Is myopia becoming an epidemic?

An unprecedented variety of electronic devices and digital media available today have improved our lives in many ways, but not without concern. As technology transforms the way we live, our eyes are impacted the most. The more time spent staring at screens, the higher the chance of developing vision-related problems. Dry eye syndrome and myopia are on the rise at an alarming rate and are linked to the increased use of electronic devices.

The other day while walking past the store window of an optician, an attractive and colourful display of spectacle frames for kids caught my eye (pun not intended), instantly reminding me of the ugly frames I was subjected to as a child because nothing especially designed for kids was ever available. But more than that, it also made me think of how stylish spectacle frames for children are no more in demand meaning more kids require corrective glasses. I also realised that I hear more and more people complaining of itchy, dry eyes. These are the iPad kids after all, and compared to older generations, there are a lot more eye and vision issues among young people now.

Numbers tell all

According to Gallup Pakistan, three in 10 Pakistanis wear glasses, out of which 42% are women and 28% are men. Several factors including the use of digital devices, lifestyle changes, posture, lighting, genetics, environment, and a major lack of eye care play a part in this perplexing situation.

The situation, however, is not so different from what is happening in the rest of the world. Countries with seemingly completely different lifestyles are unified by a startling phenomenon: rocketing rates of short-sightedness because of common lifestyle habits that unify all of us as a global village. We are all dealing with the brunt of urbanisation, we are inundated by screens and we mostly have unhealthy eating and sleeping patterns.

According to a BBC study from last year, about 40% of adults in the US are short-sighted, up from 25% in 1971. Rates have similarly soared in the UK. But their situation pales in comparison with that of teens and young adults in South Korea, Taiwan and China, whose prevalence rates are between 84% and 97%. If current trends continue, half the world’s population will be short-sighted by 2050. And the problem seems to be spreading at a faster rate than ever.

Stigma attached to wearing glasses

Iqra Khan, 43, was the first one in her family to develop poor eye-sight as a 10-year-old. Being the youngest daughter to need glasses, it became a social concern for her parents. In our society, parents get more worried when daughters have to wear glasses compared to sons because it affects their appearance and can make it difficult to marry them off if they are not pretty enough. As unreasonable as this is it is a very commonly prevalent mindset.

Iqra’s extended family and family friends started behaving as though something terribly taboo was happening to her, a grave social stigma to deal with all her life. A girl with glasses? How awful! Some advised eating almonds would help correct her vision woes, others recommended carrots. As she was only a child herself, everyone blamed her parents for letting her read so many books and watch too much TV with no focus on her diet.

“I was worried when she started complaining that she couldn’t see what her teacher wrote on the blackboard,” says Shaheen Khan, Iqra’s mother. “Being shy in class, she would not complain and instead quietly copied what her classmate wrote down in her notebook.” Six months had already passed by like this when it became apparent to her parents that she needed to get her eyes tested. “In some kind of denial, we delayed getting her glasses for another year,” her mother admits, “thinking that if we followed all the health advice that we got from people to improve her eyesight, this problem would go away. But the delay only increased the prescription numbers.”

Iqra’s five other siblings have no eye-sight issues, so she regularly got grilled with questions like does she watch more TV than them, does she eat healthy, and does she get enough sleep or not. “At first I was reluctant to wear glasses to school,” Iqra says, “but as it became difficult to see at a distance, I had to wear them.” It has been 23 years now since she has been wearing have been wearing glasses. “They have become an extension of my body,” she says.

Iqra explains that the socio-cultural attitude towards girls wearing glasses has somewhat changed now, possibly because of the media and successful bespectacled women at the forefront today. “But that does not mean that a healthy lifestyle should be ignored,” she says. “I feel our unhealthy eating habits and increased screen use are making the situation worse. Children and young people don’t want to eat vegetables and instead eat copious amounts of fast food. I don’t see green vegetables being cooked in homes because kids don’t find them delicious, whereas every edible item has its own health attributes and must be included in our regular diet,” Iqra points out.

Genetics vs bad lifestyles

Unlike Iqra, Ayesha Azeem, 43, had a genetic condition that not only caused short-sightedness in her, but also passed it on to her daughters, a three-year-old and a five-year-old. “Getting glasses for your kids as early as two years of age is worrisome for parents,” says Ayesha. “Not only do people ask all kinds of questions, it’s also difficult to manage glasses at such a young age. As for me, I wanted to get laser treatment, but my retina is weak so that option is out.” The family is working on eating healthy and controlling screen time to prevent the worsening of their eye issues.

While a family history of myopia raises the risk of a child developing it, genetics plays only a small part, and a purely genetic case of myopia is rare. Instead, lifestyle factors are thought to be more significant, in particular, a lack of time outdoors, and focusing on close objects for an extended period through an activity like reading in bad light and at an incorrect distance.

Habits for better eye care

In the last four decades, the use of glasses among kids and young people has increased rapidly and the major reason for this is the introduction of screens in our lives. The era that started with TV screens morphed into handheld devices in the last two decades, and the more screens get close to the eye, the more disastrous it has proved to be. “Children these days will not put a morsel in their mouths without watching YouTube and in families with children, the norm is to have meal times in front of a screen,” says Dr Qazi Wasiq, an ophthalmologist with over four decades of practice and president of the Pakistan Eye Bank Society.

The main problem is not just peering into screens, but the distance from the screens which is where the problem really starts. In the 80s and 90s, parents insisted that TV should be watched at a distance, but even as TV screens are way bigger now, that problem has somewhat disappeared. “Watching TV from a big screen at a certain distance doesn’t pressurise the eyes to focus, but with mobiles or tablets, the screen is smaller and nearer to the eye, making the eye focus more which builds pressure on the retina,” explains Dr Wasiq.

With urbanisation issues, as well as those of security and safety, children hardly have healthy outdoor environments anymore to run around and play as they did some decades ago. “They mostly stay indoors and their recreation and entertainment is limited to screens for gaming and watching videos,” says Dr Wasiq, pointing out that by staying indoors children only see at a limited distance. In contrast, outdoors they can see farther and this is where short and long-sightedness plays a part. “There is no nature, greenery or open green areas for people to go out and relax their eyes. In this case, screen time must be controlled.”

When a child only sees objects in close proximity indoors, the eye develops an understanding with the brain and it becomes used to seeing objects in close proximity. This is why most young adults who do have higher numbers for their glasses are not able to see clearly even at 20 metres distance. Posture and light are other things people don’t think about. They lie in bed and read even when light is not enough and they strain their eyes and the book or screen is placed too close to the eyes. “Reading on screens and in print in the dark is the worst thing you can do to your eyes because it pressurises the retina,” says Dr Wasiq.

He emphasises the importance of eye tests in schools, especially as kids now start schooling much earlier, at 2.5 years of age and are exposed to books and screens. “When a child gets close to digital means and away from nature, the eye muscles contract and the vision problems arise. A diet with plenty of vegetables and fruit is crucial, instead of the consumption of junk food and store-bought and prepared food that mostly uses mechanically separated meat and chicken. Food must contain good nutrition.”

What parents and young adults don’t realise is that when eyes do not get the focus or flexibility that is required, the educational and mental capability of the person also compromises. As the eye length suffers and reflective errors appear, myopia develops constantly, in some cases the numbers for prescription glasses increase till 21 years of age, and in a few cases, continue to increase till it becomes a case of pathological myopia.

“The easiest and most doable exercise is the 20-20-20 rule,” says Dr Wasiq. “Look away from your screens every 20 minutes and focus on an object 20 feet away for 20 seconds, this can help reduce eye strain. Another rule is 1-2-10, where the mobile device should be at a one-foot distance, the laptop should be two feet, and the TV at least 10 feet away from the eyes.”

Are you reading this on a device? How far is it from your eyes? Is the light good? Take a break, go out and leave your pet screen at home. Rest, blink, lubricate or just look out of the window from time to time, and remember that healthy lives mean healthy eyes.