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medical examiner: Health and medicine explained.

Your Health This WeekStopping nearsightedness in kids and more.

By Sydney Spiesel
Posted Tuesday, Feb. 27, 2007, at 12:44 PM ET

This week, Dr. Sydney Spiesel discusses a way to stop the progression of nearsightedness in kids, a better method of hormone replacement therapy for women after menopause, and new developments in the search for a cause for autism. His column will start appearing a couple of times a month.

Stopping the march of myopia

Condition: Nearsightedness, or myopia, is the most common eye problem. In the United States and Europe, about 25 percent of the adult population is nearsighted, and in much of Asia the condition is more common still. Significant myopia can have serious medical consequences. It has long been understood that the condition has a strong genetic component: Nearsighted parents are more likely to have nearsighted children. But recent research has shown that other factors contribute. For example, just as our mothers warned us, there is now evidence that doing close-up work, like reading, seems to promote the condition.

How it progresses: The eyeball of a nearsighted person is deeper than the eyeball of a person with normal vision and becomes deeper as nearsightedness progresses. Myopia often begins to develop between the ages of 6 and 8. As children grow, their nearsightedness worsens, continuing to do so long after they have stopped growing taller. Though we know a lot about factors associated with nearsightedness and its progression, we have no good ideas yet about the mechanism. But can we stop it?

New research: A recent study by Wei-Han Chua and colleagues at the Singapore National Eye Center elegantly built on older research and successfully used atropine eye drops to treat myopia in children. Atropine is a longer-lasting version of the pupil-dilating drops your doctor uses when you go for an eye exam. Available by prescription in the United States, the drops are mainly used to treat amblyopia (lazy eye) instead of the older treatment, patching, which children often hate.

Dr. Chua and his co-workers studied the progression of nearsightedness in 400 children between 6 and 12 years of age. Half the children were treated with atropine eye drops, and the other half were treated with placebo eye drops. Both kinds of drops were administered nightly to one eye, so the untreated eye could be compared with the treated one. The children were followed for two years. All used eyeglasses to correct their nearsightedness, and because atropine dilates the pupil, the lenses of the glasses self-darkened in bright light, to avoid discomfort for the children whose pupils were dilated.

Findings: The effects were extraordinary: After two years, on average, the children's nearsightedness had not progressed in the atropine-treated eyes but had dramatically worsened in the placebo-treated and untreated eyes. Similarly, atropine-treated eyes did not become deeper, while placebo-treated and untreated eyes did. No serious adverse effects were observed in the course of the research.

Conclusion: This is extremely promising. Further work needs to be done to determine the ideal concentration of atropine in the eye drops, to find out how long the treatment needs to last, and if the effects are permanent. Because atropine interferes with close focusing, children will probably need to wear bifocals while they're using the atropine drops. Much more research must be done to help us understand why nearsightedness develops and progresses. But in the meantime, we may have a way to head off this common problem.

Hormone replacement therapy—a safer way

Treatment: Hormone replacement therapy was introduced in 1941, when the FDA approved the use of estrogen for this purpose. Early on, HRT was prescribed with great enthusiasm. It relieved troublesome symptoms associated with menopause, including hot flashes, sleep problems, and, for some women, difficulty in concentration. And HRT (usually estrogen plus a progestin) was shown to improve the bone density of elderly women and decrease their risk for fractures.