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Massive rise in Asian eye damage

By Matt McGrath Science reporter, BBC World Service

Up to 90% of school leavers in major Asian cities are suffering from myopia -

short-sightedness - a study suggests.

Researchers say the "extraordinary rise" in the problem is being caused by

students working very hard in school and missing out on outdoor light.

The scientists told the Lancet that up to one in five of these students could

experience severe visual impairment and even blindness.

In the UK, the average level of myopia is between 20% and 30%.

According to Professor Ian Morgan, who led this study and is from the

Australian National University, 20-30% was once the average among people in

South East Asia as well.

"What we've done is written a review of all the evidence which suggests that

something extraordinary has happened in east Asia in the last two generations,"

he told BBC News.

Start Quote

Children suffer from a double whammy in South East Asia

Prof Ian Morgan Australian National University

"They've gone from something like 20% myopia in the population to well over

80%, heading for 90% in young adults, and as they get adult it will just spread

through the population. It certainly poses a major health problem."

Eye experts say that you are myopic if your vision is blurred beyond 2m

(6.6ft). It is often caused by an elongation of the eyeball that happens when

people are young.

According to the research, the problem is being caused by a combination of

factors - a commitment to education and lack of outdoor light.

Professor Morgan argues that many children in South East Asia spend long hours

studying at school and doing their homework. This in itself puts pressure on

the eyes, but exposure to between two and three hours of daylight acts as a

counterbalance and helps maintain healthy eyes.

The scientists believe that a chemical called dopamine could be playing a

significant part. Exposure to light increases the levels of dopamine in the eye

and this seems to prevent elongation of the eyeball.

"We're talking about the need for two to three hours a day of outdoor light -

it doesn't have to be massively sunny, we think the operating range is

10-20,000 lux, we're not sure about that - but that's perfectly achievable on a

cloudy day in the UK."

'Massive pressures'

Cultural factors also seem to play a part. Across many parts of South East

Asia, children often have a lunchtime nap. According to Professor Morgan they

are missing out on prime light to prevent myopia.

"Children suffer from a double whammy in South East Asia," says Professor

Morgan.

"As a result of massive educational pressures and the construction of a child's

day, the amount of time they spend outside in bright light is minimised."

A big concern is the numbers of students suffering from "high" myopia.

According to Professor Morgan, this affects between 10% and 20% of students in

Asian cities. It can lead to vision loss, visual impairment and even blindness.

"These people are at considerable risk - sometimes people are not told about it

and are just given more powerful glasses - they need to be warned about the

risk and given some self-testing measures so they can get to an ophthalmologist

and get some help."

For decades, researchers believed there was a strong genetic component to the

condition. It was believed that people from China, Japan, Korea and other

countries were particularly susceptible to developing myopia. But this study

strongly suggests an alternative view.

In Singapore, where there are large numbers of people from Chinese, Malay and

Indian backgrounds, all three ethnic groups have seen a dramatic rise in

short-sightedness.

Professor Morgan says you cannot rule out genetics completely, but for him it's

not the major factor.

"Any type of simple genetic explanation just doesn't fit with that speed of

change; gene pools just don't change in two generations.

"Whether it's a purely environmental effect or an environmental effect playing

a sensitive genome, it really doesn't matter, the thing that's changed is not

the gene pool - it's the environment."

Further evidence on the impact of light is provided by UK researchers. Kathryn

Saunders from the University of Ulster was part of a team which compared

short-sightedness in children in Australia and Northern Ireland.

"White UK kids are much more likely to be myopic than white Australian

children," Dr Saunders told BBC News. "We've proposed that this might be due to

the protective effect in Australia of increased exposure to bright sunlight.

"This requires further exploration and research, but I guess we might want to

encourage children to spend more time outside when the sun is shining. It's

unlikely to do them any harm."