Why The World Is Becoming Near-Sighted

Soon, will we all be squinting to see? (Photo: Getty Images/JGI/Jamie Grill)

Natural 20/20 vision could soon be a luxury afforded by few: New research finds that rates of myopia, or near-sightedness — a condition in which the eye grows too long and the images of distant objects can’t be brought into focus — are rising dramatically.

“It used to be that myopia was a minor refractory condition,” Maria Liu, OD, PhD, assistant professor of clinical optometry and head of the Myopia Control Clinic at the University of California, Berkeley, tells Yahoo Health.

Eyesight to some degree, is genetic. More than 24 genes have been linked to an increased risk of near-sightedness, which is a vision problem that’s a result of the eyeball being too long, or the cornea — the cover at the front of your eye — being too curved. (When this is the case, the light that enters your eye isn’t focused the right way, making far-away sights appear blurry.)

But today, science suggests more than hereditary factors are to blame for the condition. The age of onset is earlier: Myopia used to be thought of as “adolescent myopia,” but now it’s very common to see kids becoming near-sighted in kindergarten. Plus, the numbers of people who are near-sighted is increasing, as is the overall severity of near-sightedness.

Take developed East Asian countries like Japan, South Korea, China, and Singapore: Instances of myopia have doubled, and in some places tripled, there, scientists say. “Eighty to 90 percent of children completing secondary school in East and Southeast Asia are now myopic,” Ian Morgan, PhD, professor at the Research School of Biology at Australian National University, tells Yahoo Health.

But the problem is here at home, too. In 1986, about 25 percent of Americans experienced myopia. But fast-forward to 2001, that number jumped to 41 percent, says Liu. “Following that trend — almost another 15 years later — you can imagine the myopia prevalence is higher than 41 percent today,” she says.

That’s an average overall. But if you look at data by age, you’ll notice something else, Liu says: a higher prevalence in children and young adults as compared to older adults. A National Eye Institute study found that for people ages 12 to 54, the prevalence of myopia rose by 66 percent between 1971 to 1972 and 1999 to 2004.

What’s To Blame For Rising Rates?

In Asian countries with incredibly high myopia rates, children start studying earlier and harder than children in Western countries, says Morgan. “They also tend to stay inside more, only in part because they are studying. It is this combination of intense study and not enough time outside that leads to myopia.”

In China, where Liu was trained, she can attest: “Kids are imposed with schoolwork very early on, even at 3 or 4 years old — and reading for hours on end can have a more intense impact on the visual system for a 4-year-old than an 18-year-old because the eyes are still developing.”

And while U.S. children may not face the same heavy academic load from an early age, the use of electronic devices — which many elementary schools across the U.S. (and world) now use — could be making things harder on the eyes. “Reading on a handheld is not good for visual development,” says Liu. “Handheld devices are designed to keep someone very engaged — and can produce a very intense shock to visual system.” Plus, the closer a device is to your eyes, the higher the intensity, she says.

Duration of use matters, too, says Liu. “It has been suggested that the impact of the one session of work is a lot bigger when it comes to myopic development than breaking work down into multiple sessions.” That’s because your eyes have a system of recovery in place. But if you don’t give them a break, they can eventually grow longer at a faster rate than they are supposed to, she says.

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The Impact Of Being Outdoors

A break outdoors can do your eyes wonders, though. “Outdoor activity has been shown to be protective against myopia,” says Liu. There are multiple theories as to why Mother Nature can play a role in eye health — one is directly correlated with sunlight, says Morgan: “The typically bright light outside during the day releases a neurotransmitter, dopamine, from the retina, and it appears to slow the rate of eye elongation, and thus prevents myopia.”

Spending time outside could be protective for kids’ eyes, research shows. (Photo: Donnie Ray Jones/Flickr)

In fact, an Australian study of more than 4,000 kids demonstrated that children who spent less time outside were at an increased risk of becoming near-sighted. Animal studies have also shown that when exposed to bright light, the eyeballs do not grow in length as quickly as when the animals spend most of their time in normal or dim lighting, says Liu.

“With more bright, you have a lot more UV light and exposure to shorter wavelengths of light, which could be protective, too,” she adds, noting that animal studies have confirmed such an idea. But there could be more to the connection: “My personal understanding is that it’s probably a lot more complicated — when we are outdoors, all of our systems are working totally different. The body can sense that you are in an outdoor environment,” says Liu. It produces more adrenaline, you are able to see a much farther distance, and a slew of different activities activate different systems in your body.

But while research on the matter is fairly clear, schools still continue to reduce time spent outdoors, on recess, and on physical education. This past January, 23 Florida schools cut back on recess — some even eliminated it — in place of more school time. But a recent Stanford study demonstrated that a well-structured recess not only improves well-being, but also helps students succeed in the classroom and ups attendance rates. Beyond that, Liu urges that outdoor recess is important for eye health. “In East Asian countries like Singapore — which has an alarmingly high prevalence of myopia — the government is doing campaigns suggesting that kids have to spend time outdoors,” she says.

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The Healthcare Effect

Taking steps now — both through preventative measures like time outdoors and education — is crucial, not just for physical health but to protect your wallet. “The earlier you see this onset, the earlier it starts affecting each person’s life — both medically and financially,” says Liu. At an individual level, there’s no cure for myopia.

The eyewear market has continually grown year over year since 2009. In 2012, the market was 2.75 billion units — in 2020, that number is expected to be 142.8 billion. And experts say that lifestyle and environmental factors play a role in those rising numbers. But even as the numbers inch higher, insurance hasn’t stepped up. In fact, while Obamacare is required to cover eye exams and glasses for children, those plans aren’t required for adults — so glasses and contacts become pricy, fast. The average cost of glasses — without a prescription — is about $125.

 The Affordable Care Act doesn’t require vision coverage for adults. (Photo: Franklin Heijnen/Flickr)

Plus, even if you’re a candidate for vision correction surgery, such as LASIK (which, mind you, is often not covered by insurance), you may still need corrective eyewear, says Liu. (And that surgery could come with other risks, like retinal tears or detachment, which cost money to treat.)

But the problem with myopia is not just expensive glasses or surgeries. The earlier the onset of myopia, the more likely the condition is to worsen into “high myopia” — which makes the risk of complications higher, says Liu. That means more money spent on treating complications and an overall lower quality of life. “When myopia becomes severe, the risk of long-term visual impairment and blindness is markedly increased, and this cannot be simply corrected with glasses or contact lenses,” adds Morgan.

So where do we go from here? Time outdoors beginning at a young age may help reduce the risk of myopia. And for younger children with myopia, there are some (still somewhat experimental) treatments that can be used in clinical settings, too, says Morgan. One such technique is called orthokeratology or ortho-K. Liu describes it as contact lenses, which are worn overnight, that can temporarily fix vision by putting pressure on your cornea. She uses it with some patients at her UC Berkeley clinic.

Moving forward, scientists in the field have two goals, Morgan says: “We need to stop children from becoming myopic in the first place. And for those who still become myopic, we need to stop their myopia getting worse throughout childhood.”

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