INTERVIEW WITH DR. STEVEN SHEINER

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INTERVIEW WITH DR. STEVEN SHEINER

Dr. Shefali Miglani:
Good morning. Um, 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 do something about it for their children. Today I’m speaking with Dr. Steven Sheiner, a fellow optometrist and myopia management specialist running his private practice in beautiful Boca Raton, Florida, called Total Family Eyecare. Dr. Sheiner has recently joined our group. Dr. Shiner has recently joined our growing community of myopia management specialists here at Hoot Myopia Care. Dr. Sheiner, hello and welcome to Hoot..

Dr. Steven Sheiner:
Good morning. Talk to you. Good

Dr. Shefali Miglani:
Good morning. So for parents who don’t know anything about myopia, can you please tell us what is myopia and why is it something that they should care about?

Dr. Steven Sheiner:
Sure. So myopia is the technical term for near-sightedness and that simply means their kids see well at near, and they don’t see very well so far. And the reason why parents should care about that is because they don’t want their child’s vision to affect their learning in school. And they don’t want them to suffer from things like eye strain and headaches. So being near-sighted can be detrimental and it’s important that they get their eyes checked at least once a year.

Dr. Shefali Miglani:
Right. And also these kids are getting near-sighted progressively as time goes by and that’s more visually debilitating. They, you know, come in and see, uh, you know, 20, 40 lines and the next year it’s, it’s the big E. So it’s very concerning because that’s sort of the only organ in their body. That’s getting so much worse over time and we need to do something about it. We can’t just say, Hey, that’s a change, a prescription change. That’s something that’s getting worse in their, you know, self and, we need to fix, uh, you know, we need to fix that for them. So, um, I hear you, have you seen the impact of more near work, online schooling, greater use of devices in your practice? Uh, recently?

Dr. Steven Sheiner:
Oh, absolutely. Um, one of the things that, this, what we’ve learned from this pandemic over the last year or so is that kids are spending a lot more time in front of a screen, whether it’s through virtual schooling or just interacting with their friends online, uh, screen time has gone up exponentially and it’s taking a toll on kids visions, kids vision is changing from year to year because of the amount of time they’re spending in front of a screen, focusing, looking at near things and not spending time outside or their eyes off of a screen de-focused off in the distance. So there’s no question we’ve seen an increase over the last year-plus, but just in the age of technology in general, uh, kids are spending more and more time in front of a screen.

Dr. Shefali Miglani:
Absolutely. So is Boca Raton not different? Don’t kids play outside? I would think that would in the beautiful weather, they’d be outside and not inside.

Dr. Steven Sheiner:
You know, you would think so. Um, our, our generation, you know, we just see our friends, we would get on a bike, we would ride across the street or across the neighborhood and we’d hang out with our friends, but now kids in this day and age, they socialize with their friends online on their phone using apps, using social media. So, uh, despite the weather they spend so much time still, uh, just staring at a screen, focusing their eyes up close and not doing the things that we did when we were kids. So just, yeah, just so much, so much time in front of a screen. And yeah,

Dr. Shefali Miglani:
I know even with my three kids, I see them communicating with their friends in the summer, um, uh, you know, texting and that’s their socialization. They don’t want to go and meet them. They don’t want to go run around with them. It’s just, it’s a different world. So, all right. Um, now walk us through what parents should be thinking about as the kids return back to school. It’s back to school time. What should be, what should they be thinking about?

Dr. Steven Sheiner:
Yeah, it’s a strange transition, especially for kids who have been virtual schooling for the last year, they’re back in the classroom. So it’s going to be a little bit of an adjustment. So what parents should be looking for is some of the telltale signs of kids, having issues with their vision, uh, complaining about headaches, noticing them squinting, uh, fatigue, eye strain. Uh, and a lot of times, you know, kids don’t really know that they’re having a problem because they have nothing to compare it to. They have no frame of reference. So oftentimes kids’ vision might be changing and they might not even notice because they feel like their vision is the way it’s supposed to be. So it is important for parents to not only keep an eye out for these telltale signs but also again, to get their eyes checked, at least once a year for these potential changes that the kid might not even be reporting.

Dr. Shefali Miglani:
Right. Right. And they’re very good about going to the dentist, but, uh, I don’t know why parents don’t think about eyes and, you know, it’s very, very important. Um, 70% of the learning in school happens through their vision. So it’s very important that they see clearly and comfortably. Um, so kids. If their children do have these symptoms when they go back to school, what should they do? What should the parents do?

Dr. Steven Sheiner:
Well, they really, the first thing they need to do is they need to bring their kids in for a comprehensive eye exam, because we need to check to make sure if it’s visually related or there’s something else going on that’s causing these symptoms. Um, but the main thing is they should pay attention to how much screen time their kids are spending in front of, you know, the screens. And it’s, it is, it’s an ongoing battle. I have two teenage boys. It’s a struggle. I get it. We face it every day. Um, but that’s one of the things that parents can do, uh, in addition, to get their eyes checked is monitor how much time these kids are spending in front of a screen.

Dr. Shefali Miglani:
Right. And, and oftentimes when I’m talking to these parents during a con comprehensive exam when I’ve just diagnosed a child with myopia, they’re very thankful of what, when I discuss, uh, screen time with them because, uh, parents want a surrogate to help them coach and do the parenting for them. And we are as a, you know, primary care optometrist, we kind of take on that job and they always, I’m sure you have that same experience when they say, uh, you know, Hey Tommy, listen, you know, listen to the doctor what he’s saying because they’ve been saying it, they know, they know that’s the truth, but, you know, coming from a doctor and, uh, you know, it makes a very big effort, so right on, uh, Dr. Sheiner, um, so what, tell me, what are your go-to therapies for myopia management with, uh, you know, I’m sure you talk about myopia management when, when you diagnose a child with myopia, what are some of your therapies, go to therapies?

Dr. Steven Sheiner:
So for younger children, what we found with the fact that when I say younger children, I mean, kids 5, 6, 7 years old, what we found most effective are atropine eye drops. Um, for kids that are perhaps a little bit older in that eight to 12 range, um, sometimes we would fit them with a specialty contact lens, either orthokeratology or maybe just the soft daily, disposable contact lens, uh, that can help with these changes that the children are undergoing. So some of it is based on the age of the child, some of it is based on their prescription or, you know, how rapidly their eyes are changing. So it is tailored based on an individual basis, but we have a number of different therapies that are effective, uh, depending on those different variables.

Dr. Shefali Miglani:
Can you tell me a little bit about, um, atropine, um, you know, how, how is it used and, uh, you know, what it entails for the parent of the child?

Dr. Steven Sheiner:
Sure. Uh, it’s very, it’s actually pretty simple. It’s simply a daily eyedrop that is designed to de-focus the focusing system of the eyes a little bit to kind of relax the focusing system of the eye. So there’s not as much strain. There’s not as much work as, not as much fatigue. And it kind of helps the eye relax and reduce the things that are causing this progression in their myopia or their near-sightedness, uh, month after month and year after year.

Dr. Shefali Miglani:
So they continue wearing their corrective glasses, uh, or daytime contacts.

Dr. Steven Sheiner:
They can continue wearing whatever modality they’re wearing to correct their vision at that age. They’re probably not in context yet, so it’s probably just, uh, their, their glasses. Yep. Uh, and then they just add to their regimen. Uh, the daily eye drops, the atropine eye drop, which is very mild doesn’t stinger burn. Um, and they shouldn’t notice too much. It shouldn’t impact their daily vision really at all. Uh, other than the de-focus, which we talked about, which shouldn’t affect their vision, but it can help slow down the progression of myopia that they’ve been experiencing.

Dr. Shefali Miglani:
And tell me a little bit about your experience with ortho K orthokeratology and, um, its outcomes in your practice. What is, how does orthokeratology work just briefly and its outcomes in your practice?

Dr. Steven Sheiner:
Yeah, orthokeratology has been great. Um, it’s basically a specialty design contact lens based on the shape and curve of the patient’s eyes. So with a tailor-made lens designed to kind of support the structural integrity of the eye, the cornea, and again, slow down the progression of the change. Um, this is more suitable for kids that are a little bit older, that can handle putting in and taking out a contact lens, but the outcome has been good. It does not only enhance the child’s vision when they are wearing the contact lens, but it helps us slow down the rate of progression of their near-sightedness again from month to month or two years. So it’s been a very effective tool for, again, the kids that are just a little bit older, uh, beyond the eyedrops.

Dr. Shefali Miglani:
And, um, how about wearing their natural, normal eyewear? How, uh, you know, can you tell us about that? I know, but I want you to tell the parents.

Dr. Steven Sheiner:
The orthokeratology oftentimes can completely replace the glasses they’ve been wearing because the lenses are prescription lenses. Um, some contact lenses they can wear overnight while they’re sleeping. Um, and then when they get up in the morning, it actually has changed the shape of the cornea to the point where they don’t need to wear anything during the day. Um, if they don’t get that complete correction from the contact lenses, uh, we can supplement with either a soft contact lens or a simple pair of glasses just to kind of make up the gap. But again, it’s the vision that they’re going to get, whether they’re in contact lenses overnight, or they’re wearing something during the day is going to be sufficient for them to go about school and their daily activities without any hiccups.

Dr. Shefali Miglani:
Excellent. Um, what about their behavior? What about behavior modification? Is that important?

Dr. Steven Sheiner:
Yeah, definitely. So we touched on it earlier. The big one really is screen time. And like I said, it’s a daily battle in my house. It’s really, um, parents really need to be in charge of, or at least observant of monitoring. The amount of time kids are spending in front of screens can be reduced. That’s a big one. Um, certainly spending more time outside, more time playing in the sun, or at least outdoors and fun life. Um, those are two of the biggest behavioral changes because we talked about kids. Aren’t really doing a lot of that. They don’t spend a lot of time outside playing unless we kind of, you know, encourage them to do so, or if they’re playing an organized sport or activity. Um, so reducing screen time and spending more time playing outside posture is important too. Um, the distance at which they are in front of a screen when they are in front of a screen. So those are all things that we can look at, work on and try to help reduce the amount of time doing it.

Dr. Shefali Miglani:
Okay. So if you had, if you had 10 seconds with a parent, what, what’s one piece of advice that you would give for parents whose kid has just, you know, has been, uh, eyesight has been getting worse recently. One thing.

Dr. Steven Sheiner:
So, the big one I would tell them is you got to cut down on the amount of time they’re staring at a screen. That’s the biggest one. And it is hard because like I said, we’re in an era of technology and they socialize, they do school homework. A lot of things are online. So it is a challenge, but that’s the big one. I would tell them that they have to cut down the amount of time these kids are staring at a screen. So I want parents to understand the importance of myopia. If you are seeing your child with these symptoms, experiencing eye strain, headaches, fatigue, squinting, sitting too close to different screens. Don’t ignore it. If nothing else, just bring your child for a consultation. We can take a look, evaluate them, see what’s going on, and possibly even prevent a problem from getting worse down the road.

Dr. Shefali Miglani:
Great. All right. Let’s wrap up. Today we spoke to Dr. Steven Sheiner, fellow optometrists and owner of Total Family Eyecare, and now a proud Hoot Myopia Care specialist. Thank you, Dr. Sheiner, for your time today. Hope to see you soon. Maybe in the winter, we can do a live interview in the warm weather in Boca Raton. Thank you.

Dr. Steven Sheiner:
I look forward to it.

Dr. Shefali Miglani:
Good morning. Um, 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 do something about it for their children. Today I’m speaking with Dr. Steven Sheiner, a fellow optometrist and myopia management specialist running his private practice in beautiful Boca Raton, Florida, called Total Family Eyecare. Dr. Sheiner has recently joined our group. Dr. Shiner has recently joined our growing community of myopia management specialists here at Hoot Myopia Care. Dr. Sheiner, hello and welcome to Hoot..

Dr. Steven Sheiner:
Good morning. Talk to you. Good

Dr. Shefali Miglani:
Good morning. So for parents who don’t know anything about myopia, can you please tell us what is myopia and why is it something that they should care about?

Dr. Steven Sheiner:
Sure. So myopia is the technical term for near-sightedness and that simply means their kids see well at near, and they don’t see very well so far. And the reason why parents should care about that is because they don’t want their child’s vision to affect their learning in school. And they don’t want them to suffer from things like eye strain and headaches. So being near-sighted can be detrimental and it’s important that they get their eyes checked at least once a year.

Dr. Shefali Miglani:
Right. And also these kids are getting near-sighted progressively as time goes by and that’s more visually debilitating. They, you know, come in and see, uh, you know, 20, 40 lines and the next year it’s, it’s the big E. So it’s very concerning because that’s sort of the only organ in their body. That’s getting so much worse over time and we need to do something about it. We can’t just say, Hey, that’s a change, a prescription change. That’s something that’s getting worse in their, you know, self and, we need to fix, uh, you know, we need to fix that for them. So, um, I hear you, have you seen the impact of more near work, online schooling, greater use of devices in your practice? Uh, recently?

Dr. Steven Sheiner:
Oh, absolutely. Um, one of the things that, this, what we’ve learned from this pandemic over the last year or so is that kids are spending a lot more time in front of a screen, whether it’s through virtual schooling or just interacting with their friends online, uh, screen time has gone up exponentially and it’s taking a toll on kids visions, kids vision is changing from year to year because of the amount of time they’re spending in front of a screen, focusing, looking at near things and not spending time outside or their eyes off of a screen de-focused off in the distance. So there’s no question we’ve seen an increase over the last year-plus, but just in the age of technology in general, uh, kids are spending more and more time in front of a screen.

Dr. Shefali Miglani:
Absolutely. So is Boca Raton not different? Don’t kids play outside? I would think that would in the beautiful weather, they’d be outside and not inside.

Dr. Steven Sheiner:
You know, you would think so. Um, our, our generation, you know, we just see our friends, we would get on a bike, we would ride across the street or across the neighborhood and we’d hang out with our friends, but now kids in this day and age, they socialize with their friends online on their phone using apps, using social media. So, uh, despite the weather they spend so much time still, uh, just staring at a screen, focusing their eyes up close and not doing the things that we did when we were kids. So just, yeah, just so much, so much time in front of a screen. And yeah,

Dr. Shefali Miglani:
I know even with my three kids, I see them communicating with their friends in the summer, um, uh, you know, texting and that’s their socialization. They don’t want to go and meet them. They don’t want to go run around with them. It’s just, it’s a different world. So, all right. Um, now walk us through what parents should be thinking about as the kids return back to school. It’s back to school time. What should be, what should they be thinking about?

Dr. Steven Sheiner:
Yeah, it’s a strange transition, especially for kids who have been virtual schooling for the last year, they’re back in the classroom. So it’s going to be a little bit of an adjustment. So what parents should be looking for is some of the telltale signs of kids, having issues with their vision, uh, complaining about headaches, noticing them squinting, uh, fatigue, eye strain. Uh, and a lot of times, you know, kids don’t really know that they’re having a problem because they have nothing to compare it to. They have no frame of reference. So oftentimes kids’ vision might be changing and they might not even notice because they feel like their vision is the way it’s supposed to be. So it is important for parents to not only keep an eye out for these telltale signs but also again, to get their eyes checked, at least once a year for these potential changes that the kid might not even be reporting.

Dr. Shefali Miglani:
Right. Right. And they’re very good about going to the dentist, but, uh, I don’t know why parents don’t think about eyes and, you know, it’s very, very important. Um, 70% of the learning in school happens through their vision. So it’s very important that they see clearly and comfortably. Um, so kids. If their children do have these symptoms when they go back to school, what should they do? What should the parents do?

Dr. Steven Sheiner:
Well, they really, the first thing they need to do is they need to bring their kids in for a comprehensive eye exam, because we need to check to make sure if it’s visually related or there’s something else going on that’s causing these symptoms. Um, but the main thing is they should pay attention to how much screen time their kids are spending in front of, you know, the screens. And it’s, it is, it’s an ongoing battle. I have two teenage boys. It’s a struggle. I get it. We face it every day. Um, but that’s one of the things that parents can do, uh, in addition, to get their eyes checked is monitor how much time these kids are spending in front of a screen.

Dr. Shefali Miglani:
Right. And, and oftentimes when I’m talking to these parents during a con comprehensive exam when I’ve just diagnosed a child with myopia, they’re very thankful of what, when I discuss, uh, screen time with them because, uh, parents want a surrogate to help them coach and do the parenting for them. And we are as a, you know, primary care optometrist, we kind of take on that job and they always, I’m sure you have that same experience when they say, uh, you know, Hey Tommy, listen, you know, listen to the doctor what he’s saying because they’ve been saying it, they know, they know that’s the truth, but, you know, coming from a doctor and, uh, you know, it makes a very big effort, so right on, uh, Dr. Sheiner, um, so what, tell me, what are your go-to therapies for myopia management with, uh, you know, I’m sure you talk about myopia management when, when you diagnose a child with myopia, what are some of your therapies, go to therapies?

Dr. Steven Sheiner:
So for younger children, what we found with the fact that when I say younger children, I mean, kids 5, 6, 7 years old, what we found most effective are atropine eye drops. Um, for kids that are perhaps a little bit older in that eight to 12 range, um, sometimes we would fit them with a specialty contact lens, either orthokeratology or maybe just the soft daily, disposable contact lens, uh, that can help with these changes that the children are undergoing. So some of it is based on the age of the child, some of it is based on their prescription or, you know, how rapidly their eyes are changing. So it is tailored based on an individual basis, but we have a number of different therapies that are effective, uh, depending on those different variables.

Dr. Shefali Miglani:
Can you tell me a little bit about, um, atropine, um, you know, how, how is it used and, uh, you know, what it entails for the parent of the child?

Dr. Steven Sheiner:
Sure. Uh, it’s very, it’s actually pretty simple. It’s simply a daily eyedrop that is designed to de-focus the focusing system of the eyes a little bit to kind of relax the focusing system of the eye. So there’s not as much strain. There’s not as much work as, not as much fatigue. And it kind of helps the eye relax and reduce the things that are causing this progression in their myopia or their near-sightedness, uh, month after month and year after year.

Dr. Shefali Miglani:
So they continue wearing their corrective glasses, uh, or daytime contacts.

Dr. Steven Sheiner:
They can continue wearing whatever modality they’re wearing to correct their vision at that age. They’re probably not in context yet, so it’s probably just, uh, their, their glasses. Yep. Uh, and then they just add to their regimen. Uh, the daily eye drops, the atropine eye drop, which is very mild doesn’t stinger burn. Um, and they shouldn’t notice too much. It shouldn’t impact their daily vision really at all. Uh, other than the de-focus, which we talked about, which shouldn’t affect their vision, but it can help slow down the progression of myopia that they’ve been experiencing.

Dr. Shefali Miglani:
And tell me a little bit about your experience with ortho K orthokeratology and, um, its outcomes in your practice. What is, how does orthokeratology work just briefly and its outcomes in your practice?

Dr. Steven Sheiner:
Yeah, orthokeratology has been great. Um, it’s basically a specialty design contact lens based on the shape and curve of the patient’s eyes. So with a tailor-made lens designed to kind of support the structural integrity of the eye, the cornea, and again, slow down the progression of the change. Um, this is more suitable for kids that are a little bit older, that can handle putting in and taking out a contact lens, but the outcome has been good. It does not only enhance the child’s vision when they are wearing the contact lens, but it helps us slow down the rate of progression of their near-sightedness again from month to month or two years. So it’s been a very effective tool for, again, the kids that are just a little bit older, uh, beyond the eyedrops.

Dr. Shefali Miglani:
And, um, how about wearing their natural, normal eyewear? How, uh, you know, can you tell us about that? I know, but I want you to tell the parents.

Dr. Steven Sheiner:
The orthokeratology oftentimes can completely replace the glasses they’ve been wearing because the lenses are prescription lenses. Um, some contact lenses they can wear overnight while they’re sleeping. Um, and then when they get up in the morning, it actually has changed the shape of the cornea to the point where they don’t need to wear anything during the day. Um, if they don’t get that complete correction from the contact lenses, uh, we can supplement with either a soft contact lens or a simple pair of glasses just to kind of make up the gap. But again, it’s the vision that they’re going to get, whether they’re in contact lenses overnight, or they’re wearing something during the day is going to be sufficient for them to go about school and their daily activities without any hiccups.

Dr. Shefali Miglani:
Excellent. Um, what about their behavior? What about behavior modification? Is that important?

Dr. Steven Sheiner:
Yeah, definitely. So we touched on it earlier. The big one really is screen time. And like I said, it’s a daily battle in my house. It’s really, um, parents really need to be in charge of, or at least observant of monitoring. The amount of time kids are spending in front of screens can be reduced. That’s a big one. Um, certainly spending more time outside, more time playing in the sun, or at least outdoors and fun life. Um, those are two of the biggest behavioral changes because we talked about kids. Aren’t really doing a lot of that. They don’t spend a lot of time outside playing unless we kind of, you know, encourage them to do so, or if they’re playing an organized sport or activity. Um, so reducing screen time and spending more time playing outside posture is important too. Um, the distance at which they are in front of a screen when they are in front of a screen. So those are all things that we can look at, work on and try to help reduce the amount of time doing it.

Dr. Shefali Miglani:
Okay. So if you had, if you had 10 seconds with a parent, what, what’s one piece of advice that you would give for parents whose kid has just, you know, has been, uh, eyesight has been getting worse recently. One thing.

Dr. Steven Sheiner:
So, the big one I would tell them is you got to cut down on the amount of time they’re staring at a screen. That’s the biggest one. And it is hard because like I said, we’re in an era of technology and they socialize, they do school homework. A lot of things are online. So it is a challenge, but that’s the big one. I would tell them that they have to cut down the amount of time these kids are staring at a screen. So I want parents to understand the importance of myopia. If you are seeing your child with these symptoms, experiencing eye strain, headaches, fatigue, squinting, sitting too close to different screens. Don’t ignore it. If nothing else, just bring your child for a consultation. We can take a look, evaluate them, see what’s going on, and possibly even prevent a problem from getting worse down the road.

Dr. Shefali Miglani:
Great. All right. Let’s wrap up. Today we spoke to Dr. Steven Sheiner, fellow optometrists and owner of Total Family Eyecare, and now a proud Hoot Myopia Care specialist. Thank you, Dr. Sheiner, for your time today. Hope to see you soon. Maybe in the winter, we can do a live interview in the warm weather in Boca Raton. Thank you.

Dr. Steven Sheiner:
I look forward to it.

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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