(Published in ENRICH magazine, 2022)
POPULAR CULTURE (including our own) tends to portray nerds as young people wearing oversized eyeglasses. Same goes for older nerds, or the guys we like to call scientists. Nerds and glasses go together like puberty and pimples, right?
We see this well-worn trope on our big and little screens. Think bespectacled super wizard Harry Potter whose eyesight “really was awful”, said Hermione Granger. There’s also shy Daily Planet reporter Clark Kent ditching his nerd glasses as he transforms from Supernerd into Superman. But what kind of vision disorder afflicts nerds in real life, and these two superheroes?
A decades-old epidemic raging among children and young adults in East and Southeast Asia's richer countries gives us a clear answer. Kids with glasses have to contend with the curse of myopia and the many health maladies it brings in its train. Blindness is the most serious.
Also called nearsightedness and short-sightedness, myopia exacts a painful personal toll among some in the "glass-class". There's social ostracism (hot girls hate nerdy guys), and the risk a nerdy guy or girl will wind-up an "incel" (involuntarily celibate). Not a suitable state of affairs if your life-goal is to have kids and raise a happy family.
Levity aside, myopia is a huge and serious health problem in the Asian countries I mentioned. Happily, Filipino kids have evaded this worst of this plague for now -- but for reasons that aren't all that flattering.
Rich Asia's curse
There were some 2.6 billion nearsighted people worldwide in 2020, or 33% of the total world population of 7.8 billion, according to the German statistics portal, Statista. Myopia, however, runs rampant in the region I call "Rich Asia". The prevalence of myopia has been reported as ranging from highs of 70% to 90% in the Asian countries comprising Rich Asia: mainland China, Hong Kong, Japan, the Republic of China (Taiwan), Singapore and South Korea.
This means myopia isn't only a nerd problem but one afflicting a lot of kids and young adults in Rich Asia. The rest-of-the world is also becoming more nearsighted. The World Health Organization (WHO) forecasts that 50% of the world’s population will have myopia by 2050. That’s close to five billion persons.
These stats reveal why myopia is the most common eye problem in the world today. Myopia’s wide prevalence in East Asia, which includes Rich Asia, is high enough to warrant the use of the term epidemic to describe its scope.
This “unseen epidemic” is at its worse in Singapore with a population of only 5.7 million persons. Myopia's pervasiveness is so bad some Singaporean pundits have taken to calling their own country the "Myopia Capital of the World" and "the epicenter of the East Asian myopia epidemic".
"The prevalence of myopia in Singapore is among the highest in the world, with 65% of our children being myopic by Primary 6, and 83% of young adults being myopic," revealed Prof. Wong Tien Yin, former Medical Director of the Singapore National Eye Center, in a speech delivered in 2019.
"As such, Singapore is often labeled as the 'Myopia Capital of the World'. By 2050, it is projected that 80 to 90% of all Singaporean adults above 18 years old will be myopic and 15 to 25% of these individuals may have high myopia".
In sheer numbers, however, it's China that has the most number of myopes. China's myopia rate of 31% means more than 400 million of today's 1.4 billion Chinese are nearsighted.
Myopia's prevalence in China's high schools stands at 77%. This figure jumps to a stunning 80% among college students.
In South Korea, the myopia rate comes to 50% in kids aged 5 to 11 years-old and 78.8% in those 12 to 18 years of age. A decade ago, 96% of 19 year-old males in Seoul had myopia, according to one study. Of this total, 22% had what can be called high myopia, which is a rare inherited type of high-degree nearsightedness.
Taiwan back in 2014 reported that 18% of first graders, 52% of sixth graders and 80% of university students were myopic. A study by Taiwanese doctors found the prevalence of myopia among schoolchildren increased rapidly from 1983 to 2017.
A study in 1983 confirmed some 70% of Taiwanese high school graduates needed glasses or contact lenses to see properly. This percentage has ballooned to 80% today.
Japan still struggles with short-sightedness. A study by Japanese researchers revealed the prevalence of myopia in Japan rose rapidly from only 11.6% in 1949 to 62.3% in 2017 among high school students in all of the country's 47 prefectures. It also said "the prevalence of myopia among adults will increase" as these teenagers grow older.
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| Bespectacled Chinese boys |
Reasons why
Knowing all of this leads to the obvious question: "Why do many children and young adults in Rich Asia suffer disproportionately from myopia in the first place"?
There are a number of credible answers including heredity, but the three most prominent are deformed eyeballs, far too much "near work" and not spending enough time outdoors in the healthy sunshine.
Eye doctors agree most myopia is caused by misshapen eyeballs. This consensus can be appreciated when we consider an accepted clinical definition of the disease.
"Nearsightedness, or myopia, as it is medically termed, is a vision condition in which people can see close objects clearly, but objects farther away appear blurred", according to the American Optometric Association.
"Myopia occurs if the eyeball is too long or the cornea (the clear front cover of the eye) is too curved. As a result, the light entering the eye isn't focused correctly, and distant objects look blurred. Myopia affects nearly 30% of the U.S. population".
A refractive error in the eye, myopia also tends to be progressive i.e. it worsens over time. A myope's vision will deteriorate throughout childhood and adolescence before becoming more stable in adulthood. Myopia tends to run in families.
Without treatment, high myopia complications can lead to blindness. This makes it a must for myopes to have regular eye examinations and to wear corrective eyeglasses or contact lenses.
Myopia is also defined as blurred vision beyond two meters or 6.6 feet. It worsens when the eye grows longer, a deformity that causes the retina to stretch. Over time, a misshaped retina makes the eye vulnerable to serious diseases like macular degeneration, retinal detachment, glaucoma and diabetic retinopathy, according to ophthalmologists..
Too much near work is
a no-no
Excessive near work, a major cause of myopia, was defined as " . . . the sum of activities with short working distance such as reading, studying, writing, doing homework, watching TV, or playing video games, etc", by a scientific paper published 2015 in the peer-reviewed open access journal, PLOS One.
The PLOS One study found "that more time spent on near work activities was associated with higher odds of myopia,” but added a caveat the associations between time spent reading and myopia have not been consistently observed. Singapore’s experience confirms the link between near work and higher odds of myopia.
"In fact, a higher exposure to near work is the main contributing factor -- besides heredity and genetic factors -- to increased risks of myopia . . . among children in Singapore," said Clinical Associate Professor Dr. Lee Shu Yen, Head of the Surgical Retina Department at the Singapore National Eye Center (SNEC), in 2019.
These findings lead to the hard-to-accept conclusion a child seems more likely to become nearsighted the more years he spends in school. It also suggests nearsightedness is basically universal by the time children reach college.
“The more educated you are, and the higher your grades, and the more you participate in after-school classes and tutorials -- the more likely you are (to be myopic)”, said Dr. Ian Morgan, a retired biologist who studies myopia at Australian National University, in Canberra, Australia.
It seems myopia, for the most part, is an affliction of the bookish and is correlated with academic performance. A number of studies confirm a strong link between myopia and education, especially the excessive near work demanded by too much reading and writing.
"The prevalence of myopia has increased dramatically in recent years around the world and, in some highly educated groups such as law and medical students, it now exceeds 80%," said the PLOS One study.
Youngsters excessively eyeballing small smartphone screens as they play video games for hours on end also worsen the myopia epidemic. A Filipino doctor believes 90% of frequent mobile or online gamers have myopia.
Barbaric stress
A crucial reason why many students in Rich Asia study so inhumanly hard is the inordinate pressure placed on them to do well in school. This pressure reaches a peak in high school when they face the daunting task of passing their country's punishing college admission examinations. Acing these exams is seen as the guarantor of future success in countries such as China and South Korea.
Failing has been known to destroy lives. Student suicides due to intense academic pressure are a horrific fact of life in Rich Asia.
Depression and suicides are unfortunate by-products of educational systems such as those in China and South Korea that place barbaric stress on hapless high school students to pass a single, all-consuming exam.
South Korean parents believe a good university is a passport to professional and financial success for their children. They’d rather their children take college at one of the prestigious "SKY" universities: Seoul National University, Korea University and Yonsei University.
Chinese parents share a similar outlook. Their dream is to see their children matriculate at top tier universities such as the big three (Tsinghua University, Peking University and Shanghai Jiao Tong University) for the same reasons as Korean parents. And, like Korean parents, many Chinese parents apparently push their children to the limit of their endurance to pass these exams.
In China, kids have to hurdle the dreaded "Gaokao", or the National College Entrance Examination, considered by some as the world's toughest college admissions test. Gaokao was identified as a contributing factor in 93% of student suicides in China in 2014.
It's just as bad in South Korea. Since 2007, suicide has been the leading cause of death among young Koreans, according to data from Statistics Korea. Having to pass the country's dreaded "Suneung" (the Korean College Scholastic Ability Test) is one of the reasons why close to one in three students see suicide as a means of escape from the almost unbearable academic pressures they must endure to attain this aim.
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| Myopia |
Let there be light
Excessive time studying and cramming, and spending long hours playing games on smartphones means young people in Rich Asia and elsewhere are spending more time indoors. The still raging COVID-19 pandemic that began spreading in 2020 has added immensely to time young people spend bereft of healthy sunlight.
A number of studies have found that time spent outdoors is strongly associated with a lower risk of myopia. The corollary is that kids who spend less time outside are more likely to become nearsighted.
One of these studies involving children in California published in 2007 found time spent outdoors is strongly associated with a lower risk of myopia. Simply being outdoors is the key factor so it doesn't matter if kids play sports or just stroll around.
Another study, this one in 2008, involving Singaporean children of Chinese ethnicity studying in Australia and Singapore came to the same conclusion. It found that 29% of Singaporean students in Singapore had myopia compared with just 3% of those studying in Sydney.
The main difference was time spent outdoors by the Sydney Singaporeans. The kids in Sydney spent 13.75 hours a week outdoors compared to a scant three hours for those in Singapore.
“The big difference was the Chinese children in Australia were outdoors a lot more than their matched peers in Singapore,” said Dr. Morgan.
He estimates children need to spend around three hours per day outdoors to lower their myopia risk. A WHO report on myopia released in 2015 found that children should spend more than two hours a day outdoors.
The protective effect from being outdoors might be due to the intensity of sunlight releasing more retinal dopamine, which is a neurotransmitter. Dopamine appears to help regulate the rate at which our eyes grow. Too little dopamine causes our eyes to grow too long to focus properly.
Also called the "feel-good hormone", dopamine is associated with learning, memory, pleasurable sensations and other bodily functions.
This exposure to sunlight reduces a child's risk of myopia even if the child has two myopic parents and does near work. This theory explaining the positive effect of the outdoors, called the "daylight exposure theory", has gained wide acceptance.
Taiwan has taken this theory seriously. In 2010, the government began a nationwide program called “Tian-Tian Outdoor 120” that goaded schools to take pupils outside for two hours daily. The results of the program reversed a decades-long trend of rising myopia rates. Myopia rates fell from 49.4% in 2012 to 46.1% in 2015 among the millions of Taiwanese primary-school pupils involved in the program.
Myopia isn’t the Philippines’ biggest problem
Studies reveal that up to 29% of Filipino children suffer from myopia, said ophthalmologist Dr. Alexander Gonzales II of the Ospital ng Makati at a conference in 2018. He noted that 90% of frequent mobile or online gamers are nearsighted.
The prevalence of myopia in the general population is even higher. It's been estimated at 40% by Dr. John Ang, vice president for Education and Professional Services of Essilor Asia Pacific, Middle East, Russia and Africa. He also said school kids must spend more time outdoors.
"Changing lifestyles is very important like in Sydney where students have two hours outside play per day, they are three percent myopic," he said. "I'm not sure, but maybe we Asians push our children more to be indoors and study, unlike the Australians, they are more the sporty type".
It's long been proven that myopia can be corrected and managed. Early detection of the disease is vital to curbing its potential to inflict more damage to one's vision.
"Eyeglasses are the simplest and safest way to correct and manage myopia", said Dr. Ang.
Among his suggestions for eye health is for children to spend at least two and a half hours outdoors daily. Kids should also have an eye exam every six months and take a break when using computers or using smartphones and other digital devices.
The low myopia rate among Filipino schoolchildren compared to their peers in Rich Asia is something to cheer about but it’s not the worst problem our youngsters face.
In late 2019, the Philippines was assailed by the humiliating news Filipino students ranked the lowest among 79 countries in mathematics, science, and reading. The report that disclosed this shameful news came from the Program for International Student Assessment (PISA) of the Organization for Economic Cooperation and Development (OECD).
It revealed that in mathematics and science, Filipino 15 year-olds rated 353 points and 357 points, respectively, compared to the OECD average of 489 for both categories. The Philippines ranked second to the last in math and science, and last in reading.
The report based on the 2018 survey said more than 80% of students in the Philippines did not reach a minimum level of proficiency in reading. It called this failure “one of the largest shares of low performers amongst all PISA-participating countries and economies”.
“Fifteen-year-old students in the Philippines scored lower in reading, mathematics, and science than those in most of the countries and economies that participated in PISA 2018”, said the OECD report. “No country scored lower than the Philippines and the Dominican Republic”.
The poor results categorized four in five Filipino students as Level 2, or “low performers,” in the subject. OECD said Level 2 students have a proficiency “too low to enable them to participate effectively and productively in everyday life”.
The Philippines’ score in PISA has been on a steady decline for the past two decades. It dropped by 61 points (from 358 in 2003 to 297) and by 83 points (from 332 in 2003 to 249) in math and science. The PISA survey is held every three years with the last one taking place in 2021.
Another international test rubbed more salt into this wound. Our Grade 4 pupils posted the lowest scores in mathematics and science among the 58 countries involved in a 2019 study by the Trends in International Mathematics and Science Study.
Clearly, myopia is not the major problem besetting Philippine education. Ignorance is.
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| Philippine education is failing our youth |
