An optometrist checks the eyesight of a boy in Shanxi Eye Hospital on June 5. The hospital's Optometric Department receives nearly 300 outpatients daily, 70 percent of whom are children under 16 (XINHUA) 

As a toddler, Beijing boy Xiaoming was curious about his mother's spectacles. From time to time, he would grab them from his mother and try them on himself. He had fun wearing them, while the sight of the huge, thick glasses upon his small, innocent face also made his mother laugh.

Now, at the tender age of 7, Xiaoming has a pair of glasses himself to correct his nearsightedness. Understandably, he was not so enthusiastic about wearing these, and for his mother, it was not so funny either.

He was diagnosed with myopia at the age of 6 during a regular health checkup. Reading the medical report, his mother could hardly believe how far his eyesight had deteriorated in just a couple of months. Further examination by an optometrist ruled out pseudo myopia, and Xiaoming officially became one of the many nearsighted people in the country.

Prevalent impairment 

In China, one out of three people above the age of 5 suffers from myopia, according to the National Visual Health white paper released in June 2016 by the China Health Development Research Center at Peking University.

The white paper showed that in 2012, around 450 million people in China above the age of 5 suffered from various visual impairments. Of these, approximately 90 percent were nearsighted. Additionally, the number of Chinese with high myopia is around 30 million, more than 2 percent of the total population.

The report predicted that without effective policy intervention, by 2020, the prevalence of myopia in people over 5 will rise to just over half the population.

The project was led by Li Ling, Director of the China Health Development Research Center. She said that China is confronted with a visual health crisis more severe than that of any Western country. On the one hand, the high prevalence of myopia among adolescents will have a significant impact on the country's social and economic development and even national security; on the other hand, against the background of an aging population, the earlier onset of various eye diseases related to old age will further burden individuals and society.

The white paper revealed that myopia exists among 35 percent of primary school children in China, while the rate surges to an alarming 90 percent among university students.

In Beijing, 59.2 percent of primary and middle school students were shortsighted during the 2014-15 academic year, according to the white paper.

Myopia now begins at a younger age. Previously, most children became nearsighted during, or after, their junior middle school years, while nowadays, an increasing number of primary students are nearsighted, said Zhou Xingtao, an eye doctor with the Eye and ENT Hospital of Fudan University. He spoke from his clinical observations.

The causes 

Zhou attributed the current high incidence of myopia in children to the amount of time spent indoors. "Now, many children are growing up in artificially lit indoor environments. Research indicates that daily outdoor activities, even if this is just walking rather than playing sports, for two to three hours, help to prevent myopia," he said.

During indoor activities such as reading, drawing, playing the piano, watching TV or using a cellphone, children are using their eyes to look at very close objects, with their eye muscles locked in a state of fixation. Prolonged focus leads to the elongation of the eye and results in myopia, he explained.

Metropolitan Express, a newspaper based in Hangzhou, Zhejiang Province, once reported a case of a boy becoming shortsighted after years of piano practice.

The boy started playing piano at the age of 3, and passed the level-10 exam for amateur players at the age of 8. But not long after the exam, he complained that he had sore eyes and blurry sight.

His mother took him to the Hangzhou branch of Zhejiang Eye Hospital, and a doctor diagnosed him as having 200-degree myopia, which is likely to worsen over time.

The mother said neither parent was nearsighted and that the boy played piano for five hours on average every day. At the hospital, Doctor Chen explained that the boy's myopia was caused by bad habits in the way he used his eyes to read musical scores. He said that most of the piano-playing young children he knew were myopic, usually developing the problem three years after starting to play the instrument. He advised children to not begin learning the piano until the age of 6.

Zhou cautioned about the use of electronic products, such as iPads, among young children. He said that there is a view that electronic products, with their bright and flashing screens, are more harmful for one's eyesight than books.

A post on Weibo.com, a popular Chinese micro-blogging service, alleged that iPads were the biggest eyesight killers for children. It revealed that a 4-year-old, who often used an iPad, was diagnosed with 200-degree myopia, and a third-grade primary school student's vision dropped from 20/20 to 20/40 after using an iPad intensively during a month-long winter vacation. The post drew widespread attention to the threat electronic products pose to a child's vision.

Zhou said that although it is impossible for children to completely shun such activities nowadays, they should try to use their eyes sparingly, taking breaks, if possible outdoors, every 15 to 20 minutes.

"Except for excessive eye use, one severe type of myopia, known as pathological myopia, can be hereditary," Zhou said.

High myopia refers to nearsightedness of more than 600 degrees, and those inflicted are more likely to suffer from eye diseases such as retinal detachment, cataracts and even blindness later in life, he said. A child with a highly myopic parent has a higher probability of getting high myopia.

Gong Yueqiu, head of the Ophthal-mology Department of the Capital Institute of Pediatrics in Beijing, advises children to maintain good eye habits to prevent myopia. She said children should read in well-lit places and keep their eyes at the right distance from books, engage in more outdoor activities, do eye exercises correctly, and refrain from watching TV, computers and cell phones for long periods of time. She also suggests children should have a balanced diet, by eating less sweets and more vegetables, dairy products and eggs.

Children must go to hospital to check whether they have true or pseudo myopia, Gong said. If diagnosed with true myopia, their condition cannot be reversed, so there is no need to squander money on therapies or instruments that allegedly cure this, she cautioned. Instead, she suggested that children should have glasses prescribed which will relieve eye fatigue.

The cost 

After Xiaoming's myopia was confirmed by the doctor, his mother ordered a pair of glasses from a street-corner optician for about 500 yuan ($76). The prices of glasses vary greatly by brand, lens quality, frame style, etc. His mother's friend paid more than $153 for her son's spectacles, and her neighbor bought a pair of orthokeratology lenses, also known as OK lenses, for her daughter for $1,000.

The National Visual Health white paper revealed that in 2012, roughly half of the people, above the age of 5 with myopia were wearing glasses. The report estimated that every year, just over 100 million pairs of glasses are prescribed, with the cost of each averaging around 500 yuan.

The cost of myopia is much more than just a pair of glasses. For instance, myopia disqualifies people from certain professions and may lead to other complications. The white paper stated that in 2012, various types of visual impairment incurred a total social and economic cost of more than 680 billion yuan ($100 billion), or 1.3 percent of the GDP in that year. Taking into account the impact on life quality, the cost was 1.83 percent of that year's GDP, the white paper estimated.

Given the cost of visual impairment, Li suggests that China's current policy on preventing and treating blindness should be shifted toward caring about the visual health of the general public. She said that public awareness campaigns and medical services related to visual health should be improved.

Copyedited by Dominic James Madar

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