MYOPIA

The new normal in Nepal’s schools are spectacled faces, as a silent epidemic of myopia or nearsightedness spreads among mainly urban youngsters.

Over one million children under 16 have an uncorrected refractive error, according to the Nepal Blindness Survey done 12 years ago. Experts say the numbers have increased vastly, and the main factor is screen time. People with myopia have blurry distance vision so that while close objects appear crisp, corrective lenses are needed to focus on distant objects.

Explains Rohit Saiju, an ophthalmologist at Drishti Eye Center: “In myopia, the eyeball grows too long, causing distant light to be focused in front of instead of on the retina, the light-sensitive region of the eye.”

Initially, it was believed that the condition was purely hereditary, but the global increase in myopia was too rapid, leading to the conclusion that there were environmental factors involved. 

While children whose parents are both shortsighted are most likely to develop myopia, lifestyle and behaviour can be equally, if not more important.  

“How much time is spent staring at screens indoors instead of enjoying activities outdoors is a key determinant,” says Saiju.

The World Health Organization (WHO) has projected that by 2050, shortsightedness will affect half of the world population. A large portion of this newly bespectacled demographic will be in Asia, over half of whom are already myopic today.

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“This may be because of the societal factors that children in Asia are exposed to,” says Srijana Adhikari of the Department of Paediatric Ophthalmology at Tilganga. “High academic pressure is the leading concern because extended school time, private tutoring and after school classes force children to keep their noses in their books or screens for long hours.”

Outdoor activity is important not just because it provides a break from too much closed-in work, but also because it offers exposure to sunlight. Natural light helps release dopamine in the retina, which controls the elongation of the eyeball during child growth. 

“Too little daylight exposure, and the eye grows myopic, which is why it is so important for children to grow outdoors,” says Saiju.

That may be easier said than done. Pramila Sapkota, 40, encourages her 13-year-old son to play at Narayan Chaur Park in Naxal every Saturday afternoon but she has to be ever cautious.

“It’s no longer like the old days, most public spaces today are unsafe,” she says. “As a parent it isn’t easy for me to simply tell him to go outside unsupervised even though he is a teenager.”

Kathmandu is bursting at the seams and does not have enough clean, open spaces. Residents, and especially children are paying the price of haphazard urbanisation with their lungs, ears, and now even their eyes.

One parent, Sachita Rai, whose 10-year-old daughter wears glasses of -3.50 diopters, says her eye power shot up after months of Covid-induced confinement.

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“She used to attend online classes on my phone, staring at the small screen for hours,” Rai recalls. “The very first day of school after the lockdown, she complained about not being able to see the whiteboard properly.”

Indeed, experts confirm that the Covid pandemic expedited the spread of myopia among young people. “I have witnessed this in my own practice,” says Adhikari. “In the months after the lockdown, the out-patient department at Tilganga was overwhelmed with children needing new prescription glasses.”

While myopia is often said to be an affliction of city-dwellers, the pandemic lockdowns led to a surge even in rural areas. Children who did not have access to phones and laptops got the devices for online study. Even in Karnali Province, the proportion of students aged 3-24 using mobile phones is 92% — and that is the lowest among all provinces.

Research in far-western Nepal also shows that only half the public school children, who likely start school later and have a less of an academic burden, are myopic compared to students of the same age enrolled in private schools. 

Myopia is lowest in the 8.7% of school-age children who are not attending formal schools in Nepal. A 2023 study in the Madhes Province, which has the highest number of out-of-school children, found myopia in only 3.1% of children. That number was 9.4% in Kathmandu Valley that year. 

Experts say that while there is not much that can be done to actively reduce myopia, slowing its progression is possible. Vision screening should begin at age 3-4 when children start pre-school. Regular eye checkups are necessary because children that young cannot voice problems with eyesight. 

“Many cases of myopia progress in children because parents are too late to catch symptoms,” Adhikari tells us. “This is not just a matter of children requiring glasses. It is a public health concern that must be recognised and addressed.”  

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