is orthokeratology or corneal molding, which is where we use a custom-designed lens that’s worn during sleep, to reshape the front surface of the eye. And that decreases the prescription and also has an effect to slow down the progression of myopia. We can fit these lenses and kids as young as five to seven. Um, and in studies, ortho K is shown to slow down the progression by 50%, but I’ve often seen kids not progress at all after starting. So, um, most kids without intervention, they’ll go up if the prescription doesn’t go down ever. And then the second method is soft dual focus lenses, multifocal lenses that are worn during the day. It has a similar effect as Ortho K, but the lenses are worn during the day and then low dose atropine. It’s a once-a-day eye drop.

Dr. Shefali Miglani:
Well, that’s great. So you use all three methods in your practice. Very good. Um, what about, uh, behavioral modification? Is that important for kids?

Dr. Sarah Ito:
Yes, it’s important. So spending time outside at least two hours a day is associated with slowing down the rate of myopia change. Um, and near work ergonomics posture, reducing screen time. That’s important. The bigger the screen on the farther it is the less eye strain it is, uh, taking frequent breaks. Um, you know, not only do kids have eye strain but when they’re staring at digital devices, it was shown that people blink 60% less. And that can cause dry eyes as well.

Dr. Shefali Miglani:
So why should parents take action now?

Dr. Sarah Ito:
So the parents should take action now because the earlier you begin treatment, the lower the prescription will remain, and if you start later, it will not be a lower prescription ever again. A lot of parents will regret not having taken action once they find that this is possible.

Dr. Shefali Miglani:
Right. And the prescription keeps getting worse and worse every year. I just had a patient come in, the dad a couple of weeks ago and, the 17-year-old son has a minus nine prescription, and I’ve been seeing him for I don’t know, the last 6, 7 years, and every year he came in and I told him, please do something and he doesn’t, and now he’s, he almost was crying because he couldn’t believe it, that it jumped from minus 5.50 to minus 9 in a span of 2 years. Because he missed last year because of COVID, and he was very, very upset. So I see the regret in the parents and just hope they understood the serious nature of this condition

Dr. Sarah Ito:
Yeah. Some parents think that once they’re adults, they could just simply get LASIK, but LASIK doesn’t change the anatomy of the eye all the way through only the front. So the risk still remains and they could have benefited from seeing clearly without glasses all those years.

Dr. Shefali Miglani:
Finally, tell us one piece of advice that you have for parents who have kids and their eyesight seems to be getting worse.

Dr. Sarah Ito:
So my advice is to take them for a comprehensive eye exam to get the full story about the condition and to receive a personalized recommendation, because again, school screening is not enough. A lot of people rely on that. It’s just like thinking of an eye exam at the DMV as an eye exam. It’s not really an eye exam

Dr. Shefali Miglani:
Or the pediatrician, right?

Dr. Sarah Ito:
So on a device, just on a machine, sometimes it’s not very accurate. So if they’re good candidates, you can give them, the parents can give them the gift of healthier eyes for the future and prevent them from needing thicker and thicker glasses every year. Something that they do today can benefit them forever.

Dr. Shefali Miglani:
Very good. Thank you for all the advice. Um, all right. Let’s wrap up today. We spoke with Dr. Ito fellow optometrists and owner of Ocean Park Optometry, and now a proud Hoot myopia care specialist. Thank you doctor for your time today. Hope to see you soon.

Dr. Sarah Ito:
Thank you.

Dr. Shefali Miglani:
Thank you.

Dr. Shefali Miglani:
Hello. My name is Dr. Shefali Miglani and I’m 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 their children. Today, I’m speaking with Dr. Sarah Ito, a fellow optometrist and myopia management specialist running her private practice in beautiful Santa Monica, California called Ocean Park Optometry. Dr. Ito has recently joined a growing community of myopia management specialists here at Hoot Myopia Care, Dr. ITO. Hello and welcome to Hoot.

Dr. Sarah Ito:
Thank you, Dr. Miglani. I’m so happy to be here.

Dr. Shefali Miglani:
What a pleasure. So, uh, tell us for the parents who don’t know anything about myopia. Can you please, uh, tell them what myopia is and why this is something they should care about?

Dr. Sarah Ito:
So myopia is a medical term for near-sightedness, and near-sightedness means that the vision is clear at near and blurry at the distance. So a high degree of myopia has a risk factor for blinding eye conditions. The higher it is, the higher the risk and children that are developing myopia quickly, you know, especially while COVID was sheltering at home, they’ve been in an indoor closed environment. So the prescriptions have been increasing at an alarming rate. Um, and some parents might think that myopia just means that they have to wear glasses, but it’s not just a matter of wearing glasses. It’s a global concern right now with published studies and there are methods to slow it down and, uh, keep it from getting worse.

Dr. Shefali Miglani:
Wonderful. Um, have you seen the impact of more near work, online schooling, greater use of devices in your practice with your patients?

Dr. Sarah Ito:
Yes. We have seen a big impact, uh, prior to the pandemic myopia progression was already a concern, uh, during the pandemic, almost everyone spent more time on digital devices and stayed indoors most of the time. So I’m seeing children returning with much worse vision today. Um, the children who had a clear vision before they’re nearsighted, and this, you know, a lot of them, it’s not attributed to genetics or normal growth, so it’s the environment causing this. Um, so it’s estimated 50% of the world will be near-sighted, but I feel like it’s going to happen sooner than what they expected. They said it would be by 2050, but I think it’s going to be sooner than that. If we don’t do anything.

Dr. Shefali Miglani:
I absolutely agree with you, Dr. Ito, uh, is Santa Monica not different? I mean, you guys have a lot of sunlight, uh, but youR kids don’t play outside in the beautiful weather. Um, how does that, uh, you know, is that different? What do you think?

Dr. Sarah Ito:
So we are in a beautiful beach city and we’re very fortunate to have the weather and the clean air, uh, but as a densely populated popular place to live. So around the homes, there’s not that much space for children to play.

Dr. Shefali Miglani:
Wow. That’s, uh, I didn’t think of that. All right. Now walk us through what parents should be thinking about as their kids return to school.

Dr. Sarah Ito:
So, um, the children at first, they learn to read, but then they read to learn, and reading relies heavily on vision. So they need to have clear vision and eye coordination skills to learn, without good vision reading suffers and learning suffers. So, uh, children should be having a comprehensive eye exam every year, regardless of any symptoms or anything suspicious. Um, because school screening alone isn’t enough.

Dr. Shefali MiglanI:
Right, right, right. And the kids are also doing homework on their computers. They’re on their devices, more than ever, what should parents be on the lookout for at home?

Dr. Sarah Ito:
So if possible, to reduce the screen time, um, you know, it’s a, it’s a part of learning today, so you can avoid it completely. But some of the things they can do are ergonomics. For example, having the computer not too close, um, and slightly down gaze because if they look straight or up at the computer, this can cause dry eyes. And that also causes blurry vision. Um, the screen of possible should not be against a wall if there’s open space around it, it’s easier for them to follow the 20, 20, 20 rule, which means they can look 20 feet away every 20 minutes for 20 seconds. Um, so if possible, it’s less eye strain to look at a piece of paper or read on a piece of paper than on a digital device, if they can substitute. Um, and if they’re having discomfort scrolling on the computer screen, getting eye strained that way there may be eye coordination issues as well.

Dr. Shefali Miglani:
What did some of the symptoms that kids come in with your practice with what did the symptoms that the parents should be, uh, looking for?

Dr. Sarah Ito:
So eye strain headaches, looking very close on the computer screen, rubbing their eyes, red eyes, um, avoiding reading.

Dr. Shefali Miglani:
And if the children have these symptoms, what should they do?

Dr. Sarah Ito:
So they should have a comprehensive eye exam because there are many different root causes that could be at play. Um, so to determine what the real cause is and to do something about it.

Dr. Shefali Miglani:
Yes. And, what are your go-to myopia management therapies in your practice?

Dr. Sarah Ito:
So we use three different methods, primarily the first is orthokeratology or corneal molding, which is where we use a custom-designed lens that’s worn during sleep, to reshape the front surface of the eye. And that decreases the prescription and also has an effect to slow down the progression of myopia. We can fit these lenses and kids as young as five to seven. Um, and in studies, ortho K is shown to slow down the progression by 50%, but I’ve often seen kids not progress at all after starting. So, um, most kids without intervention, they’ll go up if the prescription doesn’t go down ever. And then the second method is soft dual focus lenses, multifocal lenses that are worn during the day. It has a similar effect as Ortho K, but the lenses are worn during the day and then low dose atropine. It’s a once-a-day eye drop.

Dr. Shefali Miglani:
Well, that’s great. So you use all three methods in your practice. Very good. Um, what about, uh, behavioral modification? Is that important for kids?

Dr. Sarah Ito:
Yes, it’s important. So spending time outside at least two hours a day is associated with slowing down the rate of myopia change. Um, and near work ergonomics posture, reducing screen time. That’s important. The bigger the screen on the farther it is the less eye strain it is, uh, taking frequent breaks. Um, you know, not only do kids have eye strain but when they’re staring at digital devices, it was shown that people blink 60% less. And that can cause dry eyes as well.

Dr. Shefali Miglani:
So why should parents take action now?

Dr. Sarah Ito:
So the parents should take action now because the earlier you begin treatment, the lower the prescription will remain, and if you start later, it will not be a lower prescription ever again. A lot of parents will regret not having taken action once they find that this is possible.

Dr. Shefali Miglani:
Right. And the prescription keeps getting worse and worse every year. I just had a patient come in, the dad a couple of weeks ago and, the 17-year-old son has a minus nine prescription, and I’ve been seeing him for I don’t know, the last 6, 7 years, and every year he came in and I told him, please do something and he doesn’t, and now he’s, he almost was crying because he couldn’t believe it, that it jumped from minus 5.50 to minus 9 in a span of 2 years. Because he missed last year because of COVID, and he was very, very upset. So I see the regret in the parents and just hope they understood the serious nature of this condition

Dr. Sarah Ito:
Yeah. Some parents think that once they’re adults, they could just simply get LASIK, but LASIK doesn’t change the anatomy of the eye all the way through only the front. So the risk still remains and they could have benefited from seeing clearly without glasses all those years.

Dr. Shefali Miglani:
Finally, tell us one piece of advice that you have for parents who have kids and their eyesight seems to be getting worse.

Dr. Sarah Ito:
So my advice is to take them for a comprehensive eye exam to get the full story about the condition and to receive a personalized recommendation, because again, school screening is not enough. A lot of people rely on that. It’s just like thinking of an eye exam at the DMV as an eye exam. It’s not really an eye exam

Dr. Shefali Miglani:
Or the pediatrician, right?

Dr. Sarah Ito:
So on a device, just on a machine, sometimes it’s not very accurate. So if they’re good candidates, you can give them, the parents can give them the gift of healthier eyes for the future and prevent them from needing thicker and thicker glasses every year. Something that they do today can benefit them forever.

Dr. Shefali Miglani:
Very good. Thank you for all the advice. Um, all right. Let’s wrap up today. We spoke with Dr. Ito fellow optometrists and owner of Ocean Park Optometry, and now a proud Hoot myopia care specialist. Thank you doctor for your time today. Hope to see you soon.

Dr. Sarah Ito:
Thank you.

Dr. Shefali Miglani:
Thank you.

About Dr. Shefali Miglani

Dr. Shefali Miglani is a practicing Optometrist and a Myopia Management Specialist. As the Chief Medical Officer of Hoot Myopia Care, she helps to design clinical guidelines, create content and oversee all the clinical aspects of the platform and works with other doctors in the Hoot community to help manage progressive myopia in kids. She has her own private practice called Monroe Eye Care, in Monroe Township, NJ 08831, where she sees families with comprehensive eye care and specializes in myopia management of kids. She and her husband Bob Miglani together raise their three children in New Jersey.

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