India needs to keep an eye on its myopia prevalence

Context: Millions of young children are growing up short-sighted every year because of myopia. While East Asia and the Pacific have been reporting some of the highest numbers for a decade now, current estimates out of India do not yet reflect this trend.

It may mean India has time to act and save the sight of its children.

Prevalence of Myopia in children

Myopia is commonly found in children.

As they grow and their bodies change, the length of the eyeball and its power to refract light do not always align, leading to vision that is blurry.

A pair of spectacles is enough to correct this mismatch. However, spectacles address the symptom and not the cause (eyeball length), so myopia can progress all through childhood.

Progressive myopia, after a point, leads to ‘high’ myopia, increasing the risk of retinal detachment, glaucoma or macular degeneration that can cause permanent vision loss.

What are the reasons behind Myopia in children?

Many children, especially in urban environments, are spending more time indoors and on near-work. Be it at school or at home, the quantum of near-work — looking at books, television, phones or laptops — has increased over the decades. The COVID-19 pandemic has only accelerated this trend by robbing children of outdoor playtime and exposure to sunlight.

This big shift to near-work seems to be triggering an increase in myopia prevalence.

Is Myopia turning out to be an epidemic?

Global estimates

The WHO is warning of a global myopia epidemic, where millions of children are at risk of vision impairment. Projections show nearly 50% of the world’s population will be myopic by 2050.

There were nearly two billion people with myopia in 2010 — a quarter of the human population.

Data from the East Asian countries have been particularly alarming. Even before the novel coronavirus pandemic, 80%-90% of high school children in East and Southeast Asia were presenting with myopia. Nearly 20% of them had high myopia.

India

Current studies in India are recording low myopia prevalence among schoolchildren when compared to East Asia.  In a large study that surveyed 1.2 million schoolchildren in Telangana and parts of Andhra Pradesh, experts found myopia prevalence of a little over 5%.

Even including those already with glasses, the prevalence numbers are low.

Why Myopia prevalence is still low in India?

Majority of children still live in rural areas: As urbanisation increases, so does the burden of myopia. Myopia can be twice as high among urban children when compared to rural ones. One study found a higher prevalence among South Asian children in the United Kingdom compared to those living in rural India.

And, despite a demographic shift towards cities and towns, nearly 65% of India’s population still lives in rural areas. Hence, Myopia prevalence is still low in children in India.

But, as urbanisation increases in the future, so will the Myopia prevalence.

For instance: Prediction models are pointing to a myopia prevalence of nearly 50% in India too by 2050 — similar to global projections.

What steps can be taken?

Treatment strategies to constrain myopic progression include pharmaceuticals and speciality spectacles or contact lens.

But like all public health issues, prevention strategies are far more inexpensive and cost-effective. For instance:

– Encourage parents to take children out to parks and other outdoor spaces regularly.

Schools must ensure adequate exposure to sunlight. Educational methodologies are needed at every school level that balance near-work with distance-work.

Make it easy to screen and provide spectacles for the many who will need them. Basic, annual screening can be performed by schoolteachers, who can then refer myopic children to eye-care professionals.

Tackling the social stigma around spectacle wear with tact and compassion.

It is critical that we step up surveillance for myopia so that India is not caught unawares by a runaway epidemic that will destroy its children’s vision.

Source: This post is based on the article “India needs to keep an eye on its myopia prevalence” published in The Hindu on 23rd May 22.

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