Fighting Myopia: How to Protect Our Eyes

When I was growing up, something changed with my eyesight. Over time, I gradually lost the ability to see things clearly beyond a short distance—about 10 inches from my face. Everything beyond that point became blurry. To correct this, I eventually got glasses. With them, my world changed from a fuzzy blur to sharp clarity.

As frustrating as my experience has been, it’s actually more common now than ever before. This condition is called myopia, or nearsightedness, which means needing glasses to see things that are far away. Myopia rates have been rising steadily over the years. For instance, in 1971, only 25% of people in the U.S. were nearsighted. But by 2004, that number had jumped to 42%. If this trend continues, it’s estimated that half of the world’s population will be nearsighted by 2050. In places like Hong Kong, Singapore, Taiwan, and South Korea, the rates are already much higher. A growing number of people in these regions also suffer from high myopia, which the World Health Organization (WHO) defines as needing a prescription stronger than -5. High myopia increases the risk of severe vision problems, including the possibility of blindness.

For a long time, scientists believed that nearsightedness was mostly due to genetics. It’s true that if you have one nearsighted parent, your chances of being nearsighted double. If both parents are nearsighted, the odds increase fivefold. However, human genetics haven’t changed quickly enough to explain the recent spike in myopia cases. This rapid increase suggests that environmental factors, rather than genetics alone, are driving this trend. Something about our modern way of life is making it harder for people to see clearly at a distance.

So, what’s causing this? Most people are born with eyes that are slightly too short from front to back, which causes farsightedness—blurry vision up close but clear vision at a distance. As we grow, our eyes normally lengthen to become more spherical, which allows for clear vision. However, in some cases, the eyes keep growing longer, leading to myopia. In myopic eyes, light focuses in front of the retina instead of directly on it, causing distant objects to appear blurry.

Dr. Seang Mei Saw, a myopia expert and physician in Singapore, explains that once you become nearsighted, it’s a lifelong condition—it doesn’t improve on its own. Researchers believe that the way we live during childhood and adolescence, the period when our eyes grow the fastest, plays a crucial role in the development of myopia. Two major factors are at play: the amount of time we spend focusing on things up close (like reading or using screens) and the amount of time we spend indoors.

When we look at things up close, the muscles in our eyes have to work harder to focus the image onto the retina. Some experts think that if children’s eyes are constantly straining to see things up close, their eyes might grow longer to ease the strain, leading to myopia. However, the stronger evidence points to a lack of time spent outdoors. Bright outdoor light triggers the production of dopamine in the retina, which helps regulate eye growth. Without enough dopamine, the eyes might continue to grow longer than they should. Indoor lighting is much dimmer than sunlight, making it difficult to get enough dopamine indoors.

In many parts of East and Southeast Asia, children spend very little time outdoors, partly because the education systems are highly competitive. Kids spend a lot of time studying, attending extra classes, and doing homework, which keeps them indoors and focused on close-up tasks.

Needing glasses or contact lenses for the rest of your life is inconvenient, but the long-term effects of an elongated eyeball can be serious. Mark Bullimore, a professor of optometry at the University of Houston, explains that the eyeball has a limited amount of tissue to support its structure. When the eye grows too long, this tissue gets stretched, which can cause damage. The retina, the light-sensitive layer at the back of the eye, can start to break or even detach, leading to serious vision problems like myopic macular degeneration, retinal detachment, glaucoma, and cataracts.

There’s a nearly direct link between the degree of myopia and the risk of these eye disorders later in life. We used to think of myopia as just a vision problem, but now we understand it as a disease. The earlier a child develops myopia, the worse it can become, and the greater the risk of severe eye conditions. This makes early intervention crucial.

So, what can be done? For those who are already developing myopia, there are treatments available. These include multifocal soft contact lenses and glasses that intentionally make peripheral vision blurry, which seems to slow down the progression of myopia. Another option is orthokeratology (ortho-k) lenses, which are hard contact lenses worn only at night. They reshape the cornea while the wearer sleeps, allowing them to see clearly during the day. Additionally, low doses of atropine eye drops, which temporarily paralyze the eye’s focusing muscles, have been shown to slow down myopia development.

However, the best way to prevent myopia is simple: spend more time outside. In 2010, Taiwan introduced a nationwide program encouraging students to spend two hours outdoors every day. This initiative has successfully reversed a 40-year increase in myopia rates. Since 2001, Singapore has also promoted outdoor activities and conducted annual vision screenings in schools, which has helped to control the rise in myopia.

While myopia rates are higher than ever, we have the tools to make a change. The future doesn’t have to be blurry—we can improve it by changing how we live and how much time we spend outdoors.