Near-sightedness, also known as myopia, is estimated to occur in 20–30% of children in primary and basic school. Still, the risk of developing myopia can be reduced if children spend sufficient time outdoors, and their eyes get enough rest.

What is near-sightedness?

Near-sightedness or myopia is a condition of the visual system, which makes it difficult to discern distant objects clearly. The reason lies in the fact that the myopic eyeball is slightly more elongated than a healthy eye and light focuses not on the retina, where it is supposed to, but in front of it. In order to see clearly, a near-sighted person needs ‘minus’ glasses or contact lenses. 

Near-sightedness usually develops in primary school children and results from faster and more extensive growth of the eyeball compared to the age-appropriate norm. Myopia is defined as a refractive error of ⩽ -0.5 dioptres. High myopia, a more severe form of myopia that can increase the risk of developing serious eye problems, is defined as a refractive error of ⩽ -6 dioptres. Generally, myopia stops progressing by early adulthood, once the person’s eye is not growing any more.

How to understand that a child is near-sighted?

Symptoms of near-sightedness: 

  • • The child struggles to see to the board in class and may squint 
  • • The child does not see distant objects
  • • The child keeps sitting too close to the TV
  • • Less frequent symptoms include eye strain and tiredness, and headache

At early stages, myopia is not exactly obvious. Pre-schoolers will often display no problems at home or in kindergarten.  Even as the child starts school, they may see what is written on the board rather well when they sit in the central part of the classroom. One of the first signs of near-sightedness is squinting to see the board or the TV screen. If the child asks to be seated at the front of the classroom because they cannot see well from a desk at the back, this can be the first indication that the child has developed myopia. The same can be said about the child sitting very close to the TV screen.

How high is the prevalence of myopia?

While 28% of the entire world’s population were near-sighted in 2010, myopia is expected to affect 50% of people worldwide by 2050. 

Near-sightedness is a health issue, which is becoming more and more pressing all over the world. It is already now that myopia affects 40–50% of some European populations. There is discussion about a ‘myopia epidemic’ in Asia, where near-sightedness is found in 80–90% of the residents of certain regions in East and Southeast Asia.

Kadi Palumaa, ophthalmologist at East Tallinn Central Hospital:

Judging by research performed in other European countries, the prevalence of myopia among Estonian children at lower school levels can be estimated at approximately 10–20%, and at senior grades of basic school, around 20–30%. 

As far as our clinical practice is concerned, we have clearly observed a growing rate of myopia in recent years, and it is more and more common that near-sightedness is developing in younger children. The total number of schoolchildren in Estonia is approximately 150,000. If approximately 30% of them are myopic, that amounts to a total of 45,000 children with near-sightedness in the country.

A pilot study conducted by the East Tallinn Central Hospital Eye Clinic in 2018–2019 recruited 123 schoolchildren and found that 31% of them displayed myopia.

Complications of myopia 

Myopia manifests itself in childhood and can progress significantly with age, increasing the risk of developing complications which can potentially result in visual impairment, for example, macular and retinal degenerations, retinal tears and detachment, glaucoma and cataract. 

Complications of myopia result from the excessive growth of the eye and its ‘elongation’. Myopia can lead to deterioration of vision and, potentially, to vision loss. Approximately 10% of short-sighted people develop myopic macular degeneration. Myopia also leads to a higher risk of developing glaucoma and retinal detachment. Visual impairment caused by these conditions is irreversible. There is also a heightened risk of developing cataract, but it can be surgically treated. 

For children, myopia does not usually cause more severe problems than the inconvenience of wearing glasses of contact lenses. The complications of short-sightedness occur mainly in adults and are directly related to the severity of myopia. For example, people with high myopia have a 5.7% risk of uncorrectable visual impairment at the age of 60, and the figure rises to 39% by 75 years of age. 

Myopia risk factors

  • • Children who spend plenty of time outdoors have a significantly lower risk of developing myopia.
  • • The risk of near-sightedness is increased by prolonged periods of near work, for example excessive use of smartphones and computers

Myopia risk factors have been studied for years. It has been discovered that the primary risk factor for developing myopia is spending too little time outdoors in daylight. The positive effect of the time spent outdoors is associated with the intensity of sunlight being significantly higher than indoor light levels. While the level of illuminance outdoors on a sunny day may be as high as 100,000 lux, it will reach a mere 500 lux in well-lit indoor spaces. They eye adapts to changes in illuminance very rapidly and therefore we do not perceive the difference to be this great. Even on a cloudy day, light intensity outdoors is multiple fold higher than in a well-lit room. 

Another important myopia risk factor is prolonged periods of near work, which include the use of computer and smartphone but also reading and writing. Children of myopic parents also have a higher risk of near-sightedness due to both genetic and behavioural factors. It should be noted that various genetic factors, albeit well-researched, account for only 20% of myopia cases. 

Preventing near-sightedness

Near-sightedness is less likely to develop if the ‘2-20-20’ rule is followed:

  • • the child spends at least 2 hours outdoors every day; 
  • • after 20 minutes of near work, the child looks into the distance for 20 seconds

Following these simple lifestyle principles will decrease the risk of developing myopia and slow its progression. It is recommended that children follow the ‘2–20–20’ rule: spend at least 2 hours per day outdoors and after every 20 minutes of near work, look into the distance for 20 seconds (‘the distance’ referred to means at least 6 metres, for example, looking out of the window or to the far end of the classroom). 

It is also important that the workspace is illuminated adequately, and children are encouraged to go to school on foot. Multiple Asian countries where myopia has become a wide-spread problem, have initiated national programmes, which encourage children to spend more time outdoors between classes. These measures have proven to have a positive effect on myopia prevention. 

Myopia control

  • • Atropine eye drops
  • • Special multifocal and orthokeratology contact lenses

Myopia can be corrected through the use of ‘minus’ glasses or contact lenses. However, these methods do not hinder the further growth of the eyeball and, consequently, do not prevent the progression of myopia. In recent years, new scientifically proven myopia control methods have been introduced, which reduce the growth rate of the eye. The most efficient scientifically proven method is the use of atropine eye drops. 

Atropine is found in the berries of the deadly nightshade (Atropa belladonna) and has been in medicinal use for over a century. It is used for inducing pupil dilation and the relaxation of the ciliary muscle, which controls the shape of the lens of the eye. It was only in 2006 that a study demonstrating that atropine slows eye growth was published. Subsequent work has shown that the effect is also present at very low concentrations of the substance. While 1% atropine eye drops are used for pupil dilation, eye growth is hindered already with 0.1%, 0.05% and 0.01% atropine. Such low doses do not result in pupil dilation in most subjects and only 5% of the children receiving treatment experience side-effects. 

Another method of myopia control involves special contact lenses, for example multifocal or orthokeratology contact lenses. Such lenses have been scientifically proven to hinder the growth of the eye, but research has shown that they are less effective than atropine eye drops. Further information about near-sightedness, the studies currently in progress in Estonia and myopia control can be found at www.itk.ee/muoopia or requested by email at muoopia@itk.ee. 

Colonna Charity Fund supports 

With the aid of supporters, Colonna Charity Fund will donate to the Eye Clinic of the East Tallinn Central Hospital 22 547 euros for purchasing a kerato-refractometer meant for diagnosing myopia.

The device, which has only recently found global use, is supplied with the databases and software specially developed for examining and monitoring the treatment of near-sighted children, which will significantly simplify treatment planning and monitoring myopia control. The instrument is compact and child-friendly as it can determine and register several parameters within a short period of time, eliminating the necessity to use several devices for the examination. 

Support the projects of the Colonna Charity Fund with a one-time or regular donation. Read more: https://colonnacharity.ee/toetajale/