Evolution of the Eye: What changes might be induced in the eye with higher use of near vision?

ByLucio Buratto, MD

Ocular Surgery News is exploring the unprecedented challenges the eye is facing in terms of adaptation.

by Lucio Buratto, MD

The third question included in my survey, which was sent by Ocular Surgery News Europe Edition to ophthalmology leaders worldwide, focused on changes that the intense use of digital devices and increased use of near vision might induce in the eye within a generation. The consequences of the overuse of digital devices are indeed a concern among ophthalmologists.

Several reports have shown that myopia, as well as dry eye, is on the increase worldwide, and we are witnessing this phenomenon in our daily practice.

According to the Vision Council Digital Eye Strain Report 2015, 95% of adults spend 2 or more hours every day on digital devices and 65% spend more than 5 hours. One in four children spends more than 3 hours a day on digital devices, although 22% of parents say they are concerned and aware of the potential negative consequences.

Recent studies have found a negative correlation between the exposure to daylight and myopia progression in children. The reduced time spent outdoors goes hand in hand with the increased use of digital devices and deprives children of the benefits of daylight as a protective factor against myopia.

What do key opinion leaders foresee in this respect? Here is the question, with some of the most interesting answers.

Survey question and responses

Question 3.

What changes could take place in an adult eye during the next 30 years, considering the greater, more varied and more intense near vision use of today’s children and teenagers?

Responses

Intensive use of near vision will induce more nearsightedness. Virtual reality will strongly influence future people’s visual performance, and further digitalization will increase eye-hand coordination and depth perception.

Michiel Luger, MD, VisionClinics, Utrecht, The Netherlands

We will see more myopic eyes. Some may prefer to remain myopic to see near, and some may wish to have refractive surgery to achieve better distance vision but targeting slight myopia rather than emmetropia.

Hiroko Bissen-Miyajima, MD, OSN APAO Edition Associate Editor, Tokyo Dental College, Suidobashi Hospital, Tokyo, Japan

Children today are more often inside and use their eyes more in the short distance than we did. They spend a lot of time in front of computers, sometimes very intensively for hours without relaxation. Some studies showed an increase in refraction anomalies, especially myopia, in children who spent long hours inside.

Frances Meier-Gibbons, MD, OSN Europe Edition Board Member, Rapperswil, Switzerland

Myopia is mainly due to genetic factors, but excess of near vision seems to be a risk factor. Nutrition is probably another risk factor for myopia, as well as for cataract, AMD and glaucoma. The influence of risk factors in the future is something that a clinician cannot predict.

Albert Galand, MD, PhD, OSN Europe Edition Board Member, Centre d’Ophtalmologie, Rotheux-Rimière, Belgium

As we have already seen, the incidence of myopia is increasing all around the world, and to add to this problem, the world is becoming more polluted. This increased amount of pollution will cause higher amounts of allergic conjunctivitis, which will result in an increased incidence of eye rubbing and, therefore, increase risk of corneal astigmatism.

Jerry Tan, MD, Jerry Tan Eye Surgery, Camden Medical Centre, Singapore

In my opinion, very few changes will occur. I do not believe “abuse” of near vision might be able to create a new generation of patients with low vision. However, I do believe that the eye is subjected to excessive demands nowadays, by the technology and by our artificial ways of “enhancing” vision. The eye was created by Mother Nature for far vision in diurnal solar light conditions and to serve in the first place the purposes of the reproductive time of life. Nature tends to eliminate what is not useful for its plans. So, every part of the human body gradually loses its function.

Alessandro Galan, MD, OSN Europe Edition Board Member, Ospedale Sant’Antonio, Padua, Italy

Brain plasticity has the capability to adapt to a high level of eye solicitation, and this will ensure that visual quality is maintained in adults. However, presbyopia will perhaps begin earlier, due to the more intensive use of near vision, and a myopic shift, as already observed, will occur in a large percentage of the young population.

Florence Malet, MD, OSN Europe Edition Board Member, University of Bordeaux, Bordeaux, France

Vision is a learned process that begins in the womb and continues until about adolescence. In the early stages of childhood, we develop basic skills of vision. In the final stages, we develop more sophisticated skills such as stereopsis and texture. We know that if we do not use our vision for a certain period due to optical or refractive defects, we will not develop normal vision (amblyopia). But we have not yet evaluated the consequences of developing vision in an artificial visual environment (games, movies) rather than in the natural environment where distances and textures make sense. It may compromise our visual development.

Ricardo Guimarães, MD, OSN Latin America Edition Medical Editor, Hospital de Olhos, São Paulo, Brazil

I am not convinced that the more intense use of eyes will lead to direct physiological and anatomical changes in the organ itself. It will certainly influence the willingness to adopt new technologies that alleviate the workload for eyes. And in 30 years, breakthrough technology that potentially reduces the direct use of high-resolution vision might have entered the scene. The greatest challenge, in my opinion, will be to develop new technology for the ever-growing cohorts of elderly people with visually debilitating diseases, in particular to create new devices that elderly people can learn to use easily.

Khiun F. Tjia, MD, Isala Clinics, Zwolle, The Netherlands

I do not think we will see changes in the adult eye. Regardless of the use we put them to, I do not think we will see over the next 30 years any evolutionary change. Prolonged near work with convergence of the eye has been going on for a long time, and we still cannot really document that the increase in nearsightedness we think we see is evidence of evolutionary change or just increased analysis of population and more frequent examinations of humans than previously existed. Also, people today do not tolerate poor vision as well as people of just two or three generations ago. What we may think are changes within the makeup of the eye may not be. We cannot be certain they really are changes.

I. Howard Fine, MD, OSN U.S. Edition Cataract Surgery Board Member, Oregon Health and Science University, Portland, USA

I do not anticipate noteworthy changes in the foreseeable future. In my understanding and opinion, the only possible change, namely the contribution of increased accommodative effort in childhood to the induction of myopia, has already mostly happened to the expectable degree.

Thomas Neuhann, MD, OSN Europe Edition Board Member, Munich, Germany

I do not expect significant changes except, perhaps, a low increase of spherical myopia.

José L. Güell, MD, OSN Europe Edition Board Member, IMO, Barcelona, Spain

Eye structure does not change in 30 years. Our eyes today are the same as they were 3,000 years ago. Structure is determined by genetics, and it takes thousands of years to undergo significant changes. Visual challenges may cause ocular abnormalities throughout life. However, because we correct them by artificial means, there is no natural preference and no reason for evolutional genetic mutations to occur.

Ehud Assia, MD, OSN Europe Edition Board Member, Sackler School of Medicine, Tel-Aviv University, Israel

I do not think the eye will have a chance to evolve in this amount of time; technology will rather adapt to what we have. There will be more presbyopia awareness in advertising and print, better IOLs and hopefully a corneal solution to presbyopia.

Stephen G. Slade, MD, OSN U.S. Edition Refractive Surgery Board Member, Slade & Baker Vision Center, Houston, USA

Reference:

Digital Eye Strain Report 2015. www.thevisioncouncil.org/digital-eye-strain-report-2015.