Month: April 2023

Turns out that when your mother told you to stop sitting near the TV or you might need glasses, she was onto something.

Myopia, or nearsightedness, is a growing problem worldwide. While a nearsighted child can see close objects clearly, more distant objects look blurry. Part of this growing problem, according to experts, is that children are spending too much time indoors looking at things close to them rather than going outside and looking at things that are far away.

What is nearsightedness?

Nearsightedness is very common, affecting about 5% of preschoolers, 9% of school-age children, and 30% of teens. But what worries experts is that over the last few decades its global prevalence has doubled — and during the pandemic, eye doctors have noticed an increase in myopia.

Nearsightedness happens when the eyeball is too large from front to back. Genes play a big role, but growing research shows that there are developmental factors. The stereotype of the nerd wearing glasses actually bears out; research shows that the more years one spends in school, the higher the risk of myopia. Studies also show, even more reliably, that spending time outdoors can decrease a child’s risk of developing myopia.

Why would outdoor time make a difference in nearsightedness?

While surprising, this actually makes some sense. As children grow and change, their lifestyles affect their bodies. A child who is undernourished, for example, may not grow as tall as they might have if they had better nourishment. A child who develops obesity during childhood is far more likely to have lifelong obesity. And the eyes of a child who is always looking at things close to him or her might adjust to this — and lose some ability to see far away.

Nearsightedness has real consequences. Not only can it cause problems with everyday tasks that require you to see more than a few feet away, such as school or driving, but people with myopia are at higher risk of blindness and retinal detachment. The problems can’t always be fixed with a pair of glasses.

What can parents do?

• Make sure your child spends time outdoors regularly — every day, if possible. That’s the best way to be sure that they look at things far away. It’s also a great way to get them to be more active, get enough Vitamin D, and learn some important life skills.
• Try to limit the amount of time your child spends close to a screen. These days, a lot of schoolwork is on screens, but children are also spending far too much of their playtime on devices rather than playing with toys, drawing, or other activities. Have some ground rules. The American Academy of Pediatrics recommends no more than two hours of entertainment media a day, and has a great Family Media Plan to help families make this happen.
• Have your child’s vision checked regularly. Most pediatricians do regular vision screening, but it is important to remember that basic screening can miss vision problems. It’s a good idea for your child to have a full vision examination from an ophthalmologist or an optometrist by kindergarten.
• Call your pediatrician or child’s eye doctor if you notice signs of a possible vision problem, such as
  • sitting close to the television or holding devices close to the face
  • squinting or complaining of any difficulty seeing
  • not being able to identify objects far away (when you go for walks, play I Spy and point to some far-away things!)
  • avoiding or disliking activities that involve looking close, like doing puzzles or looking at books, which can be a sign of hyperopia (farsightedness)
  • tilting their head to look at things
  • covering or rubbing an eye
  • one eye that turns inward or outward.

If you have any questions or concerns about your child’s vision, talk to your pediatrician.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

It can be devastating to watch older adults struggle with memory problems, low mood, anxiety, or a lack of motivation, particularly during times of physical distancing. With waiting lists for mental health appointments stretching for months, you may be wondering about alternatives.

Reaching out to family members or faith leaders may be helpful in talking through stressors. Alternatively, self-help books may provide skills or a new perspective for older adults choosing to keep their struggles private. But with the explosion of mental health mobile applications, telepsychiatry services, social media, and wearable technologies, where does technology fit in with treatment?

Combating ageist stereotypes

Seeing your loved one struggle with their computer, you may wonder whether to pursue technology-based treatments in the first place. Although older adults may be reluctant to use new technology due to stereotype threat (the fear of confirming negative stereotypes), a little help from loved ones can ease technology discomfort. The adoption of technology has grown rapidly over the past decade among older adults, and with it have come potential benefits to mental health, daily functioning, and quality of life.

Moving to virtual

A couple of years into the pandemic, older adults are increasingly seeing their doctors virtually. How well does this work for mental health? Thankfully, several studies have shown that virtual therapy is comparable to in-person treatment.

What about mobile apps that remove the human component? Here the data suggest that mobile apps can be complementary, although they are not sufficient as standalone treatments for mental illnesses.

Privacy

When navigating online treatments, you want to ensure that the platform used is HIPAA (Health Insurance Portability and Accountability Act)-compliant, which means your information is protected by law. Zoom and BlueJeans are HIPAA compliant; FaceTime and Skype are not. When using mental health mobile apps, read the privacy policies: red flags include sharing or selling information to third parties and using your information for advertisements.

Which apps can help older adults the most?

Navigating the explosion of mental health apps for online treatment can be tricky, as the landscape is changing quickly. For teletherapy services, Teladoc, K health, and Doctor on Demand are good places to start.

To supplement treatment of common mental illnesses, wellness apps developed by the federal government (including Mindfulness Coach, COVID Coach, and CBT-i Coach) can help teach skills, manage sleep, and track symptoms. Medisafe is the top-ranked medication reminder app for good reason: it has excellent privacy features (and with the premium subscription, you can receive medication reminders in celebrity voices).

Movement and mental health

We know that physical activity has numerous benefits on brain health in old age: it reduces anxiety and stress, it improves depressive symptoms, and it even strengthens learning and memory. Wearable technologies can play a role in helping older adults set physical activity goals. Through the use of smartwatches (which use accelerometers to keep track of movements), older adults can monitor how many steps they take, how many calories they burn, and even how well they sleep at night.

Wearable technologies have advantages for caregivers as well. They can be used to monitor their loved ones for wandering and falls, and they can alert them to changes in mood: a significant increase or decrease in usual activity levels may herald early signs of depression or anxiety.

Can smartphones be used to improve memory in older adults?

New research suggests that technology can indeed improve prospective memory, and help older adults with mild cognitive impairment continue their daily activities. Through the use of a personal assistant application on their smartphone (a digital voice recorder or reminder app), older adults who received reminders about events and activities experienced memory benefits and improvements in their activities of daily living.

Tips for using technology with older adults

While the benefits and harms of using technologies are still being studied, you can try the following:

• Encourage older adults to try out applications that are research-informed, especially if they express interest.
• If using a mobile health app, make sure to read the privacy policy. If using an online mental health platform, ensure it is HIPAA-compliant.
• Try to set physical activity goals, as physical activity helps improve symptoms of almost every mental illness. Wearable technologies that count steps are a good place to start.
• Modify device settings to improve comfort: this can include optimizing volume and font size to accommodate changes in vision or hearing.

If mental health technology doesn’t suit your loved one, that’s okay — technology is not always the answer. Treatments are most likely to work when patients believe it will help and can stick with it.

About the Author

Stephanie Collier, MD, MPH, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Stephanie Collier is the director of education in the division of geriatric psychiatry at McLean Hospital; consulting psychiatrist for the population health management team at Newton-Wellesley Hospital; and instructor in psychiatry at Harvard Medical School. … See Full Bio View all posts by Stephanie Collier, MD, MPH

Prostate cancer progresses slowly, but for how long is it possible to put off treatment? Most newly diagnosed men have low-risk or favorable types of intermediate-risk prostate cancer that doctors can watch and treat only if the disease is found to be at higher risk of progression. This approach, called active surveillance, allows men to delay — or in some cases, outlive — the need for aggressive treatment, which has challenging side effects.

In 1999, British researchers launched a clinical trial comparing outcomes among 1,643 men who were either treated immediately for their cancer or followed on active surveillance (then called active monitoring). The men’s average age at enrollment was 62, and they all had low- to intermediate risk tumors with prostate-specific antigen (PSA) levels ranging from 3.0 to 18.9 nanograms per milliliter.

Long-term results from the study, which were published in March, show that prostate cancer death rates were low regardless of the therapeutic strategy. “This hugely important study shows quite clearly that there is no urgency to treat men with low- and even favorable intermediate-risk prostate cancer,” says Dr. Anthony Zietman, the Jenot W. and William U. Shipley Professor of Radiation Oncology at Harvard Medical School, anda radiation oncologist at Massachusetts General Hospital who was involved in the research and is a member of the Harvard Medical School Annual Report on Prostate Diseases editorial board. “They give up nothing in terms of 15-year survival.”