A Message on Vision Shaping Treatment from Dr. Mike Gambino

About Visual Shaping Treatment (VST)

I want to call your attention to a serious epidemic occurring right now in children here in the United States, and that is, the increasing number of children becoming nearsighted (Myopic). Currently, 20% of American children, teens and preteens, are nearsighted. It is predicted by 2050, 50% of our children will become nearsighted. In China, that number has already reached 50%.

So what's the big deal?

Give the kids glasses or contacts and send them on their way. Wrong!

Recent research, predominantly by Earl L. Smith, III, OD, PhD, FAAO, a lifelong researcher in myopic development and control, indicates that correcting myopia in children actually makes it worse. That is, correcting a child's vision with glasses or contacts causes the myopia to progress (Google Earl L. Smith, III, OD to see his multiple research papers.) There are multiple genetic and environmental factors that cause myopia to develop in the first place and I'll list these later.

There are other reasons why it is important to control myopia.

  1. The economic impact of myopia is very bad.
  2. Myopia can limit career choices. (e.g. Wanting to be a pilot)
  3. Myopia can interfere with learning.
  4. Myopia is the leading cause of permanent blindness in the world.
  5. Retinal damage increases with age in high myopia.
  6. Myopia causes an increased risk of cataracts, glaucoma, retinal detachment, and macular diseases.

There are the many genetic and environmental factors that are causing increases in myopic development in our children. Having one or both parents nearsighted or nearsighted running in the family, predisposes a child to become myopic.

The overwhelming environmental factor is the tremendous amount of time today’s children spend looking at screens, phones, tablets, lap tops and PC's.Even babies are looking at screens. It has long been known that constant near or close work can cause the visual system to become myopic. That's because our visual system relaxes for distance and works for near. This increase in near point viewing can cause the eyes to become myopic to decrease the near point effort.

In addition, decrease exposure to sunlight can also cause the system to become myopic. (In China the myopic epidemic is so severe they are building glass classrooms to increase exposure to sunlight.) To reduce these factors today's parents must limit the child's screen time. They must encourage their children to get involved in outdoor activities. To reduce the development of myopia a child needs two hours a day of sun exposure. Take the screen away and send them out to play.

So what else can we do to control myopia?

The latest trend in the field of optometry is the development of Myopia Control Clinics. Currently, the Optometry schools at Cal Berkeley, University of Houston, and University of Alabama in Birmingham have opened such clinics. Now private doctors are getting on board. I myself own Gambino Eye Associates Myopia Control Clinic here in North Dallas.

All of today's myopia control methods are based on Dr. Smith's work. Dr. Smith's work shows that when we correct a child's vision we place the image on the central retina for best vision. At the same time we cause a blur in the peripheral retinal. Well Dr. Smith says that children can inherit a mechanism that exists in the peripheral retina, and when we place a blur on that mechanism it causes the eye to elongate and thereby increases myopia. It is estimated that 50% of our children have inherited this mechanism. What can we do? We can't let our children run around with blurred vision. Reducing screen time and increasing sunlight exposure is a start. But how can we interrupt that mechanism in the peripheral

retina? Myopia control is based on three methods. Two interrupt the mechanism, and one decreases the near point effort.

Fitting the child with Multi Focal soft contact lenses can decrease the near point work when a child is looking at a screen or reading. The lenses give the child added power for close work so the eye itself doesn't have to work so hard.

0.01% Atropine Sulfate drops is known to interrupt the peripheral mechanism in the retina. The drops are prescribed one drop in each eye at bedtime. Even very young children can use these drops. 0.01% is not commercially available in the United States and must be prescribed to a formulary pharmacy who can make up the drops. However, using these drops for a long time may not be good for children. I prescribe these drops to very young children and at about age 9 or 10 I switch them over to Orthokeratology as described below. Alcon in Fort Worth is working on a safer pharmacological intervention.

Orthokeratology ( Vision Shaping Treatment ) will take away the peripheral blur and interrupt the mechanism. OrthoK is a method that reshapes the cornea which places the image on the central retina while at the same time taking away the peripheral blur. OrthoK uses custom made rigid gas permeable lenses that are only worn during sleep. The child sees clearly all day long without glasses or contacts and as long as the child sleeps in the contacts, the eyes will never get worse. In my office we start OrthoK in children as young as age 9. Since 2010 I have provided OrthoK to well over 200 children in North Dallas.

Today there are over 1500 studies showing this works. One such study is Controlling Astigmatism and Nearsightedness in Developing Youth, The CANDY study if you care to look it up. Also last September the FDA set up a protocol for research to be done proving OrthoK stops the progression of myopia in children leading to FDA approval. The FDA has already approved the RGP materials for OrthoK use.

I feel that this is extremely important information for the public to know about. Below is a list of references to give you an idea of some of the work being done in this field.

Please feel free to contact me if I you would like more information. My office is located at 4062 LBJ Fwy, Dallas, TX 75244 and my cell phone is 469-231-1821.

Thank you,

Dr. Mike Gambino

Gambino Eye Care

References about Visual Shaping Treatment (VST) (pdf)


Press Release - Recent Discovery Leads to Stopping the Progression of Myopia (pdf)


Vision Shaping Treatment Press Release Postings (pdf)


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