Michele Andrews:
If we look back into the early 1970s, only 25 percent of Americans had myopia, and today more than 40 percent of Americans are near-sighted, and that number continues to increase, especially among school-aged children.

Speaker 2:
This podcast is brought to you by CooperVision, a global leader in myopia management.

Donna Mazyck:
Hello, I'm Donna Mazyck. NASN's Executive Director. Welcome to School Nurse Chat. Today, we'll be talking about vision screening and myopia and students. Our guests are NASN past President and Delaware school nurse leader, Beth Mattey, and Optometrist Dr. Michele Andrews. Welcome, Beth. Welcome, Michelle.

Beth Mattey:
Hello.

Michele Andrews:
Thank you, Donna.

Donna Mazyck:
Glad you're with us today. Beth, tell us what is the school nurse role in supporting students with vision problems?

Beth Mattey:
Well, as you know, vision is very closely connected to learning, and the school nurses really have a big role in screening our students to make sure that they are seeing what they need to be seeing so that they can learn. So school nurses screen their students in the school during certain times, and they also then will refer. If an issue comes up, they'll refer on to the healthcare provider, the optometrist or ophthalmologist for an exam.

Donna Mazyck:
Do you have any tips for new school nurses who are conducting those referrals and follow-up?

Beth Mattey:
Yes. I hope that all new school nurses understand how to do a proper vision screening, and I know that states have requirements for vision screening. We want them to make sure that they're using evidence-based practice when they are doing the vision screening, and there are some excellent programs out there for them to learn how to do that. That's so very important. The other piece is that there are resources for school nurses to support their students, because we know that a vision screening doesn't do any good if you don't have follow-up once you've found an issue, so there are resources within the community and within ASN to provide their students. So those are two really important points that I really want to make for new school nurses.

Donna Mazyck:
Any particular tips that you would suggest? With COVID now, we have a little bit different situation in terms of vision screening.

Beth Mattey:
Yes, yes. Excellent, excellent point. And I take it that you're asking about, how do we get the vision screening completed?

Donna Mazyck:
Mm-hmm (affirmative).

Beth Mattey:
One of the things that we've been talking in our district, I know that we have students who are still being evaluated for speech and for psychological evaluations, which we're using that as an opportune time to do the vision screening for students that will be coming in for the one-on-one evaluations if you're doing remote learning. If you're doing hybrid, then you can continue with the vision screening using the proper safeguards that you've been provided, with the PPE and that they're wearing the mask, washing hands, and making sure that you're following what's necessary to keep everyone safe.

Donna Mazyck:
Thank you, Beth. For additional information, you can go to nasn.org and look at vision and health. Michelle, we'd like to know what usually prompts a myopia diagnosis in children.

Michele Andrews:
Absolutely, Donna. But first, I'd just like to say how glad I am to be here with you today to share more about myopia, and how all of you as school nurses are helping to ensure that children grow stronger, but their near-sightedness does not. As an optometrist, I am so incredibly appreciative of the work that school nurses do in the field of vision. When I was in practice, I noticed that a large percentage of the children I saw as patients came at the recommendation of a school nurse, and we at CooperVision are really excited to be collaborating with NASN to engage in meaningful conversations about myopia. We've also kicked off a large parent-facing campaign, and you might be hearing more from parents who are worried about their children's vision and asking what they can do to ensure their children can see clearly today and in all of their tomorrows.

Michele Andrews:
Let's talk about myopia. Myopia occurs when the eyeball is too long relative to the focusing power of the cornea and lens in the eye, and this causes light rays to focus at a point in front of the retina rather than directly on its surface. And so people with myopia can see well up close, but not as well in the distance, and this is why myopia is often referred to as near-sightedness. Now, childhood myopia is usually diagnosed when children are around five to 10 years of age, and often, myopia increases during the eyes' growing years and starts to level off at about age 15 to 16. School nurses are often the first line of defense when it comes to detecting vision issues in children, and that's because the vision checks and screenings that nurses conduct in school are so extremely helpful in catching problems early on.

Michele Andrews:
Even if a school nurse isn't able to conduct vision checks, simply knowing the telltale signs of vision problems like squinting, or when a child complains of headaches or blurry vision, can help a nurse identify if a child is struggling and then prompt them to connect with the child's teacher, and then of course parents to take appropriate action, as Beth has already talked about. It's recommended, of course, that everyone, not just children, see an eye care professional at least once a year for a comprehensive eye exam.

Donna Mazyck:
Thank you so much, Michelle, for explaining myopia and what to do when parents are concerned about it.

Speaker 2:
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Donna Mazyck:
Beth, parents don't always know what myopia means, so what can school nurses do to educate parents?

Beth Mattey:
Well, one of the great things about being a school nurse in a community, school nurses get to know their families and their communities, so they can provide information to families in the beginning of school year, through the school newsletter, through parent meetings. I know we did some virtual parent meetings where we greeted parents. As staff are delivering lessons through remote learning, the school nurses have been able to do little short messages that they can also include within that remote learning. But what we want parents to know is if their children are exhibiting signs where they may have vision difficulties, sitting too close to the TV or getting eye fatigue after working on the computer for too long, things that might concern them, then they can talk to the school nurse about it or they can make an appointment with their optometrist or ophthalmologist.

Donna Mazyck:
Thank you, Beth. Now Michelle, we've got a student who's been identified with myopia. Is there anything else parents can do that can potentially impact the development of myopia in their children?

Michele Andrews:
Absolutely. It's really important, as Beth has already mentioned, that sometimes parents don't even know what myopia is or why it matters. In fact, last year, CooperVision engaged Harris Poll to survey over a thousand parents with children ages eight to 15 to understand what they knew about myopia. According to that survey, just one in three parents knew that myopia is near-sightedness, so it's so great that we're having this conversation. It's important for parents to understand what myopia is, because myopic progression has been linked to sight-threatening conditions much later in life. Even children with fairly mild prescriptions have a higher risk of things like glaucoma and retinal detachment later in life compared to those who don't have myopia, and the risk multiplies as the prescription gets stronger.

Michele Andrews:
Now, the good news was that almost all the parents and eye care professionals that were surveyed in that Harris poll believe that the sooner treatment starts, the better the outcome may be. Until now, traditional eyeglasses and contact lenses that were available in the United States had been developed to only correct the blurred vision that comes with myopia, but these products do not and are not approved to slow the progression of myopia. So for children who have been diagnosed with myopia, parents should ask their eyecare provider about new technologies that help slow the progression of myopia. For example, parents should also make sure their children get adequate outdoor time once schoolwork is completed each day, and this is because studies have shown that outdoor time is protective against a child becoming near-sighted. And when kids are outdoors, they're usually engaged in more distance-vision activities, which places fewer strenuous demands on their near vision system and on their eyes in general.

Donna Mazyck:
Thank you. Michele, this concept of slowing the progression of myopia is real new and interesting to focus on. Beth, as you reflect on your career in school nursing, what changes have you seen in terms of identification and referral for students with myopia?

Beth Mattey:
I think that we've just learned so much more about eye diseases and eye problems in children, and just reinforces the importance of having vision screening in school, and then following up to make sure that children are being seen and being treated. I just want to reiterate just how important it is, that link between vision and learning, and we want to make sure that students are getting what they need so they'll be successful in school.

Donna Mazyck:
Michelle, you mentioned a bit of a developmental process in managing myopia, and so that early age and the impact of physical activity, being outside. Right now, we hear a lot about near-sightedness, which we know that parents can make that connection with the term myopia. Why does it seem like near-sightedness is more prevalent now than it has ever been before?

Michele Andrews:
Yeah, Donna, it seems like it's more prevalent because it actually is. If we look back into the early 1970s, only 25 percent of Americans had myopia, and today more than 40 percent of Americans are near-sighted, and that number continues to increase, especially among school-aged children. Not only is myopia on the rise, but it's increasing in both frequency and severity. So what that means is not only are there more people with myopia, but their level of myopia is increasing as well, and the reason we see this is really linked to two things. First, family history plays a role in the risk of developing myopia, so the likelihood of a child having myopia increases if one or both of their parents are myopic.

Michele Andrews:
But research also shows that our lifestyles are influencing the development of myopia. We've talked about spending less time outdoors. A lot of people are spending more time reading. We're also spending a lot more time working and playing on digital devices like smartphones and tablets, and we tend to hold these things, these devices much more close to the face than we might a book or another near-point target. Oftentimes, we do a lot of these things under poor lighting levels. So it's this combination of genetics and modern lifestyle choices that we're making that is, we think, related to this increase in myopia.

Donna Mazyck:
Well, that has me thinking a lot about lifestyle and the young people in my life who are reflective of just what you've talked about, the combination of genetics and that modern lifestyle. Beth, given that, what should parents be watching for if they're educating their children at home this year?

Beth Mattey:
Well, certainly, students are complaining that things are blurry, that they can't see. Oftentimes, children might not know that though, that they're seeing something blurry. They don't understand that what they're seeing is not normal, what other people... That's when you're going to see that eye fatigue. They're maybe rubbing their eyes, or their eyes might just get fatigued. They might have drainage or they might, like I said earlier, sit too close to a TV to watch the TV or things like that, that parents might be seeing at home. But children might not know that what they're seeing is not normal, that other people can see better than they can, and maybe they get frustrated. They may get frustrated with lessons as well, and it might be something with vision if they're getting frustrated because they can't do something, so there's several things that parents can watch for.

Donna Mazyck:
That's great, and being able to share that, school nurses are good at giving parents the what to look for and what to report on. Michele, you mentioned in this whole management of myopia in young children that being able to stem the tide, if you will, or slow the progression of myopia is a factor and something that's newer. Can young children safely wear contact lenses for their near-sightedness, and if they can, what benefits are there to that?

Michele Andrews:
Donna, this is one of the questions that we get quite frequently. Parents often ask when they're thinking about contact lenses for their child, "Are they safe, and can my child even, are they even going to be able to use contact lenses properly?" There have been multiple studies on both of these topics. On the incidents or on the question of safe use of contact lenses, the incidents of corneal infiltrative events in children, so this is when the eye becomes inflamed, they are no higher in children than in adults. In fact, when we look at the young children wearing contact lenses, the age was between eight and 12, they may actually have fewer events than adults. Children learn to apply contact lenses to their eyes quickly. In our clinical study, 57 percent found lens application easy by the end of week one, and a full 85 percent were applying the lenses without help by the end of the first month.

Michele Andrews:
But beyond improvements in vision, contact lenses have additional benefits that can impact how children feel about themselves and their overall wellbeing. There are studies that show that contact lenses not only make children more satisfied with their vision correction, but they also feel better about how they look or how they perform activities. When we ask children what they like to wear for visual correction, over 70 percent say they like wearing their contact lenses a little bit or a lot better than they like wearing their glasses. It's been shown through this research that children and teens see significant improvements in quality of life within just one week of being fit with contact lenses. So when we look at the research on contact lens safety and overall quality of life, the positive findings suggest that children should be offered the opportunity to wear contact lenses.

Donna Mazyck:
That's very helpful to know.

Beth Mattey:
Donna, I'd like to add what school nurses can do to help students that might be identified, that may be having vision difficulty. They can link up with an optometrist and an ophthalmologist within their community to help get students that support that they need and the evaluations that they need, because a lot of times, we find the barriers to getting exams or parents don't know where to go or who to go to. The other piece of that is that NASN provides the VSP vouchers that parents can take to the optometrist or the ophthalmologist to have an exam. It's very, very helpful that parents can just ask about the VSP vouchers, and school nurses can go on the NASN website to get the information about the vouchers.

Donna Mazyck:
Thank you, Beth. That is true. NASN members do receive that benefit, and are very happy to be able to use that VSP voucher and certificate to connect students to high-care professionals. Thank you, Beth. Well, we've learned a lot today. We've learned about myopia. We've learned about how we can manage the progression of myopia, and this is all for the help of students so that they can be, as Beth said, able to learn. That connection with their learning is so important. I want to thank Beth Mattey, school nurse leader, past NASN President for being with us today, and I'd like to thank Michele Andrews, Optometrist, who shared a lot of information today about myopia, and how we can manage its progression in children and keep children healthy, safe, and ready to learn. Thank you so much for being with us today, Michele. Thank you, Beth.

Michele Andrews:
You're welcome.

Beth Mattey:
Thank you, Donna. You're very welcome.

Speaker 2:
This episode of School Nurse Chat has been brought to you by CooperVision. Learn more about CooperVision's Myopia Management Program at www.coopervision.com.