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The Arizona Daily Star Article
Sunday, May 2, 1999

Eye on the Children

Ophthalmologists Focusing on Tohono O'Odham

By Bonnie Henry
The Arizona Daily Star

SELLS - A cow grazes in the schoolyard, not far from the van that has brought the doctors and technicians from the city.

They are here, these city folk - along with their computers, their keratometers and their autorefractors - to test the eyesight of children growing up on the Tohono O'Odham Reservation.

This land is eye balm to those who truly love the desert - a desert teeming with green washes, rolling hills, wildlife and sacred peaks.

But the land - nearly 2.8 million acres of it splayed to the north, the west and the south of Tucson - is oft a blur to the 12,000 who live here.

For many, if not a majority of those who call themselves Tohono O'Odham, have trouble seeing.

Glasses are Prevalent

''If you go to a tribal council meeting, you'll see that most are wearing glasses. And they know that their kids are going to need glasses too,'' says ophthalmologist Joseph Miller.

Miller, an associate professor in the University of Arizona Department of Ophthalmology, is principal investigator of a three-year study being conducted on the Tohono O'Odham Reservation.

A fourth year will be devoted to analyzing the data.

During the course of the study - more than half complete - 700 Tohono O'Odham preschoolers will be screened, and if needed, fitted with free glasses.

So far, one in three is showing that need.

By comparison, one in 20 Anglo children needs glasses, says Miller, whose work is being funded by a $1.2 million grant from the National Eye Institute and the National Institutes of Health.

No one has to tell Frances Lopez, a retired registered nurse and member of the Tohono O'Odham Nation, about the importance of the study.

Her own 10-year-old granddaughter wears glasses.

''She has an astigmatism,'' says Lopez, who serves as project registrar, helping to get parental consent.

Astigmatism is Most Common

Astigmatism, which is usually caused by a misshapen cornea, is the most common type of vision problem among the Tohono O'Odham.

''They see things blurry,'' says Miller, who began noticing the problem not long after arriving from Yale University in 1991.

''I had never seen so many children with astigmatism as I saw in my practice here,'' says Miller.

''Then I found out it was common knowledge that Native American people had large amounts of astigmatism.''

During the course of his research, he discovered a previous study conducted by then-ophthalmology resident Robert Kershner and then-UA faculty member Dr. Dean Brick.

''As part of my residency, I went to the reservation and was quite amazed at the large degrees of astigmatism there, particularly for children'' says Kershner, now an ophthalmologist who specializes in astigmatism.

Not only was he seeing ''extreme levels of astigmatism,'' he was also seeing it in ''100 percent of the Indian population.''

What's more, says Kershner, the more closed off the family was from marriage to outsiders, the higher the degrees of astigmatism.

While he also found vision problems in other Native Americans, none compared to the high rates of astigmatism found among the Tohono O'Odham, says Kershner, who published his findings in 1983.

Why is it so Rampant?

Theories abound as to why astigmatism is so rampant among the Tohono O'Odham - ranging from possible genetic links to the Mongolian people, to squinting developed as a defense against the bright desert light.

None, so far, has been proved.

Meanwhile, it took several years for Miller to secure the current grant - as well as approval from the Tohono O'Odham Nation.

''We are partners with the nation,'' says Miller. ''The Tribe gets to confer. That's an important thing. The hope is that we find problems - and find the solutions.''

On this particular day, ''finding the problem'' means testing 20 or so lively preschoolers at the Head Start site in Sells.

Miller's team includes research assistants and optometrists, both in Tucson and with Indian Health Service.

All through the fall and then again in the spring, the team visits and revisits Head Start sites scattered throughout the reservation - the second largest in the country after the Navajo.

Every child enrolled as a Tribal member who's in Head Start, or age 3½ to 5, is eligible.

''Younger than that, they're too hard to find,'' says Miller. ''And we wanted to test them before they got into elementary school.''

These same children in Sells were tested in the fall and found not to need glasses, but are being tested again.

''We've already found one who needs glasses,'' says Miller. ''A prescription has been written.''

A Family Decision

Kids and parents choose the frames, the lenses are made in Tucson, and the finished glasses are delivered back to the child's Head Start site on the reservation.

Children are tested both with and without eyedrops, which dilate the pupils and relax and refocus the eye muscle.

''Sometimes the eyedrops themselves have an effect on behavior,'' says Miller, explaining the duplication in testing.

Today, the major effect seems to be squirming and crying, since the eyedrops do sting for about five seconds.

After that, the children happily play for about 40 minutes while the drops take effect.

Because the children are so young - and sometimes culturally shy - in one test they point to geometric shapes, rather than spell out letters of the alphabet.

''One of the things I've noticed is how incredibly cooperative these kids are,'' says co-investigator Velma Dobson, a nationally recognized expert in measuring vision in young children.

In one test, Dobson flashes cards with faint lines on them at a little girl with temporary glasses.

The child picks out the lines every time.

''Studies have shown that some adults who have astigmatism but didn't get the glasses until they were older can't see the lines, even with glasses,'' says Dobson.

''These kids can, even the tiny faint ones.''

Lopez checks to make sure the kids continue to wear their glasses.

About half do.

While a 50 percent dropout rate seems high, a similar program in Baltimore focusing on non-Indian children had only an 8 percent success rate, says Miller.

Keep Glasses On

To keep those glasses on, Head Start teachers do constant monitoring, says Morgan Ashley, health-service coordinator for Head Start for the Tohono O'Odham Nation.

Miller also sends letters home to parents, urging cooperation.

For if the glasses are not worn, another condition known as amblyopia, or ''lazy eye,'' can develop, says Miller.

Amblyopia, which is poor vision in one eye, is also common among children on the reservation.

One in eight has it, says Miller, compared with one in 30 children among the general population.

Children with amblyopia are referred to the child's doctor or to Indian Health Service for treatment, which can include eye patches or eye drops.

As for Miller's study, three alternative methods are being tested, using instruments that measure automatically without a child having to respond.

Once the study is done, there's a good likelihood, says Miller, that one of those three methods ''will become the property of the Tribe's Health and Human Services Department.''

Children identified as needing eye exams would then be tested either through Indian Health Service or their own eye doctors, Miller adds.

But even among the Tohono O'Odham children, not all will need glasses.

''Yes, some of them will go out of here crying because they didn't get them,'' says Miller.

That doesn't seem to be the case with Brandon Pablo, 4, whose eyes have been declared just fine.

Nevertheless, his mother, Angelina Molisto, is glad she made the trek here from her village of San Luis, about 15 miles northwest of Sells.

''This is a good program,'' says Molisto.  

The Arizona Daily Star Article
Tuesday, December 26, 2000

UA Gets Vision Study Grant

$1.7M to help O'odham children get tested,
treated for astigmatism

By Carmen Duarte 
ARIZONA DAILY STAR 

UA researchers were awarded a $1.7 million grant from the National Eye Institute to expand a vision study for Tohono O'odham children.

The four-year study will test and treat kindergartners through sixth-graders for astigmatism.

Astigmatism is a condition in which the cornea is misshapen, and it results in blurry vision. If the condition is not fixed, it leads to amblyopia, also known as "lazy eye."  This condition may lead to permanent weak vision.

Astigmatism is disproportionately higher within Southwestern tribes than among the general U.S. population, said Erin Harvey, University of Arizona Department of Ophthalmology research instructor.

Harvey, an investigator in the vision study, said the high rate of astigmatism among American Indians may be genetic. Studies also show it is common among Zuni, Sioux, Pueblo and Navajo.

One in three Tohono O'odham children suffers from astigmatism, compared with one in 20 children in an urban population, said Joseph Miller, associate professor in the UA Department of Ophthalmology, and principal study investigator.

The grant will help researchers test 1,000 children ages 5 to 12 for astigmatism.  Researchers also will study whether those age 8 and older can be treated for weakened vision.

Previous studies indicate that treatment for lazy eye is not successful after age 8.  Researchers will be traveling to six elementary schools on the the reservation to assess and treat children.

In 1997, Miller received a $1.2 million grant from the eye institute to test and treat preschool children on the reservation for the same conditions. During that time, the research team developed a vision screening program for the tribe.

In the earlier study, which is still ongoing, researchers visited Head Start Centers.

They tested 800 children and 300 were fitted with glasses and are receiving follow-up care, including replacement glasses.

"When a child says, 'I want my glasses,' I know I am doing something right," said Miller, referring to the ongoing study that documented children's vision being corrected within six months.

"Children don't see like adults. As they grow, their brain develops and so does their vision. 

"When a child needs glasses, it delays their development even further," Miller said. 

Teachers and parents are receiving education about astigmatism, said Irene Adams, a vision screening technician.

She said it is difficult to know if young children have vision problems, but parents are learning about astigmatism and how common it is among American Indians and the need for eye examinations.

"When a young child is inattentive in school, I, as a parent think my child is just goofing around and needs to buckle down. But, the inattention could be because the child cannot see," Adams said.

Adams, who lives in the San Xavier District, finds her job rewarding. She dispenses and adjusts the glasses on each child. She also collects data for researchers.

"I'm known as the 'glasses lady,' " said Adams, who offers children and their parents a choice of 20 frames, including colors of gold, silver, turquoise, purple and rainbow.

"Children run up to me and ask, 'Did you bring me my glasses?'

"I see their smiling faces. We have a connection. I give them their glasses and it is a good feeling. I feel like I am contributing to future generations by helping them see."

* Contact Carmen Duarte at 573-4195 or cduarte@azstarnet.com.