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a kid getting their eyes tested
More time indoors means more kids needing eye tests. (Image: Getty/Tina Tiller)

SocietyApril 15, 2024

Staring down the ‘silent epidemic’ of myopia in children

a kid getting their eyes tested
More time indoors means more kids needing eye tests. (Image: Getty/Tina Tiller)

Shortsightedness in kids is skyrocketing overseas. Is New Zealand next?

“Hey bro, are you blind now?” jokes a student, slapping his friend on the back. “Yeah bro, did you not know I’m blind?” his friend replies. Both are eating cereal in the whānau room of Kia Aroha College, a school focused on Pasifika and Māori learning environments in Manukau, Auckland, waiting for their glasses frames to be fitted.

Declarations of blindness, a little hyperbolic, are to be expected: the University of Auckland’s Vision Bus is parked at Kia Aroha’s campus for the week. After a screening process run across South Auckland by the university’s optometry students, the bus, decorated with rainbow eye logos, comes to schools to do in-depth checks on children who need it. 

Inside, the bus is tidy, slightly sterile smelling, and packed with what optometrists Germaine Joblin and Sachi Rathod assure me is top-of-the-line technology. “This is like the Rolls Royce of clinics, some of the stuff is better than what I see in private practice,” Joblin says. There’s space for two people to have their eyes tested, two final-year optometry students getting on-the-job experience, and two optometrists, but barely enough room for an observing journalist: I have to scoot out of the way as Rathod unfolds a vision chart. 

three women wearing blue tones outside a coloursful bus. Sachi, on the levt is short, with light brown skin, tightly curling hair and a big smile; Sila, in the middle is a pacific woman with straight hair tied back and rectangular glasses. Germaine, on the right, is a lebanese woman with no glasses and a friendly smile
Sachi Rathod, Telusila Vea, and Germaine Joblin (l-r) are stationed on the bus at every school it goes to. (Image: Shanti Mathias)

The needs are definitely high in the low-decile schools in south and east Auckland that the Vision Bus frequents, but Joblin points out that “myopia doesn’t discriminate”. Another word for short sightedness, myopia is one of the most common health issues in the world, and the main reason kids need glasses. Once thought to be entirely due to genetics, more recent research is showing that increases in time spent indoors is a cause of myopia, which can be particularly severe in kids, whose eyes are still growing. 

In eastern Asia, the myopia statistics are dire. As many as 90% of urban teenagers in Korea are shortsighted, about 65% of children in Singapore are myopic by the end of primary school and Chinese officials say that more than 50% of children in the world’s second-most populous country are short sighted. The numbers aren’t that severe in New Zealand yet, but with three years of pandemic learning and more time spent inside, it might be only a matter of time.

Results from the Vision Bus and optometrists across the country are clear: though many of the solutions are known, we’re not doing enough to protect children’s eyes and stop them from becoming short-sighted in the first place.

“I diagnose one child a day with myopia, or as many as three – we see it all the time,” says May Young, an optometrist who works for Specsavers in Rangiora, north of Christchurch. Rathod and Joblin have seen it too. “We call it ‘the silent epidemic’,” Joblin says, stage-whispering.

When the tests are done in the Vision Bus, students get to choose what kind of glasses frames they want before heading back to class. The glasses arrive a few weeks later, and community teams will check in throughout the year to make sure the glasses are being worn. If there are other eye issues, kids are referred to the university’s optometry department or given a hospital referral. Funded by philanthropy, the service is entirely free, and extremely in demand. 

“We’re scheduled until the end of the year,” says Telusila Vea, another key member of the Vision Bus team. Warm and efficient, she’s set up on a desk in the whānau room, in charge of organising consent forms, checking off names, and communicating with the school principal. She’s about to embark on a PhD looking at how parents respond to the Vision Bus, and particularly appreciates that working on the bus helps her connect needed healthcare to her Pasifika community.

May Young, an Asian woman in a specsavers store, wearing green an blue and smiling at the camera
May Young treats lots of families whose kids are short-sighted at the Rangiora Specsavers (Image: supplied)

Eye testing can make a huge difference to how engaged kids are, which can create learning issues that snowball if vision trouble isn’t picked up early. “The majority of kids we see require glasses,” Vea says. “We talk to teachers and they say, ‘this kid always wants to sit at the front’ or ‘that kid always sits at the back and doesn’t participate, doesn’t engage,’ but it’s because they can’t see anything.” 

It’s not clear how much child myopia has increased in New Zealand, because there’s no national data specifically gathered about eye issues at all ages. “To get the evidence, we’d need a national programme over time – for at least ten years,” says John Phillips, a senior lecturer in optometry and vision science at the University of Auckland. “Because it’s a big deal in China, Taiwan, Singapore, they’ve tracked it, but we haven’t here.” School screening data helps, as kid have their vision checked before starting school, but it is still difficult to tell if short-sightedness starts at age seven or 18 or somewhere in between.

With colleagues, he’s tried to make an estimate based on the number of people with mandatory glasses in their driving licence, which has stayed about the same, just over 20%, since 2000. He’s the first to point out that this method, however, has flaws: it doesn’t pick up people under the age of 25, or those without drivers licences. 

But why has myopia increased so much overseas? Phillips says that in many east and south east Asian cities, myopia prevalence went from five to 10% in the 1950s to more than 80% today, far more than can be explained by genetics. Instead, the change comes from dramatically different lifestyles: from spending lots of time outdoors, living rurally, to spending lots of time indoors, reading and looking at things a maximum of a few metres away, and living in densely packed apartments.

Trend data from meta-research in 2016, incorporating 145 studies with 2.1 million participants, estimated that by 2050, nearly 50% of the world’s population could be myopic. 

Sachi Rathod, a short woman with big bounchy curls, talks to students in uniforms in a school environment with their backs to the camera
Sachi Rathod chats to students waiting for their glasses frames to be fitted (Image: Shanti Mathias)

With more New Zealanders living in cities, and kids spending as much as a third of their free time on screens, there are good reasons to think that the increasing myopia seen elsewhere could be seen here. “I ask the kiddos who come in here what they do after school and they say, ‘I go home and game’ or ‘I go home and TikTok’,” Rathod says. “I sometimes see kids as young as two playing on phones and it horrifies me,” Joblin agrees. “I’m so big on sport for kids: if you’re not outside, your eyes can’t focus far away.” 

While the exact mechanism is complex, rising myopia isn’t simply caused by staring into the illuminated rectangles of screens all day; it seems that something about the wavelength, amount and variability of natural light outside – the conditions human eyes were historically adapted to – is where our eyes function best. It applies to animals, too: Phillips says keeping animals indoors has been shown to cause myopia in them; more evidence that the same applies to people. 

The fear that reading in dim light can make you go blind might seem like a plot point in a Victorian novel, but contemporary research has shown that it’s entirely legitimate. “People could put [myopia increases] down to too much screen use, but it has been happening for decades,” Phillips says. “It’s not the screen as such, but spending more time indoors.” Screens are simply one of the most compelling reasons to stay inside, no matter how old you are. 

Germaine joblin uses an eye machine that puts different lenses in front of kids eyes while a younger optometry student looks on
Germaine Joblin discusses the results of an eye test with an optometry student (Image: Shanti Mathias)

Rising myopia rates might not seem like a crisis: in terms of long-term health conditions, myopia is a particularly treatable one. Glasses at the right prescription solve the problem for most people, without the need for ongoing medication and its attendant side effects, only the hassle of remembering to stick the frames to your face. 

But for children, whose eyeballs are growing with the rest of their bodies, sight issues can quickly worsen. Phillips says that optometrists often see the same patients coming back throughout their teenage years, their prescription getting more serious as their eyes grow. 

“If my son had myopia, I would attack it from all angles,” Joblin says. “I would refer him to an eye specialist, get the eye drops and myopia control spectacles – those are quite specialised so they cost twice as much.” Many of these treatment options are newer, and Joblin has only been able to prescribe them in the last few years.

Just because myopia is treatable, doesn’t mean it’s not serious. Phillips explains how the mechanism that creates myopia stretches the internal tissues of the eyes, meaning people with myopia are more likely to get cataracts, glaucoma or myopic maculopathy, which require much more intense treatment and can cause potentially permanent damage.

“I can’t go bungee jumping at all, because there’s a risk of my retina detaching,” says Rathod, who was initially drawn to optometry because of the care she received as an extremely short-sighted kid. She now wears round, wire-framed glasses and beams at kids as they enter the bus, making sure they receive care like she did. 

It’s best, then, to treat myopia as soon as it’s detected. Joblin has compassion for parents who don’t know what to do with a child who has eye issues; her mother was in the same position. “Growing up in a working-class neighbourhood in Sydney, my mum couldn’t afford glasses,” she says. “In my Lebanese family, it wasn’t seen as normal – she thought, ‘You have one good eye, so you’ll be sweet!’” 

a woman with a blue shirt looking through a pair of glasses into someone's eye
Rathod working on the Vision Bus – it’s entirely funded by philanthropy, and is the only mobile eye clinic in Aotearoa (Image: Shanti Mathias)

Because short-sightedness isn’t painful, people often aren’t aware of how much it affects them. “Kids can’t compare themselves to how others see,” Rathod says. She pulls out an eye chart, the letters in rows of gradually descending sizes. “They come in here and say their eyes are fine, but they can’t see these letters – they’ve just been squinting through it.” She points to one of the top lines of the chart, several rows above the line for driving tests. 

In the Vision Bus, consistently absent students are an ongoing concern. It’s rare that all the names on the list will be present when the bus comes to a school. The week I visit is just after Polyfest, and Vea notes that lots of students have been away, resting after the high-intensity event. There are also kids who might have been absent the first time the school screening showed up, and others who can’t get the consent forms the team needs to give them eye drops and check their retina.

The need for eyecare goes far beyond schools: the Vision Bus has done some work with marae and refugees, but frequently gets requests to visit communities with no optometrists. The organisation simply doesn’t have capacity to do this. 

Beyond the bus, one of the most obvious barriers to eyecare is the way it’s delivered. There’s clearly enough demand that a standard mall or high street can host three or four eyecare chains, but unlike most other forms of healthcare in New Zealand, the majority of eye health check-ups are delivered through companies with profit margins to meet. “They have to meet their overheads – they’re in malls, there’s high rent,” Joblin says.

This commercial model can damage trust. “There’s an expectation that you’ll go to a Specsavers and be upsold,” Rathod says.

spectacles focused on an eye test
Glasses are a simple solution to shortsightedness, but it’s even better not to need them in the first place. (Image: Getty)

Young, the Specsavers optometrist from Rangiora, notes that there are heaps of subsidies available for families to take advantage of. Kids get free eye tests and discounted glasses, and families with Community Services Cards can have their glasses further subsidised, and usually covered entirely. But more advanced treatments, like the soft contacts or eyedrops that can help arrest myopia progression, come at a cost. “Often, those costs do fall on parents,” she acknowledges. 

While myopia treatment has advanced, it’s even better if short-sightedness doesn’t occur in the first place. Optometrists agree about what can be done to protect children’s vision, so it doesn’t get to the point where they need to go in for tests at all. “The best preventative thing is to have at least two hours a day outside,” Young says. She encourages parents to let their kids scooter everywhere, or leap on the trampoline.

Joblin recommends the “20/20” rule: every 20 minutes, focus your eyes on something at least 20 feet (six metres) away for 20 seconds, so the muscles focusing your eyes can relax.

At the system level, too, there are options. At some schools in Singapore and Taiwan, children are regularly hustled outside to play several times a day, no matter the weather, and it’s making a difference. Of course, these changes were only implemented after more than half the kids in these countries developed myopia. It doesn’t need to be that way in New Zealand. 

I talk to Winter, a year-seven student who just had her eyes assessed. She knows that seeing has been difficult for a while: in class, she has to sit close to the board, otherwise it’s blurry, and when she’s reading a book, she needs to put it right in front of her face. “They took a photo of the back of my eye and it was freaky, like a pool or a bad dream,” she says, making a face. The photo is projected behind her for the optometry students to look at: grey and full of wobbly lines, showing the blood vessels in her retina. 

After school, Winter likes drawing and reading books full of action and excitement. Inside activities. She’s about to look at glasses frames, opting for black (“nice and plain and neutral”), which will help her see the board in class and the words in the books she loves. But maybe the best thing for her eyes is what happens next: the morning tea bell rings, and Winter and the rest of her classmates run outside to play. 

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