Personal Experience and Global Statistics

• Speaker's vision deteriorated during childhood - unable to see clearly beyond 10 inches
• Got glasses to correct blurry distance vision
• Myopia (nearsightedness) called an "epidemic" by researchers

Rising Myopia Rates Worldwide

• US rates: 25% myopic in 1971 → 42% by 2004
• Projection: 50% of world population myopic by 2050
• Highest rates in East/Southeast Asia:
  • Hong Kong, Singapore, Taiwan, South Korea already exceed global projections
  • Growing portion have high myopia (prescription stronger than -5)
  • High myopia puts people at risk of sight loss

Genetics vs Environment

• Genetics partially responsible:
  • One myopic parent doubles odds of nearsightedness
  • Two myopic parents increase odds five-fold
• Human genetics don't change rapidly enough to explain epidemic
• Environmental factors driving rapid increase in myopia rates

Eye Anatomy and Myopia Development

• Most people born with eyes too short (hyperopic/farsighted)
• Normal development: eyes grow to spherical shape for clear vision
• Myopia occurs when eyeballs grow too long
  • Eye shape changes from basketball to rugby ball (Dr. Chiang Mai Saw, Singapore)
  • Lens focuses distance images in front of retina instead of on it
• Myopia is lifelong - doesn't regress once developed

Key Risk Factors

Near Work

• Time spent looking at things up close
• Eye muscles strain to focus on close objects
• Theory: eyes grow longer to reduce strain
• Evidence on this explanation is mixed

Indoor Time/Light Exposure

• Stronger evidence for this factor
• Bright outdoor light stimulates dopamine production in retina
• Dopamine regulates eye growth - without enough, eye doesn't know when to stop growing
• Light intensity comparison:
  • Sunny day outdoors: up to 100,000 lux
  • Indoor room: only 200-300 lux
• Modern lifestyle combines too little daylight + too much close work

Regional Patterns - East/Southeast Asia

• Children not spending enough time outside
• Contributing factors:
  • Competitive education systems
  • Increased homework loads
  • Tuition centers
  • More time reading and writing

Long-term Health Consequences

• Beyond inconvenience of glasses/contacts
• Professor Mark Bullimore (University of Houston Optometry):
  • Born with finite amount of eyeball tissue
  • Excessive elongation stresses eye structures
  • Retina stretches, starts to break and peel off "like old paint"
• Linear relationship between myopia amount and vision risks
• Higher risk conditions:
  • Myopic macular degeneration
  • Retinal detachment
  • Glaucoma
  • Cataracts
• Paradigm shift: myopia now viewed as disease, not just optical defect
• Earlier onset = more serious progression and greater risk

Treatment Options for Existing Myopia

Multifocal Contacts and Glasses

• Make peripheral vision intentionally blurry
• Appears to slow myopia progression

Orthokeratology (Ortho-K)

• Hard contact lenses worn only at night
• Reshape cornea during sleep
• Enable distance vision during day

Atropine Eye Drops

• Low doses temporarily paralyze focusing muscles
• Seems to reduce myopia development

Prevention Strategies

• First line of defense: prevention over treatment
• Simplest/most effective: get kids outside more

Successful Government Programs

Taiwan (2010)

• Nationwide program encouraging schools
• Goal: 2 hours outside daily for students
• Successfully reversed 40-year increase in myopia rates

Singapore (since 2001)

• Funded public education promoting outdoor time
• Annual vision screenings at schools
• Program appears to be working

Future Outlook

• Current high rates will continue only if no changes made
• Better position than ever to implement change