The Myopia Epidemic

Why we are growing more short-sighted and why it matters

As someone who has been wearing glasses since the age of 9 when my brother realised I couldn’t read the scoreboard at Lord’s Cricket Ground, I’ve never taken myopia very seriously. Sure, it was annoying to have to wear National Health spectacles and be called “four-eyes” by boys who were not yet similarly afflicted but it was hardly a major disability when it could be cured so simply.

The author, aged 9, with his first set of stylish spectacles

Having spoken to Jude Stern from the International Agency for the Prevention of Blindness I now realise how wrong-headed - or dare I say short-sighted - that attitude was. Jude, an Australian woman who is the director of knowledge management for the IAPB, first made what should have been a very obvious point - that for millions of people in underdeveloped countries glasses just aren’t available so their myopia goes untreated. That has serious long-term consequences.

She pointed me to an article in the Community Health Care Journal attempting to assess the scale of the problem. It comes to this conclusion:

“In total, up to 1 billion people worldwide, predominantly in Africa and Asia, are blind or have vision impairment because they do not have the spectacles they need.^”

But that was just the beginning of the story. Jude went on to tell me there was a global epidemic of myopia, and it was in fast growing Asian countries that it appeared to be most acute.

“It's predicted that half the world will be short sighted by 2050 and primarily that is led by East Asia. China already has over 80% of its kids short-sighted, Singapore, it's higher, South Korea, it's higher.”

In South Korea, 97% of 19 year old male army conscripts were found to be myopic. The figures in Europe and the United States are not so dramatic but the trend is clear - over the last 15 years the world has been getting steadily more short-sighted.

So what’s been going on? You might conclude, given that fifteen years ago was when smartphone ownership took off, that this was all about young people staring at screens for too long. The IAPB isn’t prepared to make that leap explicitly but does blame “lifestyle changes, including reduced time spent outdoors and increased near-work activities.”

Jude says the research is now pretty clear about a correlation between myopia and a lack of time spent outdoors, looking at distant horizons, rather than sitting inside focusing much closer. “And there are some studies that are linking it specifically to screens.” She says it would be great if researchers could get access to the huge amount of data Apple must have from the Screen Distance function on modern iPhones which can alert children if they are holding the phone too close.

Apple’s Screen Distance tool could provide useful data for researchers

“The other thing that we know about myopia we didn't used to know is that it is a progressive disease that we can slow in some cases,’ explains Jude. But growing numbers getting myopia younger brings a new challenge: “The longer you have it the more likely it is for you to have a complication.” She says serious threats to vision such as retinal detachment or macular myopic degeneration are now being detected in people in their fifties when they used to be restricted to much older people.

So, what can be done? The simple answer is getting children to spend more time outdoors. Jude points out that myopia rates, while growing, are about half as high in Australia, famous for its outdoors lifestyle, as in Singapore, where a humid climate means many children spend most of their time in air-conditioned classrooms or shopping malls.

But in China, Taiwan and Singapore action is already being taken to change the school environment. In Taiwan teachers apparently complained that pupils were coming back hot and sweaty from breaks outside but instead some schools moved teaching outdoors too. In China, experimental glass classrooms mean children can spend more time staring into the distance - though from what I remember of my schooldays, that can attract a rebuke from the teacher.

The irony is that the developed nations where the screens which dominate our lives are designed and manufactured will probably move rapidly to address the causes of the myopia epidemic. Meanwhile, in Africa it is possible that smartphone ownership will accelerate faster than access to the eyecare needed to prevent more people facing severe visual impairment or blindness.