Interviewing Jane Weiner: “Losing sight” a documentary about myopia.

The following article is presented to you by Miguel García, Pablo Sanz & Jane Weiner
For all the general public.

Today we have the luck to interview a filmmaker, that has been working during the last years in a documentary on myopia. She had the patience and time to answer to all of our questions.

Jane Weiner
Jane Weiner

Ms. Weiner born in New York. She studied Biology and American History at San Francisco State University, where she graduated in English Literature and majored in Filmic Studies. She also taught communication at the University of Syracuse.

Jane Weiner began as a young filmmaker and nowadays she is well known for her filmographic and audiovisual works. Currently she is making a documentary film related to myopia.

There is no better blog than this to know more about her myopia documentary work!

Go straightforward to the trailer!  Click here!


Good morning, Ms. Weiner!
It is a huge pleasure to see you again. First of all, thank you very much for taking the time to conduct this interview.
I think that there is no better place than the International Myopia Conference to introduce us to your work.

  • Have you been previously in other editions of the IMC? Are you enjoying the experience?

Well, this is my third IMC.  I went first to California, then to China and now, here we are.  I really, really enjoy it!
 At my first IMC, I knew absolutely nothing about myopia, well I can’t say nothing about myopia, because I am myopic, but I knew nothing about eye science. Before my first IMC experience, in fact, I didn’t have time to read anything about the subject, so you can imagine, sitting through those complex lectures was really a challenge, quite a challenge.

But as it happens, I already knew many of people involved in eye science quite well and they were available to answer my questions and guided me through the basic eye science of Myopia. And then over the years, attending both International Myopia Conferences and the ARVOs in United States as well as some other conferences in Europe, I began to really, genuinely understand.  So, for the last 3 or 4 years I’ve had the privilege of studying eye science with the top professors around the world.

  • So, talking about the people…what do you think when you see so many people dedicating their research to the fight against myopia?

Well, my best friend in all the world is Josh Wallman, so I’ve know these people for a very long time, not as scientists but simply as friends, which is a different kind of relationship. Their work is absolutely amazing, but I didn ́t really understand most of it – and, the key to making a movie is that the filmmaker must understand the subject extremely well in order to translate the science into an audio visual experience using everyday language and images that a wide audience of all ages and backgrounds can easily understand.  I’m not working as a journalist — making interviews and editing them together — I’m trying to develop a very clear comprehensible story of what Myopia is and why the current epidemic presents a worldwide public health problem.

  • About the general concern… Do you think that the general public is aware of this problem and its possible causes and consequences in the future?

No, I don’t think the general public knows anything about myopia, in fact in the United States they don’t even use this word. They say ‘near-sighted’ or in England they use ‘short-sighted’.  And, many people don’t have a clue as to why they are wearing glasses.  I’ve heard so many people saying: “Yeah, I’m absolutely near-sighted, I can’t see far” but, when you look at their prescription, it is all plus diopters – so they must be ‘far-sighted’.

So you know, it’s just that people are not well informed by their eye doctors. They go and get an eye exam, get a prescription for eyeglasses and it ́s all magic!

  • Talking about your Myopia documentary…what drew you to telling this story?

My goal is to use images and small stories in conjunction with those images, with the voices of the experts telling the story. We will cover everything from birth to old age, and the main point of the film, although we say it very gently, is that this is a very, very dangerous subject.

  • Maybe with this documentary the general public is more concern about…?

If you say ‘glaucoma’ to the people it’s just a word, they don ́t know what it means. Even from my personal experience, my father had glaucoma and I knew he had to take eye-drops and he could not drive anymore but I didn ́t really know what that meant in terms of reduced vision…

I didn’t understand it at all, until I got it myself, and that’s the same for most people.

  • What was your prior knowledge about myopia?

My prior knowledge of myopia was that almost everyone in my family was myopic:  My father was strongly myopic and he was photographer, architect photographer. I knew that he had retinal detachment and glaucoma but I didn ́t know about its association to myopia.

  • During these years you’ve met some of the greatest researchers in the field, what have you been most surprised to learn about?

I think the most important thing I’ve learned was how serious this subject is and how difficult it is for the scientific and professional community to communicate this to the general public.  There is a real disconnect, even between the scientists and the practitioners and, then, onto the general public. A double disconnection…

  • When you started getting to know what scientists were discovering about myopia, has there been anything that surprised you a lot?

I try to think something that was really the most surprising… I actually do remember, yes… One of the most amazing things for me was that when I began to getting involved in this — I looked first to the Josh Wallman publications, I think the most amazing thing for me was to understand that he had discovered the importance of defocus in the periphery quite early on and that is only recently that contact lenses are being made to ‘manage’ the problem of myopia progression. The scientists weren’t thinking of solving the problem; they were just looking at what was occurring to make an eye myopic.  And we are, right now, at the nexus of where science, discovery, and practical applications come together.

  • Well, yes, there is some slowness to transform into something can be exported to the practice…

Yes, that ́s very slow.  It took many stages, first trying to control peripheral defocus with spectacles, understanding something… then, finding better ways to do it. And, as everything seems to happen in this particular science, discoveries all happen by accident. Those are the great stories!

  • Talking about the documentary…what was the biggest challenge in making the documentary film?

Technically the biggest challenge is that I decided to try to simulate different aspects of vision. Video and film are both two-dimensional while vision is three-dimensional, so that ́s a handicap of making a film. Working in digital you have little bit of room to modify the depth of field and depth of vision but I’m looking into using equipment that is truly three-dimensional in order to obtain a real taste of what is like to see with different eye modalities.

  • With this documentary, are you trying to show what being myopic means for the public?

Oh yes! Absolutely, the purpose for making the documentary is to get the word out about how dangerous any amount of myopia is, particularly in children.  I mean, I have spoken to many, many adults who have never in their life get an eye exam and then they start to have problems, so I say to everyone:  Even if you think you have no problems, go now, get an exam so at least you have a starting point, so that when something else happened you will know at what point you can say, when I was 20 years old, I saw it like this, and when I was 40 I saw like this. So that it gives you some basis for understanding where you are when something goes wrong.

  • Is there any deadline? When will the documentary be released?

I need to rise 500.000 € to make the film properly and I need another one 500.000€, because it’s quite an involved project: 1) a creative feature-length film for cinema distribution, 2) a one-hour TV version – using the same footage, which that is delivered to the public in a more straightforward, basic style, and 3) I’ll also make short little pieces for web distribution or that could be used in eye doctors’ waiting rooms, etc.  Plus using this three-dimensional equipment, we’re creating an educational exhibition for science museums where the people go and discover the different aspects of hyperopia, myopia, astigmatism, and the diseases associated with myopia – glaucoma, detached retina, macular degeneration and cataracts.

From the moment I acquire full funding, I set a deadline of 18 months after so, the time it takes to finish depends on when I am able to obtain the financing. At this point, we’re anticipating the release date to be Autumn 2019.

  • What are you working on next? Is it related to myopia?

It ́s funny, I take a lot of time to make each film. People that I worked with in France told me: “You have 6 weeks to go to Burgundy and film this subject”. And I said: “No, no, no, no…” I spent 3 years living there, meeting the people, and staying on there, filming almost every day…a little bit every day and really gathered an impressive story…so I don ́t really have much headroom left to think what the next project is because when I started this project I thought, “oh no problem, I know all the scientists, it will be very simple, they know what to say and we have a film…!” But first I had to learn a lot, it was like going back to school and then I realized that the project to do in the way that I wanted to do was not a low-budget film.

It turned into a large project, so right now I don ́t really think about what I am doing next, After this is over ideas will come to me but I don ́t have a wish list.

Once again thank you very much for your time. It has been a pleasure to have been able to conduct this interview.  We are really looking forward to watching your project.

All the best!

You are welcome! By the way, I love your blog!


Movie Trailer

LOSING SIGHT – Inside the Myopia Epidemic – a documentary by Jane Weiner.

 Disclaimer, all the rights from the trailer above are hold by the author Jane Weiner. The copy or reproduction in any way is not allowed unless explicit permission from her.

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Myopia in Science!

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Ophthalmic Workshop & Complementary Skill Course ’17

The following article is presented to you by Pablo Sanz and Miguel García
For all the general public.

During the last week of June, the MyFUN fellows were at the headquarters of Carl ZEISS Vision International GmbH (Beneficiary 06) in Oberkochen, Aalen.

There, the group received a guided tour through the company, the museum and took part in educational training about OCT, Biometry and Fundus cameras with a hands-on training with these devices.

 

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After 2 great days there, the group moved to Tübingen to have a joint complementary skill course with the Switchboard network. Legal awareness, ethics in biomedical research, intellectual property, properly writing scientific reports or how to keep a lab book were only few of the topics learned during this courses.

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To give an end to that week, some ESRs (Early Stage Researchers) shared their work in front of a more varied group of vision researchers in the Young Vision Research Camp.

 

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Hope you enjoy those pics as much as we do this week!


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Myopia in Science!

Eye Growth and Sign of Defocus

The following article is presented to you by Najnin Sharmin
Disclaimer: The following text may content specific terms, requiring more in deep knowledge in the field.
  • Human Eye Growth

During birth to adulthood the human eye grows very little. The eye of a newborn is around 70% of the size of an adult and the growth is approximately 7.6 mm from birth to adulthood. The “Eye Socket” also grows with the eyeball. Different kind of variations can occur during the eyeball growth and this can cause optical errors shifting the location of the best focus within the eye. If the eye is too short in length, it will focus images behind the retina. This case is known as “Hyperopia” or far-sightedness. Difficultly in reading, headaches, eye strain, fatigue are some consequences of Hyperopia. On the other hand, If the eyeball grows too long, it will focus images in front of the retina. This case is known as “Myopia” or near-sightedness. Myopia also causes headaches, eye strain and squinting if not treated.

What is Myopia?

  • Accommodation

The human eye changes the optical power by altering the shape of its lens to focus objects at various distances, this mechanism is known as “Accommodation”. Young people can change the optical power by up to 15 dioptres by changing the ciliary body. Their eye can change focus from infinite distance to just 6.5 cm from the eye. But accommodation cannot shift images back in focus on the retina in myopic eyes. For a relaxed eye, the accommodation level is zero, when the power of the eye is 60 D. Accommodation and eye growth are intricately linked but not the same.

Risk Factors 

  • What is Sign of defocus

Like any other optical system, human eyes also suffer from aberrations.There are different kind of optical aberrations e.g. defocus, tilt, spherical aberration, astigmatism, coma, distortion etc. In optics, defocus is one kind of aberration in which an image is simply out of focus. High levels of axial aberration (spherical aberration) is responsible for night myopia. Moreover, low-order aberrations cause Myopia (positive defocus) and Hyperopia (negative defocus). One of many common techniques to measure eye aberrations is the Hartmann-Shack wavefront sensor (HS-WFS). It is comprised of a camera with an array of microlenses called “lenslets” mounted in or near to the camera.

The sign of defocus is very important for the rapid control of accommodation and also for regulating the slower long-term growth of the eye (1). Human eyes typically have a positive Spherical aberration (SA) when accommodation is relaxed. The amount of positive SA falls when the eye accommodates, vanishes with about 2 or 3 diopters (D) of accommodation, and grows steadily more negative with further accommodation of eye (2,3,4-8) because of the changes in eyeball shape (2,9) and refractive index distribution of the crystalline lens (10).

  • Retina alone detect the sign of defocus?

A fundamental question in emmetropisation (ideal vision) is – whether the retina by itself can perform the image processing necessary to derive the sign of defocus without any help from the brain?

An experiment on chicks shows that eye growth can be locally stimulated by local degradation of the retinal image, even after the optic nerve was cut. So, it was clear that the retina has at least the complete machinery to convert image features into growth signals (11).

When we talk about light absorption in the retina, we tend to consider the retina as a single surface. In general, the retina is a multilayered surface. According to the antenna model of outer-segment pigments, those retinal layers can be considered as layered circular discs (12). Each disc has around 4,000 (1 µm) to 4,000,000 (5 µm) pigment molecules that can absorb light. Each outer segment has approximately 1000 lamellae and the interspacing between the lamellae is approximately 20 nm. (12).

picnajnin
Fig.1 Photoreceptor outer-segment model.

In this retinal model, defocus symmetry is broken by the light acceptance of layered membrane infoldings –

picnajnin2
Fig 2. Role of defocus seen in a cross section through the middle of the outer segments consisting an array of 19 hexagonally packed outer segments, when each segment has 1000 layers each containing 12 dipoles. The figure shows the light incidence near the (a) upper entrance and (b) far-end exit of a single outer segment (13).

The role of defocus for accommodation can be noticed from Fig. 2 suggesting that the best focus is obtained once the amount of light within the outer segment is maximized (13). Moreover, those stacked pigments may determine the sign of defocus.


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  • References.
1) Thibos LN, Bradley A, Liu T, and Lo´pez-Gil N. Spherical Aberration and the Sign of Defocus. Optom Vis Sci 2013; 90:1284 –1291.

2) Young T. The Bakerian Lecture: on the mechanism of the eye. PhilTrans R Soc Lond 1801;91:23 – 88.

3) Tscherning MH. Physiologic Optics, 3rd ed. Philidelphia, PA:Keystone Publishing; 1920.

4) Ivanoff A. On the influence of accommodation on spherical aberration in the human eye, an attempt to interpret night myopia. J Opt Soc Am 1947;37:730.

5) Atchison DA, Collins MJ, Wildsoet CF, Christensen J, Waterworth MD. Measurement of monochromatic ocular aberrations of human eyes as a function of accommodation by the Howland aberroscope technique. Vision Res 1995;35:313–23.

6) Plainis S, Ginis HS, Pallikaris A. The effect of ocular aberrations on steady-state errors of accommodative response. J Vis 2005;5:466–77.

7) Lopez-Gil N, Fernandez-Sanchez V, Legras R, Montes-Mico R,Lara F, Nguyen-Khoa JL. Accommodation-related changes in mono-chromatic aberrations of the human eye as a function of age. Invest Ophthalmol Vis Sci 2008;49:1736–43.

8) Cheng H, Barnett JK, Vilupuru AS, Marsack JD, Kasthurirangan S, Applegate RA, Roorda A. A population study on changes in wave aberrations with accommodation. J Vis 2004;4:272–80.

9) Lopez-Gil N, Fernandez-Sanchez V. The change of spherical aberration during accommodation and its effect on the accommodation response. J Vis 2010;10:12.

10) Navarro R, Palos F, Gonza´lez LM. Adaptive model of the gradient index of the human lens. II. Optics of the accommodating aging lens. J Opt Soc Am (A) 2007;24:2911–20.

11) Schaeffel F. Can the retina alone detect the sign of defocus? Ophthalmic Physiol Opt 2013;33,362–367.

12) J. J. Wolken. Light detectors, photoreceptors, and imaging systems in nature. (New York, Oxford University Press, 1995).

13) Vohnsen B. Directional sensitivity of the retina: A layered scattering model of outer-segment photoreceptor pigments. BOE 2014;5:1569–1587.

Peripheral vision and myopia

The following article is presented to you by Petros Papadogiannis
Disclaimer: The following text may content specific terms, requiring more in deep knowledge in the field.
  • What is peripheral vision

Peripheral vision is the part of our vision that is outside the center of our gaze, and it is the largest portion of our visual field. For both eyes the combined visual field is 130°–135° vertical and 200°–220° horizontal with 180-200 degrees comprising the peripheral vision. It is weaker in humans than in many other species, and this disparity is even greater where it concerns our ability to distinguish color and shape. This is due to the density of the receptor cells on the retina and the enlargement of optical errors in the periphery. As a result, reduced visual acuity and contrast sensitivity occurs.

  •  Retinal shape and myopia

Myopic eyes have multiple variations on their retinal shape. This phenomenon is related to the potential models of retinal stretching that occurs during axial elongation. The picture below represents the 4 models of retinal stretching that can occur in myopia. The solid circles represent the shape of the retina of an emmetropic eye, the dashed shapes represent the myopic retinas, and the arrows indicate the regions of stretching. (1,2)
It was found that despite the existence of myopia in both the central and peripheral retina, myopic error in the periphery is smaller. (1)
Also, in 2009 Tabernero and Schaeffel found that myopes (even those with medium refractive error) appear to have more irregular shape than emmetropes, on the peripheral retina. (8)

eyeshape
Eye expansion.
Source: Eye shape and retinal shape, and their relation to peripheral refraction, OPO 2012
  •  What do animal studies show?

Animal studies have shown that the peripheral retina can trigger or stop the growth of the eye depending on the location of the peripheral image relative to the retina. When an image is focused on the central retina and for the peripheral retina, the image is focused behind, this results in a relatively hypermetropic periphery and a defocused image. This defocused image sends a growing signal to the eye and makes the eye myopic.
By their experiments in laboratory animals, Smith et all found that visual signals from the peripheral retina can dominate against the visual signals from the central retina in terms of regulation of eye’s refractive status. (3)
The concept that dominates is that cones are more involved than rods(they are located in the peripheral retina) in the detection of visual signals that contribute to eye growth. But a study of 2010 in mice, shows that rods are important for the detection of the signals that are involved in the procedure of emmetropization and the development of myopia.(4)

  •  Does peripheral refractive status affect the onset and progression of myopia?

A number of studies in humans, have shown that peripheral refractive errors are ante-dated to the onset of central myopia and can, therefore, be a risk factor for the onset and progression of myopia.
In a 1971 study in young trainee pilots, Hoogerheide found that emmetropes with peripheral hypermetropic refraction had greater possibilities to develop myopia, compared to emmetropes that appeared to have myopic astigmatism in the periphery. (5)
More recently, Schmid (2011) verified an important association between the greater steepness of the retina (more prolate eye shape) and the central myopic shift in children.(6)
On the other hand, Mutti in 2011 didn’t manage to verify the influence of peripheral hypermetropia in the onset of myopia. Particularly, despite the fact that he found a correlation between the magnitude of the peripheral hypermetropia and myopia progression, the total influence of peripheral hypermetropic state in central refraction was limited. (7)
To conclude with, although the hypothesis that a relatively hypermetropic periphery can drive the development of human myopia remains unproven, the existing research support the possibility of an interaction between the states of focus on axis and in the periphery.


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  • References.
1) Pavan K Verkicharla,Ankit Mathur,Edward AH Mallen,James M Pope,David A Atchison. Eye shape and retinal shape, and their relation to peripheral refraction. OPO 2012; 32: 184–199
2) Strang NC, Winn B & Bradley A. The role of neural and optical factors in limiting visual resolution in myopia. Vision Res 1998; 38: 1713–1721.
3) Earl L. Smith. The Charles F. Prentice Award Lecture 2010: A Case for Peripheral Optical Treatment Strategies for Myopia Optom Vis Sci. 2011 September ; 88(9): 1029–1044
4) S. B. Jabbar; A. E. Faulkner; G. F. Schmid; F. Schaeffel; J. Abey; P. M. Iuvone; M. T. Pardue. Rod Photoreceptor Contributions to Refractive Development and Form Deprivation Myopia in Mice. Investigative Ophthalmology & Visual Science 2010; 51: 1726
5) Hoogerheide J. · Rempt F. · Hoogenboom W.P.H. Acquired Myopia in Young Pilots. Ophthalmologica 1971;163:209–215
6) Schmid GF. Association between retinal steepness and central myopic shift in children. Optom Vis Sci. 2011 Jun;88(6):684-90.
7) Donald O. Mutti; Loraine T. Sinnott; G. Lynn Mitchell; Lisa A. Jones-Jordan; Melvin L. Moeschberger; Susan A. Cotter; Robert N. Kleinstein; Ruth E. Manny; J. Daniel Twelker; Karla Zadnik Relative Peripheral Refractive Error and the Risk of Onset and Progression of Myopia in Children Investigative Ophthalmology & Visual Science.2011;52:199-205
8) Juan Tabernero; Frank Schaeffel. More Irregular Eye Shape in Low Myopia Than in Emmetropia. Investigative Ophthalmology & Visual Science.2009;50:4516-4522.

Refraction Fluctuations in the Eye

The following article is presented to you by Dmitry Romashchenko
Disclaimer: The following text may content specific terms, requiring more in deep knowledge in the field.
  • Refraction

As it was said previously, the mechanisms for the myopia onset are currently not completely understood. That makes every difference in static or dynamic behavior of emmetropic and myopic eye of particular interest. Refraction, or optical power of the eye, (compared to its length) is the main criterion by which the judgment about ammetropia (myopia or hypermetropia (far-sightedness)) is made. Refraction is the reciprocal (1/value) of the distance to the plane on which the eye is focused. For the relaxed (not accommodating) emmetropic (healthy) eye refraction is 0D. That means that infinitely far objects (1/infinity =  0) will be in focus on the retina. Relaxed myopic eyes have refraction 0. The signs are showing the position of the plane in focus (negative – forward, in front of the eye, positive – backwards, behind the eye) and the number is showing the amount of image blur: the bigger is the absolute refraction value the more the image is unfocused.

  • Refraction fluctuations

When talking about the ‘refraction’ of the eye the ‘mean refraction value’ is meant as the value is not completely constant over time (see the fig.1). These changes can clearly be seen on the figure 1.

Fluctuations_Dmitri
Fig. 1 Dynamics of the eye refraction

This microfluctuations in the eye optical power can be categorized in 2 groups by their frequency: lower (below 1 Hz) and higher (above 1 Hz) frequency domains. The second group fluctuations are lower than those of the first one (2). The low-frequency group is believed to be responsible for ‘physiological control’ of the eye refractive state (2). In other words, when looking at any object, the eye ‘checks’ if the refractive power of the eye is still optimal for viewing the particular object. It is represented by slow fluctuations of the optical power from the mean value.
Comparing myopic and emmetropic eyes showed that myopic patients have larger refraction fluctuations for far and near targets than emmetropic ones (1). This is one of the clues to the theory idea that in myopic eyes the whole accommodation mechanism (change of the optical power depending on the distance to the object) is working differently than in emmetropic eyes. Since the loop ‘accommodation mechanics + neurological control’ is not fully understood as well, this difference can play a major role in myopia onset processes by itself or be a significant part of it. On the other hand, this observed changes can be not the cause but the result of the myopia development in the eye. In both cases it gives a better understanding of the myopic and emmetropic eyes dynamics, creates new and answers previously arisen questions on the matter.


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References.

1) Seidel; N.C. Strang; L.S. Gray; E.A. H. Mallen. The Influence of Target Vergence Upon the Magnitude of the Accommodative Microfluctuations in Emmetropia, Early–Onset Myopia and Late–Onset Myopia, 2005

2) Ronald B. Rabbets, Edward E. A. Mallen, 2007. Clinical Visual Optics, 4th edn., p. 125 – 149. References to the chapter:

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