Clearing the haze

Kathy KL Tsim 詹觀蘭

HK Pract 2013;35:73-74

It has been a long, hot and busy summer. As the children are all heading back to school for the beginning of a new school year, I am sure parents are exhaling a sigh of relief. The long look-forward-to "return to normal life" after a busy and fun filled summer begins. One of the many important things that parents would be sure to have done was to have their children's eyes checked by an optician for myopia.

As can be noted from recent statistics, 285 million people are visually impaired worldwide and about 90% of them live in developed countries like Hong Kong. Globally, uncorrected refractive errors are the main causes of visual impairment.¹

According to data available to us, the prevalence of myopia in Hong Kong is comparable with Taiwan, Singapore and Malaysia. This figure is higher than that in some western countries such as Australia.² Hong Kong was found to have a high prevalence of myopia even among preschool children. They were noted to experience significant myopic shift and ocular growth.³ This has generated interesting arguments regarding whether it is a racial or genetic issue. As shown from studies, the prevalence of myopia in Hong Kong Chinese students had a higher prevalence regardless of whether they studied in local or international schools when compared with other ethnic groups, such as the Caucasians.⁴

This is an alarming issue for parents and the medical community. It is timely that we have such a well presented update on this topic in our Hong Kong Practitioner.

There is now an array of options for possible treatment or prevention of progression of myopia in our modern society. Gone are the days of, "Oh dear, you are short-sighted and there is not much we can do but get spectacles." As a consumer, one is nowadays bombarded with commercially available therapies that are widely available in Hong Kong or our neighbouring countries. The wide use of Orthoketatology lenses has become so popular among parents of young children that we need to be aware of how to counsel our patients on their proper use. This is also true for the use of low dose atropine drops as a pharmacological agent.

Atropine eye drops is now no longer a drug for the treatment of amblyopia, anterior uveitis or as an adjunct to an eye examination only. As the 5-year study conducted by the Singapore Eye Research Institute came to an end in 2011, there has been much media excitement and plans regarding the possible widespread use of this therapy. We family physicians in Hong Kong need to familiarise ourselves with this new treatment as the Institute is carrying out plans and having discussion with the Singapore Health Sciences Authority to get this approved and become accessible in their public sector.⁵ Kwok et al have helped us not only to do this but to give us new insights into the debilitating world of myopia in their article.

Also in this month's Practitioner, we bring to you another relatively new concept - the Dermatoscope. This little handy instrument is now becoming more widely available and no longer is it limited to the experienced dermatologists. Courses include on-line lessons from well reputed overseas universities are available even to practising physicians who have no dermatology background.6 This instrument has come a long way from its humble beginnings in 1663, where it started as an instrument for skin surface microscopy, to having its First World Congress of Dermoscopy in Rome in February 2001. A mobile virtual dermatoscope app is now available for paid downloading via any iphone or ipad machines. This little instrument is found to be a valuable visual aide in the diagnoses of a number of skin conditions.

As family physicians practising in the modern world, we now have great opportunities with new technologies available to us. These are useful in helping us clear the haze and mystery that often surround our practice. Striking the balance between the new and the already known will be a challenge for us all. As Hippocrates said, "The life so short, the craft so long to learn." We all aim to continue learning to enrich not only our lives but the lives of others like our young generation who return to their schools at this time.