Farsighted Thoughts from a Visionary PioneerGlobal leaders in optometr y have been researching myopia’s origins, associations, and influences since the 1960s. The quest to understand this condition continues. WRITER Alan Saks In a paper published in the ninth annual contact lens edition of the Journal of the American Optometric Association,March 1966, 1my father Sidney J. Saks made some groundbreaking and visionary comments on myopia management, which hold true today. Journal of the American Optometric Association. Hand drawn figures by Dr Sidney Saks. Other leaders of the day featured in that edition included such legends as Mandell, Hill, Farkas, Kassalow, Koetting, and Morrison. My dad’s paper, titled Fluctuations in Refractive State in Adapting and Long-Term Lens Contact Wearers, included the following summary that I find remarkable. ‘…one may say that all the above factors will tend to load the final analysis in favour of an apparent control of myopia. ‘Ignoring these factors, however, it would appear to be true that certain of the functional origins of progressive myopia are better dealt with by means of contact lenses than with conventional spectacles. But in cases of high (and even moderate) myopia associated with posterior stretching of the globe, it is likely that the myopia will continue to progress, possibly at a reduced rate. ‘Further research is called for on a broad and controlled basis to establish whether myopia control is real (in the scientific sense) or apparent (in the practical sense), and if it be real, the associations and influences responsible for this control in respect to the physiology of the eye, the physiology of vision and the physical and/or pathological changes associated with some types of myopia must be established.’ Prophetic indeed. Some of this research is happening today and we have a much better understanding of progressive myopia and myopia management, but 56 years ago this was one of the first reports. Respected Dutch myopia expert and orthokeratologist, Gabi C. Steenbekkers, mentioned this2in one of his articles (translated from Dutch), where he stated, ‘We have already talked about controlling myopia using contact lenses by Dr Sidney Saks from South Africa (in 1966). So, the problem of progressive myopia is not as new as we think.’ My father gleaned these insights from painstaking data collection, observation, and analysis. His paper is nine pages long and illustrated with hand drawn figures, showing refractive and keratometric data for a group “ my father Sidney J. Saks made some groundbreaking and visionary comments on myopia management, which hold true today of his patients over months and years. As a child, I would see him finish dinner, go to his study, and work till late at night. I sometimes watched him hand draw the graphs and tables. If you want a copy of the paper, email me. Practising at an altitude of around 1500m in Pretoria, South Africa, the reduced partial oxygen pressure made physiological changes of the eye more dramatic. Accelerated physiological changes, corneal swelling and soft lens induced myopia (SLIM) were also noted early on when the first low Dk HEMA 38 soft lenses came to market in the 1970s. Prof Brien Holden regarded some early clinical research by my father and brotherin-law Peter H. Brauer, demonstrating oedema-induced myopia progression with early soft lenses, as ground-breaking. They also showed how this could be reversed by refitting higher Dk lenses. My Dad was fortunate to spend time learning the art and science of contact lenses in Chicago, USA in 1957, with legendary contact lens pioneer George Jessen. Dr Jessen published the first paper (in 1962) on what he called ‘orthofocus’ (a deliberate attempt to mould the cornea to reduce myopia), which he later called ‘orthokeratology’. Roy H. Rengstorff, a US military optometrist and researcher, heard of my dad’s work and flew to Africa to meet him during his vacation. The USAF transport aircraft he travelled in broke down on an island in the Atlantic. By the time he arrived in South Africa he was officially AWOL, so he met my dad at the airport and immediately flew back to the United States. He made numerous subsequent trips to South Africa and our families became lifelong friends. I recall long game-watching drives on safari, in my dad’s Alfa, while Dr Rengstorff and he discussed all things contact lenses. I still have an original, goldembossed Apollo 11 flight suit badge that Roy gave me back then. Great memories. THE PASSION LIVES ONIn more recent years, Australian practitioners rekindled these pioneering explorations into orthokeratology (ortho-k). Around 30 years ago, people like John Mountford and Russell Lowe used gas permeability, and improved design and manufacture to make Ortho-K viable. Today, the likes of Lachlan Hoy have taken it to the next level and integrated topography, advanced lathes and milling machines, to design and manufacture advanced ortho-K lenses. Researchers at Auckland University pioneered soft lens designs to control myopia, while the BHVI continues Prof Holden's vision to eradicate preventable blindness and control myopia. “ Myopia will be a big part of the ICCLC conference in Sydney, 15–17 October Dr Oliver Woo is spreading the word throughout Asia and collaborating with colleagues globally, while the Cornea and Contact Lens Society of Australia, and Orthokeratology Society of Oceania, among others, deliver world class education in these fields. Myopia will be a big part of the ICCLC conference in Sydney, 15–17 October. Don’t be short sighted… be there! References 1. Saks, Sidney J. Fluctuations in refractive state in adapting, and long-term contact lens wearers,” Journal of the American Optometric Association Vol. 37, March 1966. 2. https://www.linkedin.com/pulse/dontbeshortsightedgabi-c-steenbekkers/?originalSubdomain=nl.

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