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More educated, more short-sighted

Modern education is contributing to the proliferation of poor eyesight among young people, but it can be part of the solution too. An article to commemorate ‘World Sight Day’, observed earlier this month, and to coincide with the World Health Organisations first World Report on Vision.

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By Nick Bradman

When you hear ‘epidemic’, you might imagine hazmat suits and pathogens like Ebola, the Zika virus or Swine Flu. It’s unlikely that you would picture an innocuous exam hall filled with diligent students, their eyes focused fervently—many with the aid of glasses—on the pages before them. It may be surprising then, that researchers for the World Health Organisation (WHO) now recognise such a scene as part of a ‘global epidemic’ of short-sightedness—caused, in part, by today’s more-intense education system.

Short-sightedness, or myopia, occurs when there is an axial elongation of the eyeball. Light entering the eye focuses in front of the retina, instead of directly on it, causing a blurring of distant objects. Mild myopia, while an inconvenience, is fixable with corrective lenses and rarely a cause for concern. A greater worry is where short-sightedness progresses to moderate and, in particular, ‘high myopia’—where anything beyond 16 centimetres (6 inches) appears blurry. These more-severe forms of myopia are closely associated with serious conditions such as cataracts, glaucoma (elevated ocular pressure) and retinal detachments—which can cause irreversible vision loss, or even blindness. For instance, according to the Journal of American Epidemiology, those with moderate-high myopia have a 10-fold increase of suffering retinal detachment compared to those without myopia. The earlier the onset of myopia, the greater the risk it will progress to these more severe levels. That is why obviating the environmental conditions that precipitate myopia in children and young adults, whose eyes are still developing, is an essential safeguard to their vision.

“Nearly a billion [people] will suffer from serious high-myopia. This makes it a looming public health challenge of truly global significance.”

Precisely what those environmental conditions are remains unsettled. A lingering theory is simply that too much close-work is the culprit, spurred on perhaps by the cliché of the bespectacled bookworm. Indeed, to many IB graduates, including myself, this might seem intuitive; the need to squint into the hazy distance following a long exam is a form of ephemeral short-sightedness. However, this is not true myopia, but the overworked ciliary (lens-contracting) muscles remaining in a temporary state of accommodative flex. That said, WHO researchers have suggested that excessive close work associated with downward gaze, and without regular breaks, could gradually exert a biomechanical force of elongation on the eye—eliciting true myopia in the long run.

However, other studies suggest that it is too much time indoors, rather than close work, that is the problem. According to Ian Morgan, of the Australian National University, insufficient time outdoors appears to be a much greater risk factor. Morgan maintains that if a child spends enough time in the open, they could study all they wanted without putting their vision at risk. Morgan theorises that when children get sufficient sunlight, the release of retinal dopamine which this promotes will properly regulate their eye growth. Data backs this theory up. A study comparing children in Australia and Singapore found that the Singaporean children, who spent a quarter as much time outside as their Australian counterparts, had rates of myopia at 27% by age 6—compared to 3% for the Australians.

Whatever the precise mechanism may be, the demand of education that children spend more time indoors doing near-work clearly predisposes them to myopia. Numerous long-term studies have found a close association between short-sightedness and the number of years spent in education. This is also supported by the staggering rise of myopia throughout Asia, especially in those countries that emphasise academic achievement.

“Education can broaden a student’s horizons; it need not make them blurry.”

In South Korea, the rate of myopia in 20-year-olds has jumped from 18% in 1955 to 96% today. Over the last 40 years, rates of short-sightedness among young adults in places like Hong Kong and Singapore have risen from about 10-30% to over 80%. The emphasis on intense academic study in these areas is well known, Singaporean students receive more perfect scores on exams like the IB diploma and rank at the top of performance indicators like the OECD’s Programme for International Student Assessment (PISA). But, the problem remains a global one that isn’t tied just to trends in Asia. Across the United States and Europe, myopia has risen to about 40% in the general population. Globally, about 30% of the people are already short-sighted. By 2050, about 50%, or 4.8 billion, will be myopic. Nearly a billion of these will suffer from serious high-myopia. This makes it a looming public health challenge of truly global significance.

Clearly, education is not the sole culprit here. The advent of technologies like laptops and smartphones are obviously accomplices—whether because they promote further near-work, or they keep people indoors. Nonetheless, education should acknowledge its significant role; and know that although it is part of the problem, it can be an important part of the solution too. Students should be encouraged to take frequent breaks from close work—such as following the 20/20/20 rule (every 20 minutes, look at something 20 feet away, for at least 20 seconds). There could be reminders of the 20/20/20 rule before or during lessons and exams. If inadequate sunlight is the primary cause, then longer breaks outside or classrooms with more natural light, would be salutary changes.

To its credit, the International Baccalaureate, through its holistic approach to education, is already helping to combat the problem. The Creativity, activity, service (CAS) component of the IB diploma and the project component of the Middle-Years Programme (MYP) both ask students to engage with their communities as part of their education—­helping get them outside and away from their desks. Schools and universities should have more vision and follow suit. With more education, more study may be inevitable, but short-sightedness is not. Education can broaden a student’s horizons; it need not make them blurry.

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Nick Bradman is an IB Diploma graduate of Pembroke School in Adelaide, Australia. He is now studying a Bachelor of Laws and a Bachelor of Politics, Philosophy & Economics at the Australian National University. Nick has a particular interest in politics, and is currently working at the Australian Senate in Canberra. You can connect with him on LinkedIn here.

Although Nick is not myopic, an eye injury left him with some vision loss and has made him passionate about taking care of his eye health and encouraging others to do the same.

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