My ten-year-old son, Jason, struggled to correctly identify the letters on the exam chart at the eye doctor’s office. I was concerned: Was the lighting in the exam room insufficient? Did my son not have a good understanding of the alphabet? It was evident that Jason had poor eyesight and would likely require glasses in the near future. “There has been a significant increase in myopia among children,” the eye doctor informed us, “especially since the beginning of the pandemic.” The doctor’s diagnosis of screens as the culprit hit me hard. We reluctantly gave in to allowing screens during the pandemic. Are my son’s eyeballs permanently damaged from those endless staring contests with PBS Kids?
Myopia is a peculiar elongated growth pattern of the eyeball that typically starts in childhood and is believed to be influenced by both genetics and the environment. At times, the condition can cause significant harm in the future. Myopia is linked to increased rates of glaucoma, cataracts, retinal tears, and macular degeneration. These diseases have the potential to cause complete vision loss. Those risks seem to be much more significant for individuals whose childhood diagnosis develops into severe or “high” myopia. By 2050, it is estimated that approximately one billion people, which is nearly 10 percent of the world’s population, will be affected by high myopia. However, for the majority of children, myopia only results in nearsightedness and a lifelong dependence on glasses or other forms of vision correction.
In children with myopia, vision typically stabilises by age 20, but there are ongoing risks of developing blinding eye diseases throughout one’s life. The increase in myopia rates predates the widespread use of smart devices. According to one study, there was a significant increase in the percentage from the early 1970s to the turn of the millennium in the U.S. It is projected that by 2050, approximately half of the global population will experience nearsightedness. In certain parts of the world, the prevalence of myopia has already reached alarming levels. In fact, in certain East Asian countries, the rates of myopia have skyrocketed to an astonishing 80 to 90 percent. According to various studies, there has been a noticeable increase in myopia rates among children during the COVID-19 pandemic.
Although it has been suggested that increased screen time may be to blame, the majority of studies did not specifically examine screen time during lockdowns. Despite the widespread use of smartphones, with 84 percent of teenagers in the U.S. owning one, according to a 2019 study, experts still have uncertainties about the impact they have on our eyes. Reading, particularly close-up activities, has been linked to nearsightedness for quite some time. However, it remains uncertain whether extensive reading directly leads to myopia or if individuals with poor distance vision are naturally drawn to books. “It’s a bit of a chicken and egg situation,” explains Mark Rosenfield, a professor at the State University of New York College of Optometry. “What came first?” Is it the myopia or the reading? Rosenfield suggests that screens can lead to eye strain and potentially contribute to myopia.
However, he also points out that factors such as spending prolonged periods in dimly lit indoor environments may also play a role in this issue. “But obviously, it could be a mix of the two,” he says. He also mentions that stress could potentially be a factor. The field of myopia management has been rapidly expanding globally, with many countries providing patients with a wider range of treatment options compared to the United States, where approvals are slower to come. There are a couple of options for myopia control tools, such as orthokeratology, also known as “ortho-k,” which involves wearing a rigid lens at night, and atropine, which is an eye drop. Atropine has a long history in the treatment of myopia, dating back to 1868. However, it lost popularity due to its troublesome side effects.
Fortunately, in recent years, lower doses of atropine have been found to be more tolerable and are widely used in East Asia. However, recent trials conducted by the Food and Drug Administration have determined that the substance is not effective in treating myopia. (This raised concerns among optometrists, who expressed doubts about the trial’s methodology.) Myopia-control glasses are used in other countries as a kid-friendly treatment alternative to contacts. However, these glasses have not yet been approved for use in the U.S. There is a new treatment gaining popularity in the U.S. that involves the use of specialised contact lenses to manage myopia.
Dr. Chari Vizconde carefully removes the foil from a package containing a single contact lens at a New England College of Optometry clinic in Brookline, Massachusetts, and retrieves the thin, transparent piece of plastic. She examines the MiSight myopia control lens closely, holding it up to the light. It appears to be slightly smaller than a regular adult contact lens, but the impact of these lenses and similar technology on her conversations with families is significant. Our myopia control daily lenses are specifically designed to not only correct vision but also to slow down the progression of unusual growth, thereby preventing severe myopia and other associated risks. “It’s truly heartwarming to be able to bring hope to these children,” Vera-Diaz expresses. “There’s no doubt that we have the ability to take action now, which wasn’t the case 15 years ago.” In the U.S., insurance can be a major barrier when it comes to accessing innovative treatments such as myopia-arresting lenses, as well as quality myopia care in general.
It’s absolutely ridiculous that most health insurance plans for U.S. adults don’t include vision care. They expect you to pay extra for this essential coverage, as if it’s some kind of optional luxury. Even for children, insurance companies often consider myopia treatment experimental, leading to either no coverage or high out-of-pocket costs. According to Sandra Block, president of the World Council of Optometry, a significant number of optometrists refuse to accept Medicaid because of its low payments. This poses additional challenges for low-income families.
Despite the unfortunate reality that insurance policies and other obstacles often prevent families from accessing myopia treatments for their children, scientists have identified a more accessible and highly effective strategy for halting the progression of the disease: I’m stepping outside. Researchers have yet to fully understand the impact of sunlight and open spaces on the eyes, but they do agree that spending time outdoors can help prevent myopia. “Sunlight exposure is absolutely crucial,” Rosenfield emphasises. I strongly urge parents to prioritise getting their children outdoors and engaging in outdoor play. It’s a win-win situation.
