Kids' Wellness Matters Podcast Ep. 11: A Closer Look at Myopia (Nearsightedness) in Kids

April 4, 2024

More children are being prescribed eyeglasses and contact lenses than ever before to help correct myopia or nearsightedness, and this trend shows no signs of slowing down. In this episode, Noreen Shaikh, OD, and Magdalena Stec, OD, FAAO, pediatric optometrists and co-directors of the Myopia Clinic at Ann and Robert H. Lurie Children's Hospital of Chicago, talk about this issue and some innovative treatments and tips that could help prevent the condition from getting worse as children age.

When I work with kids who love to read books, I tell them maybe after a chapter, look away, think about what you read and then go back to it. Now, unfortunately, when using screens, it's a little bit more addictive and kids tend to just stare at the screens for a long time without breaks. So that is really our concern and really making some lifestyle changes is super important for kids.”

- Dr. Magdalena Stec

Show Notes

Myopia is blurry vision far away and is caused by the eyeballs growing too long and too fast from the front of the eye to the back of the eye. This is often due to both genetic predispositions and environmental factors
Nearly 40% of Americans are nearsighted. However, it’s becoming more and more common, including in children. Currently, about 5 percent of preschool children, 10 percent of middle school children, and 30 percent of adolescents have myopia.
Genetics play a significant role in myopia occurrence, with children having a 30 percent chance of having myopia if a single parent also has myopia and a 60 percent chance if both parents have it.
Doctors are seeing a connection between myopia and environmental factors such as spending long periods without breaks on computer, tablet, or phone screens.
Parents are encouraged to send their kids outside to play — to get off screens. Additionally, the 20-20-20 rule is recommended to give the eyes a chance to rest: every 20 minutes, look at something 20 feet away for 20 seconds.
Parent education about these risks is key, but it’s also important to teach children to take care of their eyes like they take care of their teeth — that this is a health issue.
It’s believed that the COVID-19 pandemic accelerated myopia development, especially in younger children, due to being on screens more frequently.
Because myopia tends to get worse with age, early intervention, including screening children from an early age to establish a baseline, is key.
Children with myopia might squint or tilt their heads to the side or blink frequently. They might come up close to things that are far away (like the TV, for example). Some kids might feel especially tired after playing sports because they have to force their vision to be clear far away for extended periods.
Myopia can be treated with glasses or contact lenses, and in older age, with LASIK surgery.
While myopia cannot be reversed, treatments are available that can help slow down the progression, helping reduce the chances of developing high myopia.
The Myopia Clinic at Lurie Children’s offers three different innovatie treatment types for patients beyond traditional glasses or contacts.
- One is an eyedrop called low dose atropine, the same eye drop used to dilate the eyes. When used in very low doses and very low concentrations, it can also help slow down the progression of myopia.
- The second is peripheral defocus contact lenses, special soft contact lenses, daily disposable ones that look just like regular daily disposable contact lenses.
- The third option is orthokeratology, or ortho-k, and that's an overnight contact lens. It's a hard contact lens that works like a dental retainer. When worn at night it flattens the front surface of the eye somewhat and changes the shape so that light focuses differently.
The doctors hope they will soon have an option for special glasses that can slow down myopia. This technology is available in other global markets already and hopefully will be in the U.S. soon.

Transcript

[00:00:00] Nina Alfieri, MD: Welcome to Kids Wellness Matters. I'm Nina Alfieri, MD.

[00:00:07] Rob Sanchez, MD: And I'm Rob Sanchez, MD. We are both parents and pediatricians at the world renowned Ann and Robert H. Lurie Children's Hospital of Chicago.

[00:00:15] Nina Alfieri, MD: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult. Because Kids Wellness Matters.

[00:00:29] Rob Sanchez, MD: More and more children are being prescribed eyeglasses and contact lenses to help correct myopia, or nearsightedness. And this trend shows no signs of slowing down. Doctors Noreen Shaikh and Magdalena Stec, pediatric optometrists and co-directors of the Myopia Clinic at Ann & Robert H. Lurie Children's Hospital of Chicago, join us today to talk about this issue and some innovative treatments and tips that could help prevent the condition from getting worse as our children age.

[00:00:56] Noreen Shaikh, OD: Thanks for having us.

[00:00:57] Magdalena Stec, OD: Thank you. We're super excited.

[00:00:59] Noreen Shaikh, OD: Noreen, Magdalena, thank you for being with us today. Can you speak a little bit to what brought you into the field of work that you do? In a previous life, I was a 7th grade math teacher, which is, I think, the hardest job on the planet. So much respect for teachers. While I was teaching, I just realized what a difference healthcare made to kids. So a lot of the kids that I were teaching didn't have great access to healthcare. And so getting glasses, getting dental exams, getting these things, it was just challenging. And I remember seeing one kid in particular who was struggling, struggling, was sleeping in class, not paying attention, and just had a reputation for being like a lazy kid. He was able to get an eye exam, went and got glasses, and ended up being one of the brightest kids in the class, super enthusiastic. It was night and day. I mean, that was a big influencing factor for me.

[00:01:50] Magdalena Stec, OD: I always loved working with kids. They make my day super fun. I really enjoy joking with them and just being around them really all day. I do believe that everyone deserves to have the highest quality of life. And practicing now myopia control makes a huge difference and impact in their lives. So, I really love to offer their opportunity and for us to offer the kind of help and service that we would like to receive for our kids.

[00:02:20] Rob Sanchez, MD: So, to start off, we know that nearly 40 percent of Americans are nearsighted and know very well how this condition makes faraway objects look blurry. But we might not understand why this blurring occurs. Could you explain myopia and how it's treated?

[00:02:34] Magdalena Stec, OD: As you said, nearsightedness is blurry vision far away, and it happens because our eyeballs are growing too long, too fast from the front of the eye to the back of the eye. And that happens because of some genetic predispositions and environmental factors, but when it happens, we can treat it with glasses or contact lenses, and in older age, with LASIK also.

[00:02:58] Rob Sanchez, MD: So when you think of that growth, is that something that's happening from when you're first born? Or do you see different stages where you see that growth happening at a more accelerated fashion than at different ages?

[00:03:08] Noreen Shaikh, OD: When a baby is born, their eyeball is usually about 16 millimeters long. And then within their first three years, they grow all the way to an average of 22 millimeters. And so that's quite a bit of growth in a short period of time. That is normal. That is what we expect. And then, as they grow into their adult years, they may grow maybe like two more millimeters over the course of their adolescence, and so it slows down pretty dramatically, but for kids that are myopic, we tend to see that growth continue to happen at an accelerated rate, and so once the eye grows faster than the eye tends to become too long to focus images, and that's when we start seeing myopia.

[00:03:48] Rob Sanchez, MD: And how common is it for children to be nearsighted or to have myopia?

[00:03:52] Noreen Shaikh, OD: So it's becoming, unfortunately, way more common. Specifically, it's about 5 percent in preschool children and about 10 percent in middle school kids, 30 percent in adolescents. So it is very common and the rate is increasing unfortunately. The concern is that younger and younger kids are becoming myopic and therefore their prescription, their myopia, is high when they're older. And that's why the high myopia is on the rise. It is very concerning. And to kind of just piggyback off of that too, high myopia is associated with potentially visually impairing risks later in life. And so what we've learned is that we've got these predictive models that have said that 50 percent of the global population will be myopic by 2050. And it also predicted, this was in 2016, it had also predicted that by 2020, one percent of the population will be myopic, and our 2020 U. S. census showed that 36 percent of our population was already myopic. So it's I mean, it's definitely concerning because it is very much on the rise.

[00:05:00] Rob Sanchez, MD: Can you speak to the causes of this condition? You know, you speak to the rates going higher. I imagine there's some genetic factors and some environmental factors, but can you explain those a little bit more to us?

[00:05:11] Magdalena Stec, OD: Yes, we do believe that genetic plays a big role, especially if parents are myopic. If one parent is myopic, it's about 30 percent chance of the child having myopia. If both parents are myopic, it's about 60% of children have myopia. So definitely a huge genetic factor, but more recently we're finding that environmental factors play a huge role in myopia progression and myopia onset also.

[00:05:39] Noreen Shaikh, OD: Some speculate that this increase in nearsightedness around the world has been linked to spending more time doing close up tasks indoors, like using computers, playing video games. What are your thoughts on this? How can it be addressed?

[00:05:51] Magdalena Stec, OD: We're absolutely seeing the connection between the environmental factors. So time spent up close with things like a book or iPad or other screen without breaks for a long time. And also not getting outside enough.

[00:06:07] Noreen Shaikh, OD: We used to tell kids when kids started spending more time on screens, we used to say, okay, there's something called the 20-20- 20 rule. After every 20 minutes, you look at something 20 feet away for 20 seconds. But we've now learned that those 20 seconds aren't long enough. It doesn't relax those eye muscles enough. So now we're telling patients you need to look 20 feet away, or better yet, out the window, better yet, step outside for two or three minutes.

[00:06:29] Rob Sanchez, MD: And what does that do? You kind of mentioned it relaxes the eye muscles. It helps, I imagine, limit that constraint that could be leading to some of those abnormalities and the growth that could lead to myopia. Is that right?

[00:06:40] Noreen Shaikh, OD: Right. Yeah. So when you're relaxing those eye muscles, we're actually seeing the choroid, a structure that lines the retina in the back of the eye. We see it become thicker. And so as it thickens, it's protective. When you're looking at things up close, then it thins out. And so, it puts more stress on the eye, it's more susceptible to stretching when it's at a thinner state.

[00:07:01] Magdalena Stec, OD: Or leading to growth. Yes.

[00:07:03] Rob Sanchez, MD: I mean, I've never thought of it this way, but it's kind of like anytime you're focused on something close up, you're actually kind of doing a workout for your muscles. And it's that they're not just working out all the time, nonstop, just like in real life, when I'm trying to do a workout. We need to give ourselves a break. And so to think of it that way for our eyes, is that kind of how you frame it?

[00:07:19] Magdalena Stec, OD: That's exactly right. In fact, I talk to my patients all the time. It's just, imagine when you're riding a bike or when you're running or when you're working out, you are not doing it all day long. Same thing with the eyes. You need to give them a break because they will get tired. And that leads to some changes that we don't want. When I work with kids who love to read books, I tell them maybe after a chapter, look away, think about what you read and then go back to it. Now, unfortunately, when using screens, it's a little bit more addictive and kids tend to just stare at the screens for a long time without breaks. So that is really our concern and really making some lifestyle changes is super important for kids.

[00:08:05] Rob Sanchez, MD: As we know, during the COVID-19 lockdown, children spent more time on screens. There was less time outdoors, which, you know, some are saying contributed to some of these accelerated myopia that we're seeing in the communities, and especially in younger children. Is this something that you're seeing in your clinic? Are we seeing some of that sequela from what happened during the pandemic times?

[00:08:25] Noreen Shaikh, OD: We actually studied this. We studied the incidence of myopia in our patient population prior to the pandemic. And then during the pandemic and after the pandemic to see sort of what are the trends. And we did see a higher incidence of myopia that started occurring right along with the pandemic. And we can attribute that to things that we know, right? Like we know that not spending enough time outdoors can cause you to become more myopic. We know that spending a lot of time staring at screens, which these poor kids were forced to do all day. We know that can make you more myopic, and so I think something that we have realized is that lifestyle change has sort of persisted too. I think schools have started to use the tablets more regularly. And so kids just generally are spending more time on screens. We're hoping to see a downtrend now that kids are spending more time outdoors, but, yes.

[00:09:18] Magdalena Stec, OD: And so education here is a key, just really getting to these families and letting them know about their lifestyle and trying to adjust it because there's probably going to be more screens at school. But when you have a habit of looking at something and keeping that screen far away from your face, not in your face, and taking those frequent breaks, that is going to be what's going to change, hopefully, the trajectory of myopia.

[00:09:45] Rob Sanchez, MD: There are many screenings that can catch nearsightedness in children as young as one year old. Can you explain these screening protocols and why that kind of early intervention is important?

[00:09:55] Noreen Shaikh, OD: I think the early intervention is awesome. I mean, even if we see a little bit of nearsightedness or if we see, like, a small prescription, we're not going to worry about it. The one year old probably won't need glasses for a minus one prescription. But it's good to know because then we can follow it, right? It's just more information is always better. And so getting this information early is always very helpful.

[00:10:17] Magdalena Stec, OD: I agree. The earlier the better, especially that myopia can occur in younger ages a lot more often right now. And getting a baseline, talking about these environmental habits, being outdoors, taking breaks, moving things away from face. It's, I think, so important for families. And sometimes patients listen to us more than they listen to their parents.

[00:10:39] Rob Sanchez, MD: Can you speak to more to what parents might anticipate of what these screenings might be? I mean, I think a lot of folks will think of like, Oh, reading the letters across the room and things like that. But there's lots more types of screenings that are there. I mean, sometimes bringing in technology, different types of screens that they might be seeing in their clinic.

[00:10:55] Noreen Shaikh, OD: Yeah. And you know, it's interesting because we truly know better than we do, Rob, because we don't actually see the vision screening devices. They essentially take a photo of the eyes, right? So the device is held, the child looks at that device, a photo is taken, and then It's a pass fail. And so it uses normative values for what we expect the prescription to be at that age. And if the prescription is too high or too low or if it detects any misalignment between the two eyes, it's a failed vision screening, and you should go see an eye doctor. And it's helpful to have the specifics too about what aspect of the vision screening was failed. When the child then follows up and comes in for the eye exam, sometimes we'll recheck and we'll say, okay, maybe the child wasn't aligned so well for the testing, or maybe this is saying that this is not within the normative values, but for her age, it's acceptable. But it's good to catch it because then we can keep an eye on it and we can see how things change, and you're sort of established care, and kids get used to doing the eye exams and parents understand that an annual eye exam or one to every two years is important.

[00:12:03] Magdalena Stec, OD: I agree. At Lurie Children's, we see a lot of vision screens referred by pediatricians and we love the partnership. We tried to make the exam super fun for the kids. It is a dilated exam, so that means they got special drops to make the pupils bigger. But that is probably the worst part of the exam, but we got great information from it. So really without it, the information is not as detailed and then that's why we do it. But we use fun flashlights during the exam, cool noises, and really try to make it playful for the kids so they enjoy their exam and parents get their education piece.

[00:12:40] Rob Sanchez, MD: Can you speak more about why the eye drops help to dilate and what that adds to the exam that you do in clinic for children? You know, folks might be wondering, oh, do we really have to do the drops? This can be challenging. The drops are tough, but I know that it's very necessary.

[00:12:53] Noreen Shaikh, OD: Yeah, it's twofold. One aspect is the actual pupil dilation. When we dilate the pupils, the pupils are essentially a window to the back of the eye . And by dilating those pupils, we make that window larger. So then we can see more of the retina, more of the structures in the back of the eye. And also these kids are wiggly, they're not staying still.. And so if the pupils are dilated, we can get a better view of the back of the eye as well. And then the second aspect is that it's something called a cycloplegic refraction, and so what that means is that we are relaxing the focusing system. We're relaxing the eye muscles so that kids can't focus through, and then we can very objectively measure, using lights and lenses, what their refractive error is and whether or not they need glasses. Otherwise, the kids would be over focusing, and kids that are over focusing, when we measure objectively with the lights and lenses, they measure as more near-sighted than they truly are, typically. So, we can't get an accurate refractive air measurement without the dilation.

[00:13:51] Magdalena Stec, OD: And these measurements actually can change. So younger kids, infants and toddlers, may have different numbers than what they'll have when they're actually closer to two and a half and three years of age. So, just repeating that lets us know how the numbers change. So again, as Dr. Sheikh said, when a 12 month old comes to our office and we see a minus number or plus number, it doesn't necessarily mean right away that we will prescribed glasses.

[00:14:19] Rob Sanchez, MD: When should parents anticipate for a child to have their first kind of comprehensive dilated eye exam? Should they kind of screen positive? When should they expect that to happen?

[00:14:27] Noreen Shaikh, OD: So we usually recommend that if they're not noticing any issues, if there's no strong family history of anything, then between two and a half and three years old is a good age to come in.

[00:14:35] Rob Sanchez, MD: We talked about the importance of screenings and getting a chance to do those exams, but we know that some kids do fall through the cracks for screening for nearsightedness, and they might have some symptoms that can alert parents later on as they get older. What are some of those symptoms? What should be, kind of flags that parents might be looking for to see where they can kind of bring them in and get them assessed?

[00:14:54] Magdalena Stec, OD: One of the most common symptoms is squinting or tilting their heads to the side, coming to things that are far away. Some kids feeling tired after maybe even playing sports because if they have to force their vision to be clear far away, they may complain about being tired. Maybe rubbing their eyes or sometimes blinking frequently.

[00:15:15] Rob Sanchez, MD: So helpful because as we know, once the myopia develops, there's no way to really reverse it. And it can get worse with age, as you mentioned. Let's transition to talk about the ways to manage it if you do detect it. Can you speak to some of the options that are there to help slow the progression of myopia and any new innovations that might've come out?

[00:15:34] Magdalena Stec, OD: That's right, Rob. Unfortunately we can't reverse myopia, but we are lucky to have tools that help us slow down the process of being more myopic. And it's so exciting because some of these options are just a few years old.

[00:15:51] Noreen Shaikh, OD: We offer three different treatment types to our patients. So we have an eyedrop called low dose atropine. It's an eye drop that we have used for years to dilate the eyes. And we found, incidentally, that in very low doses and very low concentrations, it can also help slow down the progression of myopia. These treatments work while you're using them. So you can sort of anticipate being on a treatment for a few years. It's not like you use a drop for two weeks and then that helps you in the long run, but it's something that you anticipate being on for some time. We have something called peripheral defocus contact lenses. So these are special soft contact lenses, daily disposable ones that look just like your regular daily disposable contact lens. You put them in in the morning, you throw them away at the end of the day. And then the third option is something called orthokeratology, and that's an overnight contact lens. It's a hard contact lens that sort of works like a retainer. You place it on the eye at night and it flattens the front surface of the eye somewhat, changes the shape so that light focuses differently. And then when the child wakes up in the morning, their eyes shape is a little bit different. It's a little bit flatter centrally. And then they can see throughout the day without any glasses or contact lenses.

[00:17:06] Magdalena Stec, OD: And hopefully soon we'll also have an option for special glasses that can slow down myopia. So they are available in other global markets already and hopefully we'll get them in the U. S. soon. So even smaller children can benefit from that also.

[00:17:23] Rob Sanchez, MD: And as you have those conversations with families about these different treatment options, are there things that you like to bring up as, you know, what might work best and to try and tailor that care to each child?

[00:17:32] Noreen Shaikh, OD: Definitely. I think that certain treatments work better, or are more manageable for parents. So eye drops might be easier for some, whereas contact lenses are more comfortable. With the orthokeratology some parents prefer it because they have control over the contact lens. They're putting it in their child's eye, they're taking it out before they go to school. And then some families are more comfortable with soft contact lenses because they wear them.

[00:17:57] Magdalena Stec, OD: Yeah, and that soft contact lens option is really great. It's low maintenance. So a brand new contact lens goes in the child's eye every day. So the risk of infection is a lot lower. And our program is designed that it's a partnership. A parent or a child can put the contact lens in, and whenever the child is comfortable, the child is handling it on their own. And, again, we are seeing great success, and kids really enjoy wearing contact lenses actually,

[00:18:25] Rob Sanchez, MD: We've spoken about the importance of screening. We were just talking about the importance of treatment. I want to focus a little bit more about why as we age, people with myopia might be more likely to develop things like cataracts, glaucoma, and other issues. Can you explain what those conditions are and why that might be?

[00:18:41] Noreen Shaikh, OD: Like we were talking about with myopia, the length of the eye is getting longer, right? So, as the eye gets longer, the tissue at the back of the eye is getting stretched. And so you can kind of think of it like a balloon. So imagine blowing up a balloon, and keep blowing it up. the balloon gets thinner and thinner, and so it is more susceptible to tear or pop. One of the things that we worry about with myopia and high levels of myopia is thinning of the retina, and that can lead to things like tears in the back of the eye, which is why we work really closely with our retina specialist here at Lurie Children's, too. We make sure that we do screenings. Anyone with a high level of myopia should be getting regular eye exams because if they start to see any areas of thinning, they can do a laser treatment to help sort of glue it down, to tack it down a bit, to prevent it from tearing. But the reason why we see a lot of these complications is because of that length of the eye. It puts more stress on the lens inside of the eye. By putting sort of oxidative stress on the lens inside of the eye, it can thicken over time. And so people with high levels of myopia tend to get cataracts earlier. And so cataracts is sort of like a clouding of the lens inside of the eye that can cause blurriness. Everybody gets cataracts eventually in their lives. But we usually expect that in your early 70s or so but we can see it a lot younger in high myopic patients.

[00:20:01] Magdalena Stec, OD: I think to add to this also we have great tools that help us measure eyeball length, actually. So, there's tools that graph how myopic myopic can you get based on your family history and genetic components and also environmental components and your age. I think that is really a game changer in our practice too, that we can educate based on just an objective quick measurement, like a picture that shows us these changes over time.

[00:20:33] Noreen Shaikh, OD: Yeah, it's actually a very cool tool because it takes the most recent studies and creates a predictive model based off of what your prescription is now. What is your eye going to look like in 5, 10, 15 years? And then can tell us more information about what you were saying, Dr. Sanchez, about how likely are you to get one of these complications, or what are your risk factors there?

[00:20:53] Rob Sanchez, MD: What are some of your favorite things that you like to tell parents about having some of those good eye health habits in children?

[00:21:00] Magdalena Stec, OD: I love to, at that point, just kind of come face-to-face with the child and have this conversation. I think getting that child understanding me, I think is a key component also to make this lifestyle a change for this child. So we actually talk about, you know, do you take care of your teeth? Do you brush them every day? Do you take care of your body? Do you eat breakfast? Do you drink water? Do you put sunscreen when you go out? And the answers are yes. Yes. So, I say, that's the same way we have to take care of our eyeballs. And what that means for you is just really keeping that book, keeping that tablet screen far away from face. And I show them, you know, how long is their arm and we try it in the office. And then I talk to the parent about tips when to prompt the child, especially the young one to look away every 20 minutes. So, I may tell a family, well, make sure you call his name. You can call his name every 20 minutes, or there are some parents who get bookmarks with timers So, those are some great tools. I also talk about the screen size. So just really bigger, the better, and really stress that getting that phone away from childhoods beyond 10, if it's possible, that is really beneficial.

[00:22:16] Noreen Shaikh, OD: And there's that setting that you can put on phones and Apple products and tablets that if the phone is too close, the screen turns black . And so it forces your child to keep the phone away.

[00:22:26] Magdalena Stec, OD: And get outside, enjoy the outdoors, grab that bike, go for a ride. Just be out there, because that sunlight excites the cells in the retina that also give the information to the brain. Okay. I'm happy. I don't need to grow as fast. And that is the key. So really being outside in sunlight makes a huge difference.

[00:22:48] Rob Sanchez, MD: All really great stuff for us to think about. For those that do have myopia, those who do need some of those treatments I imagine there might be some, you know, fears or misconceptions that parents might have. Is there anything you like to share or, kind of, speak to for families that might have those kinds of concerns?

[00:23:03] Noreen Shaikh, OD: A very common misconception that we've come across is that parents feel that if they start wearing glasses, their eyes are going to start getting worse. And we have actually studied this and learned that the opposite is true. So by under correcting vision, by not correcting that myopia, then the eyes are more likely to become worse over time. And the other aspect to know is that these treatments that help slow down myopia, they slow it down. They don't stop it from growing. So, once the child becomes myopic, once their eye is a little bit longer, we can't shorten it but we can slow down the growth of the eye.

[00:23:37] Magdalena Stec, OD: As Dr. Shaikh said there are some kids that will do better with the eye drops and they work very well for them. There are some kids who will do better with contact lenses and they will. do great with those. So there's a few different treatment options depending on the lifestyle of the family. There are some kids who are just really, really scared of eye drops, but they love an idea of being free from glasses and enjoying their sports. And they do better with contacts, but we have patients taking drops in contact lenses. And most of our kids who are treated for it, we definitely show a significant slow of myopia. And I'm very excited that we can offer that to those families. We're definitely one of the first children hospital actually to offer these options. I think these options are definitely way more popular as myopia is becoming a really global pandemic. So more practices are offering. And I'm happy for it. It's really great. I think the reason why I got into it is because, I think, you know, every kid deserves to have the best quality of life. And if these myopic numbers, if we can keep them lower, the quality of life I think is much higher.

[00:24:45] Rob Sanchez, MD: I mean, it truly is exciting to have these various treatment options to really try and tailor that care to the child, and work with families to figure out what works best for them and give them the best chances for their eye health overall as they grow older into adulthood and beyond. It's been wonderful to talk with you both, Magdalena and Noreen, thank you so much for being here and talking with us here today on Kids Wellness Matters.

[00:25:06] Noreen Shaikh, OD: Thank you for having us.

[00:25:08] Magdalena Stec, OD: Thank you for having us. It's been a pleasure.

[00:25:10] Noreen Shaikh, OD: Thanks for listening to Kids' Wellness Matters. For more information on this episode and all things kids wellness, please visit LurieChildrens.org