RTB - Petition Beer Corner

(BACKGROUND CHATTER)

CAMPBELL:

OK, ladies and gentlemen. Thank you very much for coming to the Petition Bar. I thank the Petition Bar for hosting this event. Raising the Bar started in San Francisco. It's been moved to Melbourne and Sydney, Auckland, it's now come to Perth. What we're trying to do with Raising the Bar is bring...make the research of the University of Western Australia thus accessible to people in our community, through our CBD bar district, and one of the opportunities we have to showcase the impact that the research that the university has. Our very first speaker in Raising the Bar is Professor David Mackey. David is a professor of ophthalmology at the University of Western Australia, also managing director of the Lions Eye Institute, so he has a very great deal of experience and I'll pass it on to David. First of all, at the end of the talk...I think, David will talk for 30 or 40 minutes, there's opportunities for people to ask questions. There'll be a roving mike, so everyone can hear the question, and by all means, stay after the talk and enjoy the hospitality of the Petition Bar, so David...

DAVID MACKEY:

Thank you very much, Campbell. There'll also be questions during my presentation, 'cause I'm gonna ask the audience if they know things, because that's a pretty important feature about learning, is to get good feedback. Back in July, when I was asked, "Would you like to give this talk?" I thought, "Yeah, that sounds a good idea," and as it got closer, I thought, "What on earth was I thinking about?" I think, probably it was because it was in the middle of dry July, that the idea of giving a talk in a pub seemed a pretty good one. Now, the thing of talking about glasses - so I might get everyone here to raise your glasses! So, most of you are clearly thinking about the wrong thing of what I'm meant to be talking about today, so I'll have to intertwine our glasses and not glasses.

The types of glasses that we have, you know, very quite a bit, just like the types of eye diseases that we work with, very quite a bit. Now, Juleye, spelled J-U-L-E-Y-E, is actually a public awareness month for eye diseases, and the leading causes of blindness in Australia are age-related macular degeneration, glaucoma, diabetic retinopathy, cataract, inherited retinal degeneration, and poorly or uncorrected refractive error. Uncorrected refractive error or poorly corrected refractive error is where you have the wrong glasses, and I might point out here, I think I've actually got the wrong glass for beer. How many types of glasses do you think there are for actually drinking out of? There's over 50, you know. You need to have the right glass. If you're gonna have a wine glass - so this is more like a brandy balloon here. This is something you need if you're gonna smell the wine - it's good white beer here - you can smell better.

Now, a nose is very important with glasses, because if you have no nose, your glasses will slip off. Now, the types of glasses - there's one made famous by a Western Australian that I should ask about, and I hope the bar doesn't have any of these available. Does anyone here have experience with the yard glass? Yes? Ah, right. I'm a bit worrieder now about the audience here. Which Australian holds the record for the yard glass?

AUDIENCE:

(INAUDIBLE)

DAVID MACKEY:

Very good, so you've got good knowledge about glasses here, not about spectacles, but drinking glasses. So, having the wrong glasses and not being able to see clearly is a problem, so I'm gonna try and enlighten you to a bit about why that happens and what we're doing about it. Now, to start off, get a bit of historical perspective, and see, how many people know where the quote on my T-shirt comes from?

AUDIENCE:

(INAUDIBLE)

DAVID MACKEY:

Very good, so a Game of Thrones T-shirt here, so here's someone who's watched the entire box set. I was on the same flight as Campbell going to London, the 17-hour flight, and you could have watched the entire series seven on that flight. It was available there. Anyway, this is the Game of Thrones. Most people here will have heard about it, some seen it. A question there, how many of the characters in Game of Thrones wear glasses?

AUDIENCE:

(INAUDIBLE)

DAVID MACKEY:

None. Are there any characters in Game of Thrones that need to wear glasses?

AUDIENCE:

(INAUDIBLE)

DAVID MACKEY:

Who?

AUDIENCE:

(INAUDIBLE)

DAVID MACKEY:

Yes, and someone actually commented in one of the earlier episodes that they had problems seeing in the distance.

AUDIENCE:

(INAUDIBLE)

DAVID MACKEY:

No. Who does a lot of reading and studying?

Last night in Game of Thrones you had a, very good. So, if you've got Sam who's studying all the time indoors goes outside on a big wall looking at infinity, can't see anything inside rating, he's fine. So, you do have the potential for factors that make people short-sighted in that story and people showing evidence for it and pretty good the epidemiology fits with the name of one of them. But Game of Thrones is set in a time when we didn't have spectacle glasses.

And in reality that could have made them. What did they have the resources to make spectacles there? Yeah. You're the only person who saw the shark. Thank God you're here. (LAUGHS) So what kills white walkers?

Dragon glass. So, dragon glass which is what it's referred to in the series is actually volcanic glass or obsidian. And so, some of the very earliest records of glasses are actually volcanic glass that was then ground down to make lenses and the oldest recorded Spectacle lenses in the British Museum called the Nimrod lens and it's 3000 years old.

Now, another famous reporting of the use of glasses although fortunately, we don't sell them at the same price that these would go for, is that Emperor Nero had a ring with a large emerald and he'd hold it up to his eye and peer through it to see clearly. So, these were the very earliest examples but it wasn't really till the 1350s that spectacles as we know it, began to appear.

And in the painting of the Bishop of Madina in Italy, where all of Semic vinegar comes from, that's the oldest recording of seeing it. And it was really the glassblowers of Venice who gave us the high precision glassblowing skills to actually make lens which had power in them. So, they were making glass for things like stained glass windows, for people's drinking glasses, for vases and other ornaments but also they started making lenses for not just refractive correction, but also for research.

So, for the optics used in microscopes and in telescopes, this is where the skills came from. And it was, in fact, Kepler the famous astronomer, who was the first person to notice that presbyopia, where people have trouble seeing up close, was corrected by convex lenses and myopia where people have trouble seeing in the distance was corrected by concave lenses.

Now, presbyopia is something that some of the group here will be experiencing and know far too well. There will also be some here who are aware of myopia. That presbyopia is I think a physiological adaptation so that as we age our partners up close go into softer and softer focus and therefore you can stay united together.

But bringing in reading glasses and bifocals, does anyone know who invented the bifocals? He was so sick of changing between his distance and needed glasses. OK. So, if you go to America and get $100 bill, that's who's on that. Benjamin Franklin Very good.

So he developed the bifocals. So these are relatively recent phenomena of these ways of adapting for something that's been present for a long time. Now short-sightedness probably hasn't been present for that long. But we see a lot of it now but there's another feature that we see looking at children where they're actually hypermetropic and their eyes are very small and they don't have the right power of the lenses to match the length of the eye.

And you often will see little kids who are wearing their glasses if their vision is blurred particularly if they're cross-eyed which can be an adaptation for this, we might need to put a patch over the good eye to make them see out of the bad eye. And this is some of the research we've been doing looking into the genetics of this feature of children's eyesight but it's been far more challenging. We're still working on it.

The more common thing when people are in later school age is, so primary school, particularly secondary school and university, is where people become short-sighted. And often it's called school myopia because that's where it's noted. And that's because the length of the eye is growing in access to the focusing power that the cornea and the lens of the eye are providing.

Now, this is something that affects 23% of 20-year-olds in Western Australia. We saw 1350 of the range study participants who here knows about the range study? That's great. Is anyone here a participant or member of the range study?

Fabulous thank you very much. (APPLAUSE)

So, we've been studying the members of the range studies since you were embryo's and your mum said, "Yes, I'll volunteer my child's whole life for medical research." And what has been so impressive is the really high continued participation of the participants.

So, many studies initially with Professor John Newman here at UWA and Professor Fiona Stanley, looking at very early childhood factors and for the eye study exams we invited everyone in at age 20 and we examined how many people were short-sighted at that age and it was 23% which was one of the lowest rates of myopia in the world.

Now, the area where we're seeing a boom in myopia, are the cities of East Asia. So it was first noted Japan, Korea, and Singapore. Singapore now has rates of 95% of young adults who are short-sighted needing glasses. It's created a huge problem for them to get pilots for their air force who aren't short-sighted. So it's literally you don't wear glasses you're in the Air Force.

Then we had thought with Taiwan and Hong Kong also showing shortsightedness, something strange was happening in China where it wasn't present. Well if you have seen any of the Chinese students who come here to Western Australia and we had about 80 issue, was a 100 this year winter medical students come here from Shanghai, Guangzhou and Beijing and they were here at UWA and I usually ask who he is not short-sighted.

And when we tallied up the numbers this year similar to previous years, 95% of them are short-sighted. So there is this massive epidemic that's happened in East Asia and it's probably one of the biggest epidemics the world's ever seen where you've gone from numbers like 20% to 95% of people being affected by a disorder.

So a lot of researchers going into this to try and find out why it's happening. So the questions for any disease is could it be genetic or is it environmental. And one of the best ways to sort this out is to study twins. Now have any of you, any idea of what different sorts of twins there are there?

Any hints? So we've got identical and non-identical twins. So, identical twins aren't really totally identical but they have very very similar and their genetics is almost 100 percent the same just the

way that different cells in your body might have a few different mutations and have a little variation or one cell might switch on one gene from one parent in the other might switch on another from another parent. That way you can have identical genetic twins being a little bit different or if one of them was a lot smaller when they were born.

One that might persist through life. So, what we do in medical research is we compare identical with non-identical twins. Now, usually you can tell the difference and one of the easiest ways to tell if twins are non-identical is if one is a boy and one is a girl. But if you know any parent or twin that is a boy-girl pair ask them what do you say when you've said Oh yeah one is a boy, one's a girl. And the people then say, are you identical? And you'll hear some of the most amazing answers that people give and I probably won't say them out loud at the moment.

However, the reason for this confusion is probably the fault of William Shakespeare. And he had two plays that had twins. And the play, '12 knights' had Sebastian and Viola, and they were meant to be a boy and a girl who were identical. So, why did Shakespeare get away with that?

Well, back in those days all the actors in Shakespeare's play even if you are doing Romeo and Juliet were men. And so, therefore, he had a pair of identical male twins one dressed up as a girl one as a boy. Now, we don't have identical male-female twins. You can have people are very similar but I won't go into any of the Game of Thrones comments about twins either.

Now, with the twins, we can compare how similar identical twins and how similar are non-identical twins. And what is the difference between those two similarities? Now if they're both equally similar or dissimilar the correlations, it suggests it's all environmental.

But if the identical twins are incredibly alike. And the non-identical twins are random just as any brother or sister might be, then you know that genetics is there. So we did these analyses not only for short-sightedness but for all powers of lenses and we also did it for the length of the eye and the curvature of the cornea and all the statistics came up very strongly.

There is a strong genetic contribution to myopia. Now even though we're seeing a massive epidemic going from 23% to 98%, still most of the drive for whether you'll be short-sighted is genetic. So to find the genes, we went out and look to for families that had strong short-sightedness in the family. Now the problem is if Mum's got myopia and dad's got myopia and I've got myopia, it could be the genes first thing to think of but it could be that we all went to university and studied and we had the same environment that caused us to be that way.

So, we teased out some families that was very difficult to find genes and then we combined a massive amount of data and this involved several groups going around the world saying who are all the researchers in the world, who've done any work where we've collected measurements of myopia and we've collected genetic analysis and can we pull all our data into a giant meta-analysis to find out what genes do the people who have had short sightedness share in contrast to other people.

Now, we were cruising along thinking this is really good. I had two professors the lead researcher in myopia families from the United States came here as a rain visiting professor and at the same time lead researcher in the United Kingdom, Chris Hammond came over as well. And we were looking at what grants we'd write. Preliminary analysis and the very first dataset came off the computer to say

it looks like we've got 20 to 30 genes from this analysis and we thought, great we'll spend the next year writing this paper up.

At the same time, we read in one of the abstract books for the American Society of Human Genetics that the direct to consumer DNA testing company 23 and me had analyzed the whole lot of their participants and they also found about 20 genes.

So we went into an absolute panic because this talk they were going to present was in four weeks and we knew if we were beaten by them everyone would say well we just copied what they did. So we had to take our data and get a group of over 60 people around the world to contribute to writing a paper within one week which we actually managed to do here in Western Australia.

We were doing our draft of writing in the morning, we'd send that to the UK. They would do their work with the Netherlands group then it would bounce back and it was a really exciting time in both papers ended up being published at the same time. And four years later we've now combined all that data with the UK Biobank data and we've got over 100 genes that we know contribute to short-sightedness.

And the main pathways that are coming up, is the pathways involved in actually seeing and it's the things in bright light seeing. So, in this dim environment here, I'm probably making myself a little bit more short-sighted if I was a teenager or as if I was outside in the bright Western Australian sun I'm probably holding it at bay.

So, what environmental factors? I've just mentioned sunlight and it was the Sydney Myopia Study that showed that the kids who stayed inside were more likely to be short-sighted than the kids that went outside. So we looked at that in our twin studies in Tasmania in Queensland, we looked at it in the Norfolk Island Dyce study which is about as far as you can get from Perth and still be part of Australia and we looked at in the range study here in Western Australia and also in the Busselton study.

So, we looked at signs of sun damage on people's eyes and the people with the most sun damage is people with tourism, people who are surfers. It used to be cricketers, had the big fleshy lump on the inside of their eye, less likely to be short-sighted.

Now in that area, if you shine a UV light there, that will glow and tell you this person's got a fair bit of sun damage. I've got a moderate amount of sun damage myself and I'm a little bit short-sighted so, I probably got a balance there. But we've done this research and shown this is a very good marker.

We also looked at other markers of whether you're outside. And one of the good markers of whether you've been outside in the last 30 days is what your vitamin D level is in your blood. And for the younger kids in the range Study, our group found that there was a good correlation but for the older adults in the Busselton study where what they are doing now that they see changed retirees, is different from what they did as kids when there was study.

So, there isn't a correlation of vitamin D so much in the older individuals. Now the other thing we did with the Busselton study, you know, people here are aware of the Busselton study. So, Colin actually

is famous for starting Cullins winery down there I don't know if they have any in the bar here, but he also set up the Busselton study a little over 50 years ago.

And they've been following the population there and we were involved in the Busselton healthy aging study so 5000 people measured their eyes for what strength of glasses they need. We also asked everyone, "Have you had skin cancer?" Now if you want to have a good marker of having spent a lot of your time outside as a kid, skin cancer is a pretty good one. And the people who'd had skin cancer were half as likely to be short-sighted as the people who weren't. So we're pretty much supporting all that analysis we do more time you spend outdoors, less likely to be short-sighted with the Busselton study showed the real balance that one has to do in the tradeoff.

You're gonna increase the risk of getting skin cancer. So what other things can we look at? Now, I won't dare in front of the academics in the audience suggest well, if we stop people going to school and university that would decrease the amount of short-sightedness here.

But can we ameliorate it by having more lessons outside perhaps and redesign some of the older dark lecture theatres that we've had? The other treatment that we're now starting as a trial is looking at a drop that we've actually used in children we used it in adults to dilate your pupils to examine your eyes and that's using atropine. Now atropine's other name, does anyone know that? Belladonna. So why is it called Belladonna?

So he gave it to young women to dilate their pupils allegedly to make them look beautiful. Again, I think it's a bit like the presbyopia story as the young women would put this in so that the men they were with were in soft focus and quite blurred and then they wouldn't have too much of a problem.

So, the older men thought the women with the dilated pupils were fantastic cause they didn't knock them back. So, belladonna is also known as deadly nightshade. Now, in history does anyone know any famous people who have been murdered with deadly nightshade?

Who are Romans scholars here? Classics? So, Augustus Caesar was apparently poisoned by his wife Livia and Claudius was also apparently poisoned by his wife Agrippa, who got another person to actually do it. It's alleged that Macbeth used it to kill English soldiers and which storyteller's great on poisons in her novels?

Agatha Christie. Yes. So she's got a couple of novels where this is used. So here I am saying let's put more deadly nightshade in children's eyes. Well, we're actually using an incredibly low dose. In fact, this dose is so low that the research study we're doing at the moment where we're treating 150 kids, the entire dosage dilution that we give them would be in 1, 1 percent bottle of the drug. That we're giving them all one-hundredth of that dose that they need to put in their eyes every day over a two year period.

And it was a study in Singapore that was comparing high dose atropine which they'd shown does work except these kids can't see very well its eyes are so dilated and they used very low dose one-hundredth dilution as the control. And surprisingly the kids on the control arm had the best long sustained suppression of myopia and therefore everyone flipped around said we've got to do this treatment.

Now there are a lot of people who are suggesting this treatment that there hasn't ever been a trial showing that this low dose versus nothing makes it different. And there are three trials now underway. Our arm here in Western Australia, we've got two sister arms one in Dublin in Ireland and another one based out of Belfast also in Northern Ireland as well as other cities in the UK.

So, this study is being done. We'll be able to tell you in a few years whether it works and how many years we're gonna have to be doing this for. But the balance is which is the best treatment. So sending people outside don't wanna cause skin cancer but at least don't have less time in sight. Does anyone know how much time the Chinese medical students last year spent outside per day?

So, the question I asked was how many of you spend one hour outside per day or seven hours per week, guess how many hands went up. None. Not one of these Chinese medical students spent that much time outside. I pointed out if any of them go down to Fremantle Prison you'll hear that if someone was in solitary confinement in Australia you had one hour outside per day.

So, there's a huge difference in what we're doing here in Australia compared with other countries. Now there are other treatments such as using rigid contact lenses to sleep with but most children don't like that. And about half of them stopped doing that and it's definitely very expensive.

The other treatments, of course, we can say well let's let Little Johnny be short-sighted and the treatments we have of course glasses. We have contact lenses and I know there'll be contact lenses whereas here in the audience and then you can have things like laser surgery.

And what laser surgery is actually doing is carving a contact lens surface into the cornea so you have to have a fairly thick cornea to be able to do this. That if you are at a moderate amount of myopia with a thick cornea it's possible for a lot of people it's not possible. And if you're only a little bit short-sighted when you're over 40 you decide that having that minus one or minus two is a real advantage when you wanna look at your mobile phone when you wake up in the middle of the night and don't know where you've put your glasses.

Now, other treatments when you get older. One of the other leading causes of blindness I mentioned was cataracts. And we have people who when they have their cataract surgery can choose to get rid of their glasses. So, we had one prime minister recently whom everyone remembers when he was in office wearing his thick glasses hiding his thick eyebrows.

And now you almost never see him wearing glasses. Who's that? John Howard. Indeed Bob Hawke actually never wore glasses when he was officed in that was because he wore a contact lens and he'd had one eye for near one eye for distance. So politicians are a bit there are.

Other reasons for wearing glasses, maybe if someone doesn't have any need for a refractive correction. We need people to wear glasses for eye protection. Now, if you're outside in the sun wearing sunglasses is clearly a benefit to prevent UV damage but wearing a hat is equally good. I should show you my hat that I have here.

So that will block out the sun as well as protecting the skin on my face. The Other major time people need to wear glasses are safety glasses. So you're in a role where you're with toxic chemicals that can burn the eye or bits of metal or rock that can shoot up into the eye. It's critical if safety glasses need to be worn they should be worn. An area that gets missed a little bit is some of the sports.

People should be wearing glasses where all the projectile can hit you in the eye, saying, playing squash and cricket are the two major ones where we've seen a huge change in eye protection. But other sports like tennis you are at risk of getting a ball hitting you in the eye.

Basketball you can get a finger in the eye. And those with common injuries at the Olympic Games from the basketball teams. So I think I've given you the real reasons for wearing glasses but there's one other reason and that's for fashion. And there are a lot of famous people that you could actually recognize just from their glasses.

So I wanna see if the audience can name some classic glasses that one would recognize. Elton John. Dame Edna. Dame Edna's quote that I love is that the eyes are the window to the soul and the glasses are the Venetian blinds. (AUDIENCE LAUGHS) So, other famous characters. John Lennon, who had glasses similar to John Lennon the fictional character in movies?

Harry Potter indeed. Buddy Holly. Yeah. So, some people really define their appearance from their glasses. So, you might choose if you want to wear glasses to really make a name for yourself. So, I might open up for questions. But I hope that I've opened your eyes a little bit to myopia, the research that we're doing to find out what genes are causing it.

Can we come up with new medical treatments for it that are better than the current atropine trial that we're still not quite sure how well it works? Can we work out how to give people the right amount of time outdoors? And it may be a really simple measure that can be used to solve the myopia epidemic in China, is that we advertise that if all of the middle-class Chinese kids come to Western Australia for their high school and university, they won't be as myopic.

So, you'll have to increase the enrolments a little bit there. But please take care of your eyes and of course, we love support for medical research and particularly for eye research. So thank you for listening. I hope I've opened your eyes.

(AUDIENCE APPLAUDS)

CAMPBELL:

We do have time for questions and I will ask is a roving mic at the back there.

If anyone wants to while people were thinking of that. Can I just let you know that UWA is holding this event annually from this point on. We are probably gonna go to two talks per bar for 10 bars in and around the September period for next year so please keep an eye out for, it allows people to have an opportunity to see more than just one researcher. But at the moment just anyone who has a question of David there's one at the back.

SPEAKER:

Hi. The genes that you discovered in these Southeast Asian populations, any idea what the distribution is amongst other population?

DAVID MACKEY:

With the crame study the consortium for refractive error and myopia, we analyzed the two major ethnic groups within that study separately and there's actually quite a large overlap. So, a lot of the same genes affect all races. We haven't yet teased out why it appears that there are more people in China now being affected.

We do know that the rates of myopia are going up in Europe particularly in the United Kingdom. That's why Ireland and U.K. have funded their studies there. So, it may just be the behavioral difference that's driven the change in the genetic predisposition is about the same. In the Sydney Myopia Study, they compared the children who are born in Australia with the children who are of East Asian origin verses of European origin. And there was a huge difference in the amount of time spent outdoors and the amount of study. And it's the tiger moms driving the kids to do it rather than letting them go outside and play. So disentangling genes and environment we're still working on.

SPEAKER:

You mentioned that there are about 20 genes that were related shortsightedness. I was just wondering if there was any kind of correlation between the gene presence and actual expression of short-sightedness like are there certain genes that if you have this gene you will always be short-sighted or is it very much a product of your environment that causes you to be short-sighted?

DAVID MACKEY:

So, the Tele went up to over 100 genes a few months ago. So there are, the way that we look at genetics is traditionally we learnt what is called Mendelian genetics, where a person has a disorder and there's a 50/50 chance that one of their children would be affected if it's a dominant disease, recessive diseases the parents are both carriers and a quarter of the children get two faulty copies and end up with the disease.

So in terms of Mendelian presentation for myopia, there are some diseases that we call syndromic myopia and there's a particular disorder called stickler's syndrome, which is involved with the mutation in one of the subtypes of collagen, collage 2A or collagen 11A. And those people end up being very short-sighted. So I'm only a minus two myop.

These people are between minus 10 and minus 20. So very short-sighted in fact, the eyeball is so long. One of the problems with the eye stretching is it can damage the retina and the retina tears and detaches and that can cause complete blindness.

So, we know of that disorder, we know some of the inherited retinal diseases are very highly correlated with developing myopia. So the ones where you've got the gene very likely you're going to get the disorder. For the 100 genes analysis which done through this system called genome-wide association studies, those genes all contribute 1-2% risk.

The thing is if you've got 100 genes that all put in a 1% risk and you add them all up, you're then likely to get the disease. So Mendelian disease is a bit like playing a card game where if you could draw the Joker you've got the, you know, condition. Whereas what we're finding now with genetics it's a bit more like the analogy of playing poker where you've got different combinations of cards that can give you a winning card.

Although probably a more accurate analysis, if anyone's been to the Mona museum in Tasmania the guy who made all the money to build that museum, David Walsh did it from card counting playing blackjack. And he knew where all four decks of cards were dealt out and how that affected the risk of whether the player or the bank would win. And that's what we're actually really working with in this complex genetic disease for most of the diseases that we're looking at.

SPEAKER:

Thank you very much.

SPEAKER:

Hi. At the increase of myopia, is there annual studies? is there any correlation between the increase and the use of screen time?

DAVID MACKEY:

It's very hard to disentangle all the different factors. So, if I'm going to be spending a lot of time reading books or on a computer, I'm gonna to spend less time outside. And one thing people blame screens. So Kepler in the 1600s blamed all his near work and reading as the cause of his myopia.

People blamed books and reading until television came along. Then we blame television. When computers came along we blamed computers. We've only had smartphones for a bit over a decade. So, this huge upsurge in all of these personal electronic devices we don't have good data yet to know that the epidemic happened well before all of this was happening.

And so a lot of these kids, you know, we're staying inside. And epidemiologists nightmare has been things like Pokemon Go where they're outside but they're using their near device to look in the distance thing it's far too hard to put that into an analysis.

And although we've given lots of people diaries, the Singaporeans now have the smartphones and devices that gear how much time you're allowed and your logic is up and then the machine turns off. And in fact, China has just brought in a ban on extensive computer game use by children.

I don't know how that's going to be implemented but it was only announced in the last month, having had to lock my brother's two children's tablets in the hotel bedroom safe and watching the way they could hack the password. It was a bit upsetting to know whether you can actually control screen use by children but it's possibly there that when you do the big covariance analysis the ones that come out the strongest is the amount of time and intensity of education and the amount or lack thereof time spent outside.

SPEAKER:

So, hello, I've got two questions. So, I myself I'm quite like short-sighted, I'm a minus 10 and I'm yet to come across anyone who has it this bad. So I'm just wondering what's like the highest what's the worst that can get? And who's like what's the worst you've personally seen?

DAVID MACKEY:

So, I think the worst I've seen is minus 28. So that's very large. If we were to look at a normal population distribution if you were minus 10, I think we may have had one or two people in the range study who with that amount.

Now if you look at myopia as a biological measure in the population, it's actually quite an interesting phenomenon. If you look at a population where there isn't a high rate of myopia, the normal distribution is actually broken down. There are far too many people very close to zero than you should expect by chance and that's suggesting the people who are a little bit short-sighted or a little bit long-sighted.

The eye actually self-adjusts it's growth to stop it being short-sighted. But when we looked at the Chinese medical students where instead of the median refractive error being about minor.

Sahhaf which is Jesus for the Western Australian kids, the median was about minus three. It's this sort of fairly flat lump. So, maybe one or two people in the range study are at minus 10, but within the Chinese medical students I think it was maybe five or even maybe 10% would be that high. So it depends on the population.

SPEAKER:

Thank you.

DAVID MACKEY:

You had a second question?

SPEAKER:

I know just, what's the worst you have seen?

DAVID MACKEY:

Yeah. So minus 28 was someone who had stickler's syndrome, this collagen abnormality.

SPEAKER:

Hey, you touched on this a little bit earlier but when you were talking about this study that correlated time spent outside with myopia, was there any consideration for genetics in that study?

DAVID MACKEY:

Well, we've done both pure genetics, pure environmental and now we're doing gene time's environment. So one of the very good studies that we're doing and Gareth, who is during his Ph.D. on it, was a study that was set up through the Telethon Kids Institute with Liz Milne as part of her Ph.D., with Della Singlish, Donna Cross, and a few other researchers.

Where they actually were trying to look at improving children's skin protection and they randomized 30 schools around Perth to have intensive sun protection behavior education or standard education. And so the schools that had the intervention, the kids were spending about 20% less time outside in the middle of the day.

And we're now tracking all these people down there now aged 28 and we're trying to get them to come back here and let us have an eye exam we've seen nearly 300 of them so far there's 1,700 altogether but we may have enough with what we've got. But ideally we want to get more and when we've got large enough numbers, what we can do is look at the genetic profile and say, do the people with the highest genetic risk, when you give them the environmental risk, and we have done this for education in the Dutch cohort, the people who had both of those were 75% of them were short-sighted whereas if people only had one or the other, it was much less around 30%.

So the genes and the environment are interacting but for the outdoor activity we haven't quite got a good enough biomarker yet and a large enough sample with it to do it on.

SPEAKER:

Thank you.

SPEAKER:

You touched on this earlier with his question, but you mentioned that the main factors that you've identified for myopia are genetic and time spent outdoors,

DAVID MACKEY:

And education.

SPEAKER:

And education. And then his question was about screen time. So time spent kind of looking at things close to your eyes, I guess cause I spent a lot of time on computers, reading books when I was a child and I've got my APR I kind of made that correlation myself. I guess what I'm asking is...

DAVID MACKEY:

You've been following Kapler with his observation 400 years ago.

SPEAKER:

Are you saying that's an unlikely correlation that's unlikely hypothesis or we just don't have enough evidence?

DAVID MACKEY:

It's there but we can't accurately tease out the fact that if you do the reading, you're actually doing it close to your studying and so no one's done a trial to show if we made children read blackboards with huge writing of long distance away instead of reading books that are up close. Is there a difference if they do the same amount of study from that optical thing?

We don't have that data yet so we can't disentangle it but the signal from the statistics is more that it's the education than it is the reading. But definitely with some study designs it will come up dramatically. The more reading you do or the more near work you do with computers, tablets it is associated.

SPEAKER:

Yeah. So just another question is that as well. You said the mechanism of myopia is your eyeball is too long and so obviously the rays fall short of your retina. Is it possible that it could be the lens itself in your eye not being able to adjust to objects that are far away?

DAVID MACKEY:

So, strictly speaking, it's the imbalance of the two. So bigger people have bigger eyes but everything's in proportion. And you know that's the issue is it the strength of the lens power at the front. Now there possibly is some subtle changes and I think the reason that more people are very close to zero is you probably remodel a lens inside the front of your eye and it's position to just adapt to a slight bit.

But it's only about half adapted that you probably do with that may be a few adapters in some people. So it's the combination but if you actually look at the graphs of the axial length of the eye, you can see quite a dramatic thing from about 24 mm in length, going up to some people might be 30 mm in length. So if you go one millimeter longer you're about three or four adapters more short-sighted.

SPEAKER:

Just quickly, you know, the age-old truth if you ate heaps of like food it helps your eyesight. Is there any truth to any sort of remedies or stuff like that which actually helps your eyesight rather than having to get glasses?

DAVID MACKEY:

Right. So, not going with glasses, so one of the treatments was suggested was that all, you know, because I started getting short-sighted and then I wore my glasses and it got a whole lot worse. So the glasses made it worse.

The thing is you've got a trajectory that's happening and you've started the glasses here and then you notice it. The other thing is also once you start wearing glasses you suddenly can see everything and you want to wear them and you want to be as clear as possible and when you've progressed a little bit more you will say, "Can I get them, you know, adjusted they're not as good as they were a little while ago."

So, do nutritional factors affect myopia? We haven't pulled anything out yet. It's a possibility. The biggest nutritional story with vision, it is rumored it may have been developed by a professor of ophthalmology who came here to Western Australia in her retirement Dame Ida Mane. And she was a professor at Oxford University during the Second World War and the British had discovered radar and they didn't want the Germans to realize this but had to explain why they were able to shoot down more of the German planes than they had previously been able to do.

So there was a massive campaign of getting the British to eat carrots because the vitamin A in the carrots would improve their night vision and allow the pilots to see the German planes better. So that was actually a propaganda campaign which is still stuck in our community that carrots are good to eat for your eyes.

SPEAKER:

Thanks.

SPEAKER:

Just what about sunglasses? So I had a friend who was wearing sunglasses for a long time, had real problems if he didn't wear the sunglasses, I've never worn sunglasses, ever since he's not worn sunglasses, he's not worn them again. And now he's got no problem?

DAVID MACKEY:

So it would be he was wearing them all the time but at the times he took them off. He would have glare sensitivity I'm presuming but he's gone on and now he's happy hasn't had any operations or treatments for anything.

SPEAKER:

No operations.

DAVID MACKEY:

So the most common reasons for people having glare sensitivity is if you get cataracts where the lens in your eyes starts getting a Pache it's a bit like having a car windscreen where you start getting chips in your windscreen or a smudge across your windscreen.

If you're driving in the morning with a dirty windscreen into a sunrise or in the evening into a sunset, it's absolutely terrible to look through. And so people with that will usually have a lot of problems with glare and want to wear sunglasses to prevent that. If someone's got inflammation in their eyes that can make them a bit more glare sensitive. So those would be known disease.

Things that contribute to glare sensitivity but I suspect what might just have happened is that he got used to not wearing his sunglasses and coped with that, rather than there actually being any actual change happening with his eye.

SPEAKER:

Hi, you mentioned very briefly that you could adjust your eyes if it was only slightly plus or minus,

DAVID MACKEY:

Well, your eye does it. We don't know how to get your eyes to do that but yes.

SPEAKER:

So, if you only had a mild abnormality and you were given glasses as a child is that going to prevent that from happening?

DAVID MACKEY:

Now the studies looking at, you know, if you give glasses or you overcorrect or you under correct to prevent myopia progression, haven't shown any solid correlation with that. The thing that has is if

you put rigid hard contact lenses in and get a person to sleep with them overnight it's quite uncomfortable. It's actually a real physical mold of your eye that forces the shape to change of the cornea that does work. But a lot of people don't tolerate it. And there's a moderate risk of getting an infection from that, which can lead to serious vision loss although that's uncommon to occur.

SPEAKER:

Fantastic talk. Thanks very much.

DAVID MACKEY:

You're welcome.

SPEAKER:

You mentioned being outdoors in the sunshine is being the thing that's good for your eyes, why? What does it do?

DAVID MACKEY:

So what is it about being outside? So having got over the years of debate of is it genetic or is it environmental and the answer is it's both and working together. So what is it about being outside? So some of the things that we've looked at one of them which we specifically did in a few other studies did was, well could it be the vitamin D levels, we've shown that they go up.

And we did a very elegant study called the Mendelian randomization where if you look at the general population you'll find some people have slightly higher and some people have slightly lower levels of vitamin D.

So it took a very large number of people with that variation and found there were some genes, particularly vitamin D receptor and other related genes, that influence a person's vitamin D level.

So we then did this Mendelian randomization study where you don't actually give the person the drug or the agent or the intervention you actually look at what with their genes suggest they'd get. So we looked at the people with genes that should have made their vitamin D a little bit higher and compared them with people whose genes should have made their vitamin D a little bit lower and then we compared myopia between those two groups and if vitamin D was part of the pathway, you should have had an effect and it was pretty flat.

So that suggests that vitamin D isn't part of the pathway but it's a good marker of how much sun you've had in the last 42 days. So tick that one off. Is it the different colors of the light and if you go outside in the evening it's an orange light less bright, middle of the day it's the brightest blue white colour. And in different parts of the world will be a different colour.

In China it's sort of a murky brown. So, whether the actual different colors may influence has been a hypothesis. There's one group trying to have children wear rose colored glasses. I think it was probably more of an emotional thing rather than a scientific thing.

Then there are the issues of if you're outside, you gonna be looking a lot further away than if you're in a room like this. So this is, you know, the distance hypothesis, but again not 100% certain with

that and the actual one that the genetics is supporting, it's just the simple brightness of the light that's driving it. If you can't see well because it's fairly dimly lit, your eyes they're trying to change might activate some pathway to grow.

Whereas if you've got lots of light it's easier to read and your eyes just saying yeah I'm fine, I'm just gonna stay not gonna grow abnormally.

SPEAKER:

So we should turn the brightness on our phones all the way up?

DAVID MACKEY:

Possibly. The battery or go flat quicker and then you know not do as much near work so will work either way then.

SPEAKER:

You mentioned a bit about how you didn't know much about the reasons why adults develop myopia when they get older.

DAVID MACKEY:

I didn't talk about adult myopia so the main myopia we're seeing is childhood myopia. So, people start in the plus area and through childhood, you drop them too close to zero and then 23% of West Australians go below zero to become minus in myopic.

The myopia peaks probably around the age of 30 but we're looking at the range study participants now in their late 20s and we'll have data to support that in a year's time and then as people get older, there's a little bit of a drift back to the plus end and that will continue till people are up in their 50s and 60s and then what happens if people start getting cataract that affects the lens and makes people more shortsighted again.

So you often see this in elderly people who've used to wear reading glasses and suddenly oh actually I'm much better in focus for near than I used to be. So there is this fluctuation with age, which makes it very hard to tease out big social factor changes such as suddenly the iPhone appeared. Well, that suggests that people of that age are a bit less or a bit more than another age.

SPEAKER:

Can you tell us a bit more about the reasons why people become more nearsighted when they get older?

DAVID MACKEY:

Presbyopia why does that happen? So the lens in the eyes, so for not being able to look up close, the lens in the eyes actually growing very slowly and when you're young it's very flexible you can zoom in and out about 10 diopters in a young baby. When you're an adult usually about three, a third of a meter, you need three diopters to see.

So, she's something I forgot to say. We measure glasses here in MIL's glasses that you wear we measure in diopters, a unit of measure, one diopter is actually a one inverse meter. So at one meter, light that is parallel coming from infinity will be focused to a point a meter from the lens.

So we have about three diopters of zoom in early adult life and that allows you to focus at a third of a meter, which is about the reading distance. Elderly people who've got no focus will wear reading glasses of about plus three to allow them to do that.

So about the age of 40, you start getting, losing that three doctors of accommodation and by the time you're about 70 you've lost most of it. So we usually start wearing plus ones, one and a half to two and a half three and then you'll probably get cataracts and then you decide if you wanna see for distance or near.

(AUDIENCES APPLAUDS)

CAMPBELL:

Can I just thank Professor David Mackey very much that's a lovely talk. Very informative. It's a great example of UWA research as being relevant to everyone in the community. I think David will be staying around a little bit longer. So people want to ask particular questions please stay and enjoy the hospitality of the Petition Bar. I thank the Petition Bar very much for hosting us and please also watch out for raising the bar event next year. Thank you very much.