Got it. Hey, Aloha, and welcome back to the Think Tech Hawaii studios for this episode of Security Matters Hawaii. Today, we have author Mel Fatahbab with us, and we're going to be talking about the friendship advantage. Mel, thank you so much for joining me today. I know you're a super busy guy, so I appreciate you sharing with us. My pleasure, Andrew. A pleasure to be with you. Thank you. I've got to do my own sort of generosity thing for a minute because I'm one of these guys. I wanted to know about 20 or 30, maybe more security CEOs and owners who've shared with me many wonderful things, and I think that I can blame you for that, that you influence them in a lot of the meetings, and then they bring that same generosity out into the rest of the community. So thank you. Thank you. Thank you. It's been a pleasure. I'd like if you could go ahead and give our audience just a little bit of your background as much as you care to share, sort of bring us up through EO and then into the Forum Resources Network and maybe up to this book. You got it. You got it. So 1990 Fresh Outta College got a job as Associate Director of the Entrepreneurs' Organization. Within about a year, I was promoted to Executive Director, and while I was there, we were putting together forums for our members, our entrepreneur members, and these forums were groups of roughly 8 to 10 people that meet every month to help each other with anything and everything so they could be the best that they can be. And by 1997, it became my favorite part of my job. I really decided this is what my life's work is going to be, so I quit. I started Forum Resources Network, and that's how I got into the business of peer groups for CEOs, entrepreneurs, and how I started with the PSA Security Network and with these groups that we've got going with them. It's been absolutely wonderful. We've had two groups for 10 years now, maybe even 11 for one of those years. And it's been really amazing to watch the relationships within the groups blossom and to see some members sell their businesses or do amazing things. Yeah, it's interesting. And the security folks, security people attend in my mind to be sort of, I'm going to say hardheaded, and that's probably not very nice, but they come from law enforcement backgrounds or military backgrounds a lot of the times and relationship building maybe isn't their first skill. How did you hone in or how did you break into working with security groups in particular? Yeah, there was a guy, Mark Murphy, who was a speaker for PSA, and he heard that PSA was interested in putting together a couple of groups, and he referred them to me. And that's how I got started with PSA Security. Well, and then are there other security groups outside of that or other like low-voltage industry groups that you work with that you could compare and contrast like security ownership with other, because we're sort of like contracting industry folks, are there other groups that you work with that are contractors like electrical contractors or construction, I guess like general contractors that build buildings and things like that? Do they have groups like this as well? They do, they do. So there's definitely, there are groups in the construction industry through the National Association of Home Builders. They call them 20 groups and I've worked with some of those groups over the years. There are some construction companies that I work with directly, one out of New Jersey, one out of Chicago. And really at the end of the day, I'm going to go back to what you said. You know, you're like, how did you get these people that are bullheaded to really kind of soften up and listen to one another? And, you know, what I would say is the process is pretty proven. It's the same process that I've applied to many entrepreneur groups over the years. And I would say just being an entrepreneur or a CEO also requires a bit of bullheadedness. I wouldn't necessarily say that that is more true in my observation of the security folks. I'd simply say they're entrepreneurs or CEOs. And what I hear from a lot of CEOs, Andrew, I don't know if you've heard this is, you know, I'm not employable. I started my business because I'm not employable. Yeah, well, my wife says that about me, but I don't know if I said it about myself. Yeah, yeah. So back to the other question is, you know, how do we get to the book? So when I started realizing and working with a lot of these groups, as often people would say, wow, you guys are like better than my best friends or I've shared things with you that I haven't shared with my best friends. And initially, I took a pride in that. I'm like, we're doing something really good here. But I started to realize the reason for the book is so people can take these lessons and apply them in other parts of life, apply them to their relationships at work, and these groups were simply a conduit to teach those skills. So the seven keys to building relationships really comes from what I learned in working with these groups since 1991. Wow. Yeah, and I know, in particular, this book opens, it opens with a story about Carl, who's a fictitious person for our purposes, but I think all of us can empathize with what Carl was going through with the medical condition with the family member of his. What do you think differentiates the company that allows everyone else to empathize and share in Carl and the ones who don't? I think the culture starts at the top. So whenever I go work with a company, I can tell you 99% of the time, I'm getting a call from the CEO. Okay. Nobody else. Nobody else is making that purchase decision for whatever reason. It's coming from the CEO, whether I've worked with a company that's a $2 million company or a multi $100 million company. It's always a call from the CEO. Wow. And the culture starts at the top. So I start with the executive team. And how does the executive team work together? What are their tools for communication? How effective are they? How do they deal with conflict? Do they avoid it? Do they take it head on and punch each other? Or do they do it kindly? So the chapter on that conversation is called kind truth. And kind truth is the ability, the skill to say the difficult thing that has to be said in a way that is pleasant. In a way that it's going to be heard. And not just to bludgeon somebody on the head with it or to avoid the conversation altogether. Because you know what happens when you avoid it. It doesn't go away. Of course. So interestingly, I've seen it myself just from a small business perspective. But I didn't consider the fact that larger organizations may require this relationship building to happen amongst like the C-suite if it's large or upper management first, before it can really flow down, I guess genuinely flow down to middle management and to other team members on the staff. Would that be a fair thing to say? That's how it's been in my world. I mean I could imagine that there's a big multi-billion-dollar public company where they say we have a problem in XYZ department. But it always starts with the head of that department. Because if the head of that department doesn't buy in to the notion that we're going to have open communication, that we're going to treat each other as human beings and not just transactionally. And that means we're going to be vulnerable. We're going to be real. And if that department, if the CEO isn't buying into that and isn't studying that example, then who's going to buy it? Yeah, it's interesting. When did you start to see in business in general the change to relationships? I mean was already there in the 90s where everyone was already recognizing this need to relate to other? I mean I remember IBM's sales training for example you know you made your statement and then you didn't say anything else until the other guy spoke and all that type of stuff. So was there a recognition early on or was this fairly new to the business community itself? The relationship building could actually improve the bottom line, improve productivity, efficiency, all those sort of things. I think we're riding a trend. I mean I'll never forget, I worked at General Motors as a co-op when I was in college. And this was in the 80s. And the CFO who was CFO of this plant was this guy that was kind of a mentor to me and I thought he was the sweetest, nicest guy that I could imagine. And I was singing his praises to some of my co-workers and I couldn't believe what they said. They said you should have been here two years ago. He literally was on somebody's desk. He would stand on somebody's desk and yell at them. At the top of his lungs. And that is not the person I knew. So I think we're part of a trend and I think more and more companies are becoming aware of this trend and the importance of treating people like human beings. I'm speaking April 23rd at a conference, Conscious Capitalism. And there are 500 people coming to this event and really they're all about how can we be conscious about what we're doing as a company. How we're treating our people. And not just running this machine that's here to make money.  You are actually the value of the firm itself. I'm not schooled enough in this to know when that sort of occurred, but obviously it's needed. I don't know how organizations function today, keep staff, build any kind of morale or anything at all without sort of that a bit of others centeredness. You know, at least understanding what others are going through, you know what your coworkers are going through. It's interesting to me that things happen at all. It must have been very sterile. You know, I mean, the Navy was, I guess, kind of sterile when I got in in the early 80s, but it changed a bit, you know, with Tail Hook and this focus on HR and sexual harassment things. It was a bit of a wake up call in the military. I'm just guessing that commercial industry sort of followed some of that awareness about other and the condition of other and how we impact other with our words and our actions. Yeah, and it's funny that you use the military reference, because one of the things that I know from my friends who have served in the military is particularly if you've been in a war zone with somebody, you develop this real powerful bonds and part of what I believe causes that bond is, you know, when you're in a foxhole with somebody, when you have a shared purpose, when you have those shared values of what are we going to do to survive, thinking it to an extreme case in the company, it's not usually about survival, but in the military it certainly is. That bond is people in a way that you cannot imagine, and you can imagine it because you've been there. Yeah, so I think recreating that, I do talk about that with our team if you haven't had sort of that sense of life saving urgency, right? Everybody does their job or someone dies. That kind of an idea doesn't, it's hard to sell that in a corporate environment because no one should be dying, obviously, as long as, you know, we're taking safety and things responsibly. It's interesting. Yeah, the other thing is whether you're talking about security companies or whether you're talking about any company in general, and you look at the low unemployment rate in this country right now, you know finding good talent is not easy. Retaining good talent is not easy, and it's costly. And so if we have the people on the bus that we want on the bus, then let's invest in getting them to actually love each other, know each other as you please, and value their time at work more than just coming and getting a paycheck. Yeah, and I do think there's that sense of personal sharing, being able to empathize with what others go through, and they're like, you know, outside of the work, creating that shared experience. And we're definitely going to kind of walk through these seven keys and walk through the book in the second half of our episode. But I do think that it's a critical element that, you know, a lot of the great offices that I go in have that going on. But I'm sure there's many that are still missing the boat trying to catch up and maybe those of us who are doing this are all their good people away from that. I don't know. Tell you what, we're going to take a break for about one minute. We'll pay a few bills and we'll be right back, Mo. All right, thank you. Hi, I'm Rusty Komori, host of Beyond the Lines on Think Tech Hawaii. My show is based on my book also titled Beyond the Lines, and it's about creating a superior culture of excellence, leadership, and finding greatness. I interview guests who are successful in business, sports, and life, which is sure to inspire you in finding your greatness. Join me every Monday as we go Beyond the Lines at 11 a.m., aloha. Hi, Mabuhay. My name is Amy Ortega Anderson, inviting you to join us every Tuesday here on Pinoy Power Hawaii. With Think Tech Hawaii, we come to your home at 12 noon every Tuesday. We invite you to listen, watch for our mission of empowerment. We aim to enrich, enlighten, educate, entertain, and we hope to empower. Again, maraming, salamat po, Mabuhay, and aloha. Hey, aloha, and welcome back to this episode of Security Matters Hawaii. We're in the Think Tech Hawaii studio, and we've got Mel Fatahbab with us. He's remote today, and we are talking about the friendship advantage. Mel, we're going to get into this book a little bit now. We've done the background, I think, for everybody. We talked a little bit about Carl's story, but I want to get into these seven keys. The first chapter really rolls into some of the research that you did, I think, to support that meaningful workplace relationships really can create a better business. Yes. So the keys. You want me to get going in there, or do you want to try and see what's your son? Well, I was just, so this research was, I read through it. I didn't notice if it was, was it 20 years old? Was it 10 years old? Was it modern? Is it ongoing work that you continue to keep track of to just to help sort of bolster for maybe some people who are more metric driven? You know, what's this really going to get me if I do this investment in my people? Yeah, yeah. So the work that is the majority of the book is purely based on my own observations of working over 20,000 CEOs and 2,000 groups since 1991. And that is absolutely purely my observation in working with these groups. Okay. However, there is some research in the book which cites how much more productive people are, how much happier they are, how much nicer they are to the customers, how much healthier they are if they have a best friend at work, if they have somebody they could trust and talk to at work. So that research has been done and it is out there and you'll see it referenced in the book, but clearly there's lots of research that shows that having a friend at work absolutely has a big impact on all sorts of areas. And I think it's a great way to start the book as well because if you're reading it for a business purpose, like from a business owner and you're trying to understand maybe some of the things you are or aren't doing with your organization, that should give you enough impetus to turn the page to chapter two which gets us into one of that first tough things which is judgment. It can be one of the really biggest traps. We think we're encouraging someone or we're saying something to someone or maybe we're trying to help them, but we're really coming off as very judgmental or they're just perceiving what we're saying is judgmental when we didn't intend it that way. How do we avoid that trap of getting into that judgment mentality? Yeah. So I think the most common way that people get trapped in that is when somebody is needing help, they often say, I want your advice. And you could interpret it that different ways.  Or you could say, he wants me to listen and to understand what's going on. Or you could say, he'd like my experience. What have I been through that might be similar? That might be helpful. And the path you choose can have different implications. So if you have children, I know you do, but for those people that do out there, you know pretty early on the moment that they start to tell you, I'm not doing this because you told me to do it. Right? Yeah. And you know, I believe from Gazelles and scaling up. And one of the things he always says, I think tongue in cheek to the CEOs that he works with is you guys are not really in business to do whatever you think your business does. You're running adult daycare center. And so in that paradigm, you know, you could say whether it's your employees or whether it's your children or whether it's your friends, just giving advice obliviously is a big trap for somebody feeling judged.  And then when they tell me what's going on and I understand it, you know, I make sure I understand it. And then I want to find out what they feel about that. So often you get a lot of facts, is it something frustrating? Is it angry, angry in you? Is it making you sad? What are your emotions? I could fully understand how it's impacting. And then I might say, sorry, I was going to say the giving of advice starts with more questions. Yeah. Yeah. Absolutely. And then I might say, so how can I help? Right. And often my friends might say, well, that was helpful already. You're such a great listener. Thank you. I feel heard. I feel understood. Sometimes that's all you have to do. Okay. But sometimes it takes a little more. And I say, well, would you like some experience? I have a similar thing that happened to me. Yeah. That kind of sharing is, is awesome. And it's, I do think people have to train themselves to do that. Right. Just takes practice. One of the next. Sure. Yeah. One of the next keys that I was wondering, I missed you this fun. Can that go too far? It can go too far. You got to be careful. When I thought of this as one of the chapters, I definitely had mixed feelings on the one hand. I chuckled. I was excited. I knew it's real. I know it's real. Right.  Yes. And by having that differentiator, the very people with whom you don't do that already, you have a barrier with because you're not being yourself. Very good. So I don't care.  But what is it? What is it that connects you in a mischievous way? Yeah. Trust. Maybe. Yeah. It shows I trust you. Yeah. And then our next key is the vulnerability and we've, we've been doing some Brene Brown work at our place with shame and vulnerability. Really tough. Really tough one for a lot of people to practice and to get into a vulnerable or recognizing when their courage takes is vulnerable as well. Kind of advice do you have for people to practice being vulnerable? Yeah. So the first thing I just want to quote, because I think it's brilliant when I heard it, David Bradford, who is a professor at the Stanford graduate school of business, says vulnerability is the currency of relationships. And without relationships, vulnerability, without vulnerability, relationships remain surface. Yeah. So when I first heard that, it just hit me between the eyes as the most succinct way to explain the value. So you have to take a risk. I got that. And you have to decide with whom you're willing to take that risk and that takes a leap of faith. But the thing to remember is there's a chicken and egg of who goes first. Will you go first? Well, I go first. And at some point, at some point, somebody has to say, okay, I'm going to take this risk. And when that happens, I'm watching very carefully to see, does the other person reciprocate? Or do they roll their eyes and come across as judgmental? Or do they just give me advice? Or do they tell me, oh, your issue is no big deal? And just kind of... Terrible. And if those things happen, what do you think I do next time? I'm with that person. No, you don't talk. No more sharing. Fine, life couldn't be better. Awesome. So we have... We're back to kind truths. So kind truth. Yeah, we've been saying clear is kind in our office. That's another one that people don't always receive well. And I think the book does a great job of talking about sender, receiver, and understanding messaging and how things can be miscommunicated and how to work through that. So kind truths, is that something you have to practice in the groups that you facilitate? Because I think it would take a bit of learning for a lot of folks. Yeah, so every meeting, we start with something we call clearing the air. We go around the room and each person looks at each other person and says, I'm clean with you. Or briefly says, here's why I'm not clean with you. It hurt my feelings that you didn't respond to 10 e-mails of mine. Or you're late and we waited for you. And that bothered me, right? And so it's little things, but if I don't say them to you, either I'm just bursting inside, carrying it with me, continuing to make up stories about you, which are judgments, and probably not true, or I'm doing what's even worse and poisoning other people. I complained to other people about you. And now I'm fairly poisoning them without giving you an opportunity to ever be aware of how I feel and how I was impacted by what you did. We've only got a minute or so left, but one thing about one of the last points, not one of the last ones, but one of the next chapters is about sharing and generosity. And you're being very generous with your information here today. I want to thank you for that. I want to let everyone know this is a great quick read with great tools that you can deploy very rapidly. You can read this before you even go to a meeting. You can read a chapter when you walk in the door for that meeting. Thank you for your generosity. Yeah, I don't thank you, but take a final minute. What's your number one tagline you want to share with our audience today? Well, as it relates to generosity, I'm going to quote my friend Maria Sipka from Sydney, Australia, who says, people either come from givington or takington. And so I think I come from givington, and as such, I choose to surround myself that also come from givington. Because if you don't, then somebody's in a struggle in that puzzle. Awesome. Thank you so much. Be from givington, people, not from takington. Thanks a lot. We'll talk again soon. And thanks to our audience here for joining us today. Hello, everyone. My pleasure. Bye-bye.


Welcome to this session on the epidemiology of refractive errors and specifically myopia. At the end of this session you should know the definition of refractive errors and myopia in children, be able to describe the distribution of refractive errors and myopia, be aware of the geographic variation in refractive errors and myopia as a cause of visual loss and possible reasons for this variation. You should be able to list the potential risk factors for the development of refractive errors and understand the main hypotheses for the development of refractive errors. You will remember from last term and other sessions in this module that epidemiology is the study of the distribution and determinants of disease or health related states to understand and allow for its control. So in this case of refractive errors and myopia we want to understand what is refractive error, how many people are blind and who is blind from refractive errors and myopia and why are children blind from refractive errors and myopia and then finally how can blindness from refractive error and myopia be reduced. We will cover this in a separate session later today. I want you to pause for a minute and define what is a refractive error. You pause the video now and make a note of your definition. It is common to have different ways to define a refractive error such as based on vision, anatomical or physiological condition, the type of correction that is required, the symptoms someone has or even just the type of refractive error. None of these are incorrect and they're used dependent on the context. So we'll define refractive errors as a disorder in which parallel light entering the eye from a distant object is not focused on the retina. The retina converts the light rays into signals that are sent to the brain via the optic nerve. The brain then interprets these signals into the images that we see. Refractive errors can cause blurred vision in the affected eye or eyes and can vary in severity. The refractive state of the eye is determined by the cornea, the lens, anterior chamber depth and axial length of the globe. The three most common types of refractive errors are myopia, hyperopia and astigmatism. Presbyopia typically affects the adult as part of the aging process and we won't consider this further in this session. We'll start with hyperopia and astigmatism and then go into a bit more detail about myopia. Hyperopia or hypermatropia is caused by a focusing problem. If you think about it like this, when you watch a movie at the cinema the film projector has to be focused to get a nice sharp picture on the screen. The light passes through your eye's natural lens like it passes through the projector's lens. Light then focuses on the retina at the back of your eye the way it focuses on the cinema screen. Imagine if the distance between the projector and the screen was too short. The picture on the screen then would be blurred. In hyperopia the length of the eyeball is too short for the strength of the eye's lens. So the light is focused too far back behind the retina and so things appear blurred. Is hyperopia common in young children? Yes it's perfectly normal for most children to have mild hyperopia or farsightedness early in life. In many cases no treatment is necessary because a child can accommodate by using their own eye muscles to properly focus. Astigmatism. Astigmatism causes distorted vision as the refracted power of the cornea or the lens are not consistent in all the meridians. So parallel light rays enter the eye and are refracted unequally in different directions. This leads to a lack of sharp point of focus on the retina and again causes blurred or distorted vision. Astigmatism can be classified in three ways. With the rule when the refracted power of the vertical meridian is the greatest. Against the rule when the refracted power of the horizontal meridian is the greatest. And then oblique when the two primary meridians are neither horizontal nor vertical. Astigmatism can affect all age groups and doesn't significantly change with age. Myopia or short sightedness is when objects up close appear clear but there is difficulty in seeing distant objects. So parallel light rays from the distance objects enter the eye and focus in front of the retina instead of on the retina because the eye is too long. Sometimes myopia can also be the result of the cornea being too curved for the length of the eye or the lens being too thick. Myopia is the most common from a refractive error in children and usually it starts around the age of eight to 10 years and it progresses in severity throughout the childhood and adolescence and into adulthood. However in China and other East Asian and Southeast Asian countries myopia begins earlier and is prevalent in children as young as five years old. The prevalence of refractive errors in children can vary in different ethnicities and cultural settings and comparing regional prevalences are very difficult because different definitions of myopia, hyperopia and astigmatism are used. These studies are done in different age groups and also the different procedures that are used to measure visual acuity and refractive error status. However uncorrected refractive errors are the most common cause of visual impairment in children. Global estimators indicated that there were about 12.8 million children visually impaired from uncorrected refractive errors. This translates into approximately one percent of all children and given the current global trends in myopia this is set to rise. What I'd like to talk about now is something called the refractive error studies in children. The risk studies are a set of eight population based studies not school based and they were conducted in children aged five or seven up to about 15 years old using a very standardized methodology to estimate the prevalence of refractive errors in different ethnic groups and cultural settings. They used consistent definitions and common methods in all of the eight locations. These locations were Nepal, India where they did two studies urban and rural settings, Chile, Malaysia, South Africa and then again China where they also lived at the urban and rural difference. The results from these studies confirmed that there is a significant variation in the prevalence of refractive errors in the different regions and also that there is a difference within countries and the variation is between urban and rural settings and this was seen in India and China. On this graph you can see that the difference between presenting visual acuity and best corrected visual acuity is the unmet need for spectacle correction. The prevalence of hyperopia. Again it's difficult to compare studies that report on the prevalence of hyperopia due to the different definitions that are used. The risk studies attempted to use the same definitions throughout. Hyperopia is a known risk factor for the development of strabismus and ambliopia and there is also a growing body of evidence that suggests uncorrected hyperopia may be linked to poor academic performance and deficits in the visual cognitive and visual motor motor measures. Privilege of myopia in teenagers and adults. This map is a compilation of various sources to illustrate the range of myopia prevalence in different regions. In 2016 Rednicka et al published a review to quantify the global variation in childhood myopia and myopia prevalence taking into account ethnicity age and the study design. In this paper it stated that there are noticeable differences in prevalence by ethnicity and these differences increase with age. So East Asians have the highest prevalence of myopia reaching to about 80% by the age of 18 years of age compared to Black children in Africa in late adolescence where 5.5% of 15 year olds are affected. Also children who predominantly live in urban areas are 2.6 times more likely to be myopic than children living in rural environments. This graph shows the distribution of people with myopia and the prevalence across all age groups. In 2000 the greatest number of people with myopia were between the age of 10 to 39 years. However the projections suggest that throughout both cohort and age effects this distribution will spread by 2015 with large numbers of people with myopia from 10 years of age all the way through to the age of 79. Looking at the numbers of myopia in the year 2000 and looking at those values you can see that the bulk of myopia in age groups younger than 40 years. This reflects the significant lifestyle changes for children and young people over the past 10 to 25 years especially in large population centres of Asia. Looking at this graph this is from a recent systematic review and meta analysis by Holden et al. This suggests that between 2020 and 2050 the number of people with myopia globally will increase from 1.9 billion to 5 billion and 1 billion of those will have high myopia. Now these projections were based on existing data and assumed that current lifestyle patterns would continue so things like the amount of time that's spent indoors, the amount of time that's spent doing near work and that lifestyle changes will continue to spread with increasing urbanisation and development. There is a jury out there at the moment whether the COVID-19 pandemic will have an impact on these figures given the increased screen time and time spent indoors changing drastically for all age groups especially children with homeschooling. With this increasing prevalence of myopia, vision impairment from uncorrected myopia is also increasing. So what we've understood from this is that there's an increasing prevalence of myopia globally. Myopia affects children from a young age which means that the vision impairment from uncorrected myopia is also increasing. Given this epidemic in myopia there is insufficient attention from a public health perspective in terms of assessment of prevalence, preventive and possible treatments. There is also a lack of consensus on the threshold for classifying myopia and high myopia and the terminology classification and methods used in epidemiological studies is not always defined in order to assess the extent and contribution of myopia to vision impairment. These findings together with the lack of consensus on standard definitions for myopia and high myopia and insufficient attention from a public health perspective led to a global scientific meeting on myopia in March 2015 and this was led by the WHO and the Brian Holden Vision Institute. Participants at this meeting were scientific and clinical experts in myopia from six different WHO regions and they published a report called the impact of myopia and high myopia. This report led to a great definition of myopia and high myopia. Myopia was defined as a condition in which the spherical equivalent objective refractive error is greater than or equal to minus 0.5 diopter in either eye. High myopia defined as a condition in which the spherical equivalent objective refractive error is greater than or equal to minus five diopters in either eye. There was also a clinical definition of myopic macular degeneration and the need for it to be used clinically and in research agreed. There was a call for clinical and epidemiological research in myopia to use standardized methodologies and then also the inclusion of myopia and high myopia and myopic macular degeneration as attributable causes of vision impairment in epidemiological surveys. There were calls for evaluation of the evidence and myopia control strategies such as increasing time spent outdoors, the use of atropine or spectacles of contact lenses. There was also a call for evaluation of the evidence on environmental, optical and therapeutic factors on the progression of myopia. So what causes myopia and why does it progress in some children versus other and why are some children more at risk of becoming myopic? These are all really valid questions however they're also very complex with a number of factors making it very difficult to disentangle the effect of nature versus nurture that is genetics versus the environment. The next few slides will briefly go through the different determinants of myopia and I'll highlight the different conclusions from various studies. So the four things that we will look at in terms of etiology and risk factors for myopia are genetics, emitropization, near work and outdoor time. So we'll start with genetics. Now it's now sort of generally accepted that genetic change is too slow to explain the rapid increase in the prevalence of myopia seen over a short period of time in places in East Asia, thus indicating that environmental factors associated with more widespread education and urbanization may be playing a larger role in this. Furthermore, the higher prevalence of myopia is not limited to a single race. It is higher in people of Chinese, Indian and Malay origin in Singapore than in Indians in India and rural Chinese in China. For the purpose of completeness it's good to note that genetic factors impose a level of baseline risk of myopia, but the association of myopia with environmental risk factors has led to the epidemic of myopia. So twin studies have showed that genetics can explain 60 to 80 percent of variants in spherical equivalent refractive error and axial length. Other studies however have indicated that the genetic contribution is far less and does not explain the majority of cases of high myopia. Studies of the genetic contribution should include evaluation of environmental aspects as factors such as time spent outdoors and time spent doing new work vary by families. This other studies have found that the children of myopic parents have higher prevalence of myopia, but the relative risk varies and is lower where the prevalence of myopia is high as in East Asia. What we do know is that family history and environment increases the risk of developing myopia and so this is an opportunity for clinicians to manage myopia in school age children. Emitropization. The development of an eye towards emitropia is known as emitropization and this process is guided by visual input and the mechanisms that coordinate this process are not fully understood. What we do know is that the fovea alone is not responsible for the development of vision. Eye growth is responsible too and that peripheral retina signals can dominate eye growth regulation. So based on this there are certain optical strategies that bring the peripheral image onto the retina therefore removing the stimulus for elongation. I won't dwell on this too much but there is thought by some that relative peripheral hyperopsy focus encourages the growth of the eyeball and as a consequence increased axial length in myopia. This also forms the basis of some myopia management interventions that we will cover later on. So basically hyperopsy focus which is common in corrected myopic eyes can increase ocular growth whereas myopic de-focus especially when it is imposed of a large area of retina can slow axial elongation. Environmental factors. The projected increase in myopia and high myopia are widely considered to be driven by environmental factors so nurture. Principally lifestyle changes resulting from a combination of decreased time outdoors and increased near work. Long environmental factors so-called high pressure educational systems especially at a very young age in countries such as Singapore, Korea, Taiwan and China may be a causative lifestyle change as may the excess use of near electronic devices. Other proposed causes include light levels which may directly be related to time outdoors with peripheral hyperopia in the myopic eye encouraging axial growth and diet. There's also some observed seasonal variation in the progression of myopia and that adds weight to the argument that time spent outdoors slows down the progression of myopia. Near work. The next two slides summarize the different pieces of evidence linked to near work and outdoor time and the theories for myopia onset and progression. There is some evidence that does a higher prevalence of myopia with increased near work and for example students, tailors etc. There is also accommodative lag and this has been studied extensively. Accommodative lag contributes to the hyperopic de-focus on the retina and that promotes eye growth. Myopes have a greater accommodative lag than emetropes. It's very unclear and it's a bit like chicken and egg unclear whether myopia comes first or the accommodative lag. Outdoor time as a strategy to prevent the onset of myopia. As a strategy to prevent the onset of myopia outdoor time is now recommended and is also built into some school curriculums. Time outdoors is protective against the development of myopia. There's also evidence that higher levels and spectral composition of the natural light act as a protective factor. Then there's individual factors such as smaller pupils, a relaxed accommodation, reduced dioptic value variation that also play a role. The high light levels increase dopamine and slow eye growth in animals however this has not been validated in human myopia. Myopia progresses faster in winter compared to the summer suggesting that time outdoors or light plays a role in myopia development. There is a hypothesis that myopia myopes have a lower level of vitamin D however evidence of vitamin D playing a role in myopia is not very strong. There are theories about why time outdoors reduces myopia risk. It's more likely that it's because of the hyperopathy focus and the increased light levels outdoors rather than it being because of the spectral composition of light. Advocating for children to spend more time outdoors generally has a positive impact on their well-being and their development so regardless of how and why it reduces the risk of developing myopia it's strongly encouraged that children spend more time outdoors. So in summary, refractive errors are a common cause of vision impairment. Myopia is the most common type of refractive error in children and usually starts from a young age. There are geographic variations in the distribution of refractive errors in specifically myopia and this is now being known as the epidemic of myopia. Both genetics and environmental factors play a role in the development of myopia however it is widely accepted that genetic contribution is considered small and there is a consensus that genes may determine susceptibility to environmental factors. Also the genetic contribution does not explain the majority of cases of high myopia.


We got a three pack of news for you guys today. Nintendo dropping some sick news about Kirby. We also have a leak thanks to a data mine of a major Nintendo game. So I'm really excited to dive into this news, not back on camera yet. We'll talk about that towards the end of the video, why I am not, at least in this video, maybe the next. But before I do, I wanna remind you that we are on our road to 100,000 subscribers. And if we can get there by the time tears of the kingdom comes out, we will be giving away a collector's edition of Tears of the Kingdom. So what are you waiting for? Hit that subscribe button and let's get into that news. First up, Nintendo dropped a six minute overview trailer of Kirby's Return to Dreamland Deluxe. It's a beautiful trailer because Kirby's Return to Dreamland Deluxe is a beautiful game. In there, they talk about two of the new copy abilities. They talk about how the Mecca lets you fly a little bit, which I mean, Kirby already can do that, so sure.  So if you ever wanted to do that, I guess that's the thing you can do now. There's also a new sand ability that lets you avoid attacks and lets you summon a sandstorm, which, and you know what, what at this point can't Kirby do. It also details how Megalore can help you during the game by doubling your health and saving you from falls and giving you items during boss fights. Yada, yada. The point is it's like an easy mode, okay? So it's an easy mode for the game. It does also introduce the Merry Megaland that has a bunch of sub games and you can play them with friends. It's like a mini game mayhem mode. It details extra content as well so that new content called the Megalore Epilogue. I don't wanna dive too much into that because that's brand new content. I don't wanna spoil it all for you, but it has some details in this six minute overview trailer. There's also an extra mode that is unlocked after your first playthrough. That is basically a higher difficulty. You have fewer items, less health, helping items in your playthrough, more enemies, and this is what's really neat. They actually made the boss AI better so they made the boss AI fights harder. So cool, that is really awesome. Glad to see that addition. They also added an arena mode, which is a boss rush mode. And of course, reminder, there's a demo available. So yeah, this is an amazing experience. I'm really happy. Let's move on to our next story, which also has to do with another game coming out this month. It actually comes in a week, and that is Autopath Traveler 2. The reviews are in a week early and it is sitting at an 84 overall on Metacritic and OpenCritic. This is actually notable because that's a smidge higher than the original critically acclaimed game, Autopath Traveler, which landed at an 83. Now, there is a demo available to play of the game right now. If you want to see if this holds up to your expectations, it releases next week. We'll put a pre-order link to the physical version down in the description shop. We'll have a physical version pre-order link as well for Kirby. See, if you guys want to go nab those games, that's awesome. It's also notable. This isn't really originally part of our news tales. It's a funny remaster drop today, but it's an embarrassment. You shouldn't buy it. I'm sorry. If you're someone who's never played the game and you were looking forward to it, this ain't it. Just don't buy this version of the game. It's bad. I don't even want to dive into it. It's really bad. It's an embarrassment. And it makes me feel bad because this is one of my favorite JRPGs of all time, but whatever, not everyone gets it right. Like Nintendo did with Metroid Prime Remaster and Kirby's Return to Dreamland Deluxe. Honestly, they did a lot with Dreamland Deluxe and I'm really, really happy for that game. That being said, let's get into the last story we have today. And this deals with a leak. Now, we get leaks like this every now and again. And this time we're talking about Xenobite Chronicles 3, Wave 3 DLC, because it has been datamined to reveal cutscene names. And well, there's a bunch of small spoilers in here of certain character names and locations. Again, I don't want to say this stuff out loud because I don't want to spoil it, but here's a look at the datamined itself on screen. You can feel free to pause the screen around here if you would like to actually check out all of these leaks. I don't want to list them off and spoil the game too much for people. What's interesting of course to me is that this stuff obviously happens. Datamining is something that Nintendo is well aware of. All companies are at this point. Anytime you release anything that the public can access, it's going to be datamined. So these are probably considered minor spoilers because of that, but they're still spoilers long times Xenobite Chronicles fans. Like those are the ones that are really gonna see some interesting spoilers in this batch. Also, I'm really, really excited for Tears of the Kingdom. Nintendo has continued their marketing campaign and they dropped a brand new screenshot, sort of brand new, okay? It's not actually brand new. They released it with a press package, but because it was something that Nintendo themselves has never posted before, it made people want to kind of zoom in and see if they could find anything new. Look, this screenshot is something again that we've already looked at and examined. Some people are trying to like pick out little things that look different compared to the last game. Of course there's gonna be things that look different. So that is kind of something. I also wanna know that Nintendo did remind us as well that Breath of the Wild's on sale right now. It's on sale for only another two days and they are selling Breath of the Wild for just $40, 40 buckaroonies on the Nintendo Switch eShop and they even have the DLC discounted down to 12 bucks. So they're really trying to get people to get into Breath of the Wild and reminding people that this sale ends soon. Again, I'm just throwing this out there. This is sort of a bonus story because it happened right as I was wrapping things up. Also, by the way, they did their grand opening for the Super Mario World. I don't know that, or Super Mario World, Super Nintendo World out in LA. It's actually been open for a little bit, but they did a grand opening with Miyamoto and Doug Bowser was there and obviously all the images coming out of Super Nintendo World look absolutely incredible and make me jealous because I'm really, really into theme parks and I don't know if and when I'm going to get to visit this. I was hoping that Nintendo would be at E3 this year and then I would make a trip to Super Nintendo World while I was out visiting E3, but since that's not happening, I'm not sure when I'll make a trip, but who knows? I mean, if they had a Zelda land, I guess children, pack your bags, baby! We're going! But until then, we're gonna hold back a bit. It's an expensive trip to bring the family on. That being said, that's all of our news for today. So I wanted to end by just telling you guys why we're not on camera right now. I have been feeling under the weather for the last week and honestly, well, I feel a little bit better every day. My headache doesn't. My headache from whatever this is, a cold, COVID, whatever, just keeps getting worse every day. Every day I wake up, the headache is worse and worse and worse. Obviously if this continues, we'll be making a second trip to the doctors because I don't like that the headache part's getting worse while nothing else really is. So I'm not really sure what's going on there. I hope it's not sleep deprivation because I've been getting extra sleep in. Maybe I'm getting too much sleep, I don't know. So that's kind of why I haven't been on camera because I'm not always feeling the greatest and don't know if I can bring that energy. That being said, I took some medicine earlier and it's starting to kick in. So if I make another video today, I might actually come on camera if I'm feeling up to it. But that's sort of what's been going on around here.  So I'm not really complaining. I just wanted to explain. Anyways, you guys are amazing and awesome and epic. Remember that, remember to love yourself, remember to tell your loved ones that you love them today because we should appreciate every day that we exist on this lovely planet that we call Earth. I am your host of Nintendo Prime, Nathaniel Rumpeljantz, and I'll catch you in the next video.


Hello everybody, E here. Welcome back to another Top 5 Friday. Today's video is, I completely stole this idea off of that's what she read here on YouTube. You can also follow her on Twitter, her name's Stephanie, on Twitter, on Instagram, on Goodreads. I will link you guys to her channel right there. So we're going to wait a second until that disappears and then we're going to continue on with the book. Anywho, with the list, I should say. So the point of her list was her biggest disappointments. I'm not sure if I watched her video, but I'm still not sure if those were recent disappointments or if there's disappointments of all time. If we were going to go with disappointments of all time, this list would be massive. So I decided to go with the last five years, roughly, of disappointments and two of them were released in the last year. I think this one was, yeah, I think it was the last year. I might be wrong. Let me know down there in the comments if I'm wrong. Actually, it's been over a year since I ordered the limited edition of one of these. So yeah, it's been over a year. Never mind. So we're going to start off with the absolutely massive boring tone that is The Bone Tree by Greg Iles. Man, was I disappointed with this. I finished it, but I had to get the audio book through the library because I wasn't about to buy it again. I unfortunately own both the paperback and the hardcover edition of this book because I love the first four books in the series so much and unfortunately this one was such a letdown. There is a lot of JFK subplot and it doesn't even happen in the 60s. JFK assassination subplot and he just went on and on with the storyline I didn't care about at all. I wanted to know about his dad and from what I understand is he had a car accident before he before he published Natchez Burning which was the fourth book in this series and he lost his leg and had a traumatic experience, of course, losing a leg. You're losing any part of your body is traumatic. Just car accident can be traumatic. But he had written a book called Unwritten Laws, something like that. In fact it's still on Goodreads if you want to go check it out. But he was going to release it as one book. When he got back he decided to cut it up and make it three long books. So Natchez Burning, The Bone Tree, and then Mississippi Blood were what those books became. And then I got to the last book, Mississippi Blood. This one is a disappointment because the series went in a whole new direction I didn't care about. But then in the last book I didn't even finish the last book because he says at some point in the narrative, not in dialogue, but in the narrative that black people smell funny. And I finally decided to give it up. I don't know what he was getting at. In fact he knew what he said was weird because he goes on to try and I guess defend that point of view by saying, oh it's not bad, it's just different. Which is very odd to me. I just finally gave up with it because I don't care to read about that. Especially not if that's how the protagonist of the series feels. It's written in first person, so anything. So if that protagonist feels that way, I just don't care to read about it. You might be different, have fun with that. Next up is Beautiful You by Chuck Pollanik. I was expecting something amazing with this. I read that Chuck was going after the Fifty Shades of Grey crowd. And I guess he went after him. I mean he put all barrels into it. This book was just no fun to read. And then in the very end he parodied himself. I mean I understand sometimes that authors feel the need to not take themselves seriously. I'm the same way. But when the entire ending of your book is a joke, I just can't, I just can't gel with it. I don't know. Joe Hill did the same thing with what was it? Rain I think in strange weather. He pretty much said, hey the whole thing is a joke. So then the ending was the only part that really felt like a joke to me. The rest of it seemed like he was trying to be serious, but yeah he just never pulled it off so he decided to make a joke out of it. I don't know. And the third, number three on my disappointment list is The Vegetarian by Han Han Kang. I'm not sure. This lady is a tremendous author. Her, I guess it's a novel. A human being or something like that is a terrific, terrific book. I'm just going to look in here and see if they tell you what it came after this one. So I don't guess they don't. But the book that she released, the translation she released in America after this one is fantastic. This one, I don't know what happened. There is so much that is left to the imagination that the comments section on my review of this book turned into a clusterfuck. No other way. Women coming on telling me that I was wrong, that I was right. Guys coming on telling me I was wrong and I was right. So many people read so many different things into this book. I had people agreeing with me, disagreeing with me, some people on the fence, whatever. The inside of the jacket says that it's supposed to be an allegory for modern day Korea. And then you come to find out that she, in an interview with her, she says it's not supposed to be that. So I don't even know that she knew what she was writing about. But what I'm getting at is there are a lot of women who enjoyed the book. What I've been told is because it speaks to the hidden violence and hatred inside of a woman. Anyway, just go read that. I will link you to the comments section of my review for this book and you can read it for yourself. I'm not one of the detect person to delete comments. So I just leave it open. Now on Goodreads, I do have my comments shut off unless we are friends. And that's just to keep the trolls down. So if you want to comment on it, just send me a friend request and put in the friend request. Hey, I'm offending YouTube videos or I watch YouTube videos, whatever, and I want to comment on your stuff. I'll let you in. All right, next up, let me just say the book started out great. Going back to the vegetarian real quick, the book started out great. I would highly recommend the first third of the book because the book's been broken up into three different parts. Highly recommend that. But after that, it becomes a confusing cluster.  Next up, you guys have been a recent fan of the channel or how long you know, I have already reviewed this, but never World Wake. I waited five between five and seven years for this. I can't remember how long after reading night film. This thing was a disaster. I cannot think still to this day. I cannot think of one positive thing to say about this book. Not even the writing was very good. Nothing about this book did anything for me. And a lot of people going, yeah, it's YA. It's not meant for you. I have read and enjoyed YA. In fact, Andrew Smith is one of my favorite authors of all time. He's got a new book coming out, by the way. And he he doesn't write down to the people that he's writing to. This does. And other YA I've read talks down. I would I would much rather my children read Stephen King than any of the YA that's being published nowadays because it it's just the language is so dumb down as if they're not going to understand what you're saying unless you say it in the most simplistic language. Last, but not least, if you didn't see this coming, you don't know me very well. Sleeping beauties by the one, the only Stephen King. Or if you think like I think Owen King. I can almost promise you Owen King wrote the majority of this book. It lacks all the passion and storytelling ability of Stephen King. The only thing that says Stephen King about this book is the feeling that the entire plot and cast is just rehashed and reused from under the dome. So yeah, this was my most disappointing recent book. I cannot look back on any of these other ones and feel more disappointed than I was with this one. Not even having read and enjoyed the first four pen cage books by by Greg Iles. Can I look back and say, oh, well I was more disappointed than that than I was in this one. This one broke my heart because I really love Stephen King and I love Owen King by themselves and it just feels like a 700-800 page novel that was completely not only phoned in and they got lost in their message and forgot to entertain people. So that's my list. I hope that you will definitely go check out Stephanie's video over on that's what she read. But until next time, I have been E, you've been U, this has been another Top 5 Friday. I'll talk to you guys later. Bye bye.