A Childhood Disease Worth Preventing | Nicholas Despotidis | TEDxAsburyPark

Translator: Yordanka Stefanova
Reviewer: Theresa Ranft When my son was six years old,
he failed a test, an eye test – not a big deal, right? But I don’t like
when my sons fail at anything, let alone a vision screening. You see, I’m an optometrist. And I remember going to the mall and picking up this portrait
of both my sons and feeling conflicted. On the one hand, they looked so cute! But on the other, I could not believe
they both were wearing glasses. They suffer from a very common
visual condition called myopia. They need glasses to see at a distance. It’s also called nearsightedness. And up to recently, doctors were taught
that myopia was primarily due to genetics. But my wife and I did not wear glasses
until much later in life. So I remember asking myself,
“What’s going on here?” Because I noticed this more
in my exam room as well. This led me on a career-long journey that started with a study investigating 6- and 7-year-old children
of Chinese ethnicity. One group lived in Singapore, the other group in Australia. Despite sharing the same genetic makeup, the children in Singapore –
30% of them suffered with myopia, compared to only 3% in Australia. The major difference
between the two groups was how much time they spent outdoors. And I remember saying, “Outdoors? What’s up with that?” (Chuckles) And then, later on, researchers feel the most prevalent theory is that we need daylight
to stop the eye from stretching, which causes myopia. And this is not a problem
isolated to East Asia. In the United States,
the prevalence of myopia has nearly doubled
since the 1970s, to 42%. I wonder what has changed?
A lot of things! But the sad truth
is there are surveys that suggest that our children spend less time outdoors than prison inmates, who are mandated to spend
two hours a day outside. Makes you wonder, “Who’s locked up?” The World Health Organization
is now calling this a myopia epidemic. They project, by the year 2050, half the world will suffer with myopia. The reason this is so critically important: the younger a child develops myopia, the more likely their vision
will continue to deteriorate as they age, which makes them so much more susceptible to a potentially blinding complication,
like a retinal detachment or glaucoma. So in parts of China, where the prevalence of myopia
has already skyrocketed, scientists are experimenting
with classrooms that optimize the amount of light
children are exposed to during the day. And my career is also focused
on this epidemic of myopia. I fit children as young as five years old with a contact lens that may help prevent
myopia from progressing, since daylight does not have this effect
once the deterioration begins. I design a lens that the child
puts in their eye before they go to sleep. As they’re sleeping, the lens gently reshapes
the outer part of their eye. So when they wake up,
they remove the lens, and their newly-shaped cornea allows them to see clearly the entire day
without the use of glasses. All the child has to do is put the lens back in every night
to maintain the good vision, sort of like a retainer after braces. So you can imagine,
if I’m at a party and someone asks me, “So what do you do for a living?” I give them this talk,
and then they look at me and say, “I thought optometrists
prescribed glasses, not stopped children from wearing them.” Today, there are doctors around the world who are certified
to perform this technology called orthokeratology. The reason practitioners
have to be certified: this is much more complex
than a standard contact lens fit. It also doesn’t come
without risk, like infection. Yet, since this has been
FDA-approved in 2002, I have fit thousands of children, including my two sons. Now, there are eye drops
and daytime contact lenses which have been shown
to be equally effective in stopping the progression of myopia. The FDA has not approved
these contact lenses to prevent myopia, only to correct it, but there’s really good
peer-reviewed studies now that demonstrate
they can slow down progression upwards of 50%. So I think between doctors
and scientists, we are going to derail
these grim projections. But my concern is that this is not the only childhood
disease worth preventing. I view all these treatments
I’ve described to you as a band-aid, because no classroom, no eye drop, no contact lens will stop
a different type of myopia I notice in my exam room: social myopia, which occurs when children replace
face-to-face interaction with screen time. It’s the elephant in the room, guys! When I think back,
when looking at that portrait, I now know I was not feeling conflicted, I was feeling guilty. Because I remember,
when my children were busy indoors, I was working right beside them
on my computer. It was convenient for me
to have them indoors because I fooled myself
into thinking that it was safer. And lastly, they didn’t buy
all those devices by themselves. When children play outside, they receive so much more than daylight. They develop the social skills
for happy living, like eye contact, and empathy, and just human interaction. But we don’t know
how much screen time is too much and it probably varies
from family to family. So the American Pediatric Association has established guidelines
when it comes to screen time. And you can find these … well, online. (Laughter) But the most telling recommendation for me is that they recommend
no interaction with screens for 18-month-olds or younger. It shows me how habit-forming
these devices can be at such an early age. They did make one exception
to that recommendation: video chatting. And I’m convinced there was
a grandparent on the panel who gave us all a pass. (Laughter) But parents confide in me
the reality within their homes. They’ll say to me, “The school gives my children tablets, and all their homework is online.” They’ll also tell me
they don’t want to ostracize their son or daughter
by not giving them a smartphone, because most of their peers own one. And lastly, for the most part,
their kids are really good. They don’t want to seem
like they’re punishing them by limiting their screen time. So this is what I learned after practicing for 30 years
and examining countless families. You are the guidelines. You set the tone. What is lost when families
stare at a device while eating? Or isolate themselves on their phone
during family drives? Yet, we’re all guilty of this,
including myself. So as a healthcare provider, I give you permission to limit your child’s screen time
and send them outdoors. Our roles may have changed – I remember my mother
used to corral me indoors, but now we have to just
send them outdoors. I remember, my fondest memories
of a child were outdoors. And from this photograph I located, it seemed like I really
aspired to be a speaker back then. (Laughter) Some things don’t change. So here’s my message to you: Listen to your gut when it comes to your child
and screen time. When I embraced that technology,
orthokeratology, that’s what I did. If I had waited for unequivocal proof, I’d still be waiting. And thousands of children,
including my two sons, would have suffered. I strongly believe this epidemic of myopia is a symptom of a much broader problem. Yet technology is not going away, nor should it. But our lives are out of balance. We need to collectively open our eyes and learn what it takes to raise
well-balanced children, physically and emotionally, as our world fills up with technology. I thought I was being a good dad
by keeping my kids indoors, ensuring they got good grades, ensuring they were safe. I was wrong. Little did I know,
the screens they were working on, while I was doing the same, was possibly robbing them
of their eyesight, and much more insidiously, perhaps … stealing their joy. Thank you. (Applause)


  1. The man you see on stage is exactly who you get in the office during a check-up. Loud, passionate, focused and of course optometry. Great TED Talk!

  2. Prevention is possible, at 20/40, self measured -0.75 diopters, if the young man will take long term plus lens wearing – very seriously.
    I appreciate your passion.
    But the correct prevention science – must be in the educated man himself.

  3. Maybe the difference between the two Chinese samples is that the Chinese alphabet has up to 50,00 characters(one needs to know about 3000 characters to be able to read a newspaper) while the English(Australian) students only need to know 24. A lot more close-up studying time.

  4. Dr D, what a wonderful message & wake up call for all parents & doctors! Prevention is the key. We must embrace this. Myopia is a disease. Thank you for spreading this message.

  5. You are 100 % correct.
    The problem is self induced nose on page habit – of the child !!
    At 20/40.
    1) Child sits up and wears a plus lens for all close work.
    2) This is and educated scientific choice.
    3) Dr. Young's plus study confirns this.

  6. Nick, Congratulations on getting up on stage & speaking for all of us orthokeratologists!
    I thoroughly enjoyed your sharing of studies and personal experience, as I too, am an optometrist, trying to stabilize my sons's myopia while engaging in battles over screen times!
    I will share this message with all my patients, family, and friends. The best we can do in this technologically advanced era is to focus on prevention and knowledge.

  7. Several things I do not understand here.

    How does a contact lense that reshapes the cornea prevent the eye from becoming too long?

    We have had populations of kids that spent very little time outdoors. So much so that they became vitamin D deficient. Why hasn’t a major connection between myopia and lack of time outdoors been discovered before?

    It makes sense that there would be some sort of feedback mechanism that keeps the eye growing at the same rate the lens is developing. maybe that mechanism is being disrupted. Maybe screens and lack of outdoor activities play a part (how about if you are seeing blue light, your eye is expecting to focus far off).

  8. So lets deal with the real issue. The fact that our society has prioritized criminals over the rest of society. Our kids can't go outside because catch and release leaves our streets overrun with predators.

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