Hope for myopes

 

Most 12- to 14- year-olds in China are short-sighted

Experts say they should get out more


THE PHONE on Wang Xiaoying’s desk rings incessantly on a weekday morning. An optometrist in Shanghai, Ms Wang doubles as a part-time operator for China’s first publicly funded call centre providing information about myopia. It began operating on January 7th. Most callers are parents who worry about the deteriorating eyesight of their young offspring. “Make sure your child spends two hours outdoors each day!” Ms Wang often urges them. Another tip she offers is to avoid reading when supine. Trying to focus on an object held up by an unsteady arm is likely to strain the eyes, some experts believe.

The government reckons that more than 450m people in China, or at least one in three, are short-sighted (meaning that distant objects appear blurry). Globally just over one in five are. The prevalence of myopia among Chinese schoolchildren is even more alarming. In 2018 an official survey of 1m pupils found that among those aged between 12 and 14, 72% had myopia, up from 58% in 2010. Early onset of myopia is associated with a higher risk of eye diseases such as glaucoma, which can lead to blindness. In 2018 Xi Jinping, the president, declared the swelling ranks of young myopes a “big problem concerning the future of the country” which “must not carry on”.

The affliction’s spread in China is partly related to genes. Myopia is more common among East Asians than among white people. A study in 2016 found that just 19% of white 17-year-olds in Britain were short-sighted. But lifestyle plays a big role. A report by the World Health Organisation says the genetic contribution is “considered small”. To the extent that genes are involved, they “may determine susceptibility to environmental factors”. These are often a lack of outdoor activity and excessive “near work”, ie, too much time staring at close objects. The combination of an exam-crazed culture with the rapid spread of smartphones and computer-game technology explains much of China’s problem.

A paper in 2008 by a group of Australian researchers supports this idea. The study tracked hundreds of ethnic Chinese children in Sydney and Singapore. Whereas only 3% of the children in Sydney had become myopic by the age of seven, 29% had in homework-obsessed Singapore.

Officials fret about rising myopia not only because they care about people’s health. Legal Daily, a government-owned newspaper, recently suggested that China’s security could be compromised by its shortage of military recruits with normal eyesight. Last year China’s navy relaxed requirements for new pilots, no longer insisting on 20/20 vision.

The Communist Party is trying to reverse the trend. In 2018 it pledged to ensure that, by the end of this decade, less than 60% of 12- to 14-year-olds would be short-sighted. It also said the proportion of 15- to 17-year-olds with myopia should fall below 70% by then, down from 80% two years ago. Since 2018 periodic eye exams have been made compulsory at schools. Qiu Yu, a headmaster in Beijing, says his 1,800 pupils take eye tests twice a year. Headmasters whose pupils show a worsening trend in eyesight are summoned for “talks” by education officials, Mr Qiu explains—ie, a dressing down.

The party’s remedies include evidence-based as well as unorthodox prescriptions. Schools must ensure that students have at least an hour a day of outdoor activity (many experts believe sunlight helps prevent myopia or slow down its progression). Pupils in the first two years of primary school—a time of life when eyes are highly sensitive to strain—must not be given written homework. Those in the final year of primary school should receive at most one hour of it daily. Video-game makers must release fewer new products and devise ways of limiting the time children spend playing them. Schools and families must encourage children to avoid sweets and eat more fish. Experts agree that fish, which has high levels of omega-3 fatty acids, is good for eye health. Many doctors also recommend avoiding sugary foods, though why this helps is unclear.

More controversially, schools must ensure that pupils do “eye exercises” twice a day. These involve massaging the region around the eyes using the knuckles, with the thumbs placed on the temple (see picture). Mr Qiu, the headmaster, says that each set of exercises takes five minutes. The practice has its origins in traditional Chinese medicine. As with many remedies of such provenance, there is no sound evidence that it works.

The government could be doing more. Academics believe the proportion of pre-teens in China’s countryside who suffer from myopia may be five percentage points lower than in urban areas. That may be because they spend more time outdoors. But only one in seven rural schoolchildren who need glasses wear them, says a recent report by James Chen of Clearly, an international charity. A pair of cheap spectacles costs less than 50 yuan ($7). Yet many rural Chinese think that wearing glasses aggravates myopia. In fact, squinting without glasses puts more strain on the eyes, and may cause sight to worsen. Officials should try harder to discredit mistaken beliefs.

Yang Lili, a mother of a bespectacled 12-year-old in Beijing, is grateful that officials are belatedly paying attention to “the poison” of myopia. But they are “only scratching the surface, not solving the real problem”, she says. Ms Yang blames the entire culture of education. The fact remains that admission to the best universities involves intense cramming for a single exam. Schools may reduce homework. But parents “will continue to find private tutors and anything that gives their child an edge”. Another plan may be needed.

参考翻译:

中国12-14岁少年儿童许多都近视了,他们应多参加户外活动。

工作日的早晨,王晓英办公桌上的电话一直响个不停。王女士是一名验光师在上海工作,同时兼任中国第一家公共资助的呼叫中心的接线员,这一中心提供有关近视的咨询,于1月7日开始运行。大多数打电话的人都是担心年幼子女视力恶化的父母。“确保你的孩子每天在户外活动两个小时!”。王女士经常敦促他们。她提供的另一个建议是避免仰卧时阅读。一些专家认为,试图将注意力集中在一个由不稳定的手臂支撑的物体上可能会使眼睛紧张。

官方估计,我国超过4.5亿人,或至少三分之一的人是近视(这意味着远处的物体看上去模糊不清)。在全球范围内这一人数仅大于五分之一。我国学龄儿童近视的患病率更是惊人。2018年,一项对100万名小学生进行的官方调查发现,在12—14岁的学生中,72%患有近视,高于2010年的58%。近视的早发与青光眼等眼部疾病发生的高风险有关,而青光眼会导致失明。2018年,国家领导人宣布,日益壮大的年轻近视队伍“是一个关系国家和民族未来的大问题”,“必须高度重视,不能任其发展”。

这种疾病在我国的传播一定程度上与基因有关。近视在东亚人中比在白人中更常见。2016年的一项研究发现,英国只有19%的17岁白人近视。但是生活方式起着很大的作用。世界卫生组织的一份报告说,基因的影响“被认为很小”。在基因影响的范围内,它们“可能决定对环境因素的易感性”。常常是因为缺乏户外活动和过度“近距离工作”,例如,盯着近距离物体的时间太长了。狂热的考试文化与智能手机和电脑游戏技术的迅速传播相结合,解释了中国的许多问题。

澳大利亚一组研究人员在2008年发表的一篇论文证实了这一观点。这项研究对悉尼和新加坡的数百名华裔儿童进行了跟踪。在悉尼,只有3%的孩子在7岁时就近视,而专注于家庭作业的新加坡儿童中这一比例为29%。

官员担心近视问题会加剧,并不仅仅是因为他们关心人民的健康。《法制日报》(Legal Daily)最近表示,我国缺乏视力正常的新兵,可能会损害中国的安全。去年,中国海军放宽了对新飞行员的要求,不再坚持20/20。

政府正试图扭转这一趋势。2018年,政府承诺,到本世纪末,12-14岁儿童中只有不到60%的人近视。还表示,15-17岁近视患者的比例将从两年前的80%降至70%以下。自2018年以来,定期眼科检查已成为学校必修课。北京的校长邱宇说,他的1800名学生一年做两次检查。如本校学生视力有恶化的趋势,则追究校长责任。

政府的补救办法包括基于实验证实的以及非实验的处方。学校必须确保学生每天至少有一个小时的户外活动(许多专家认为阳光有助于防止近视或减缓近视)。小学阶段的头两年——是眼睛对压力非常敏感的时期——学生绝不能多写作业。小学阶段最后一年,学生每天最多应得到一小时的教育。电子游戏制造商必须减少新产品的发布,并想出办法限制孩子们花在玩游戏上的时间。学校和家庭必须鼓励孩子们少吃糖,多吃鱼。专家一致认为,富含omega-3脂肪酸的鱼类对眼睛健康有好处。许多医生也建议不要吃含糖的食物,尽管这样做的原因尚不清楚。

更有争议的是,学校必须确保学生做到: 一天两次“眼操”。包括用指节按摩眼睛周围的区域,拇指放在太阳穴上(见图)。邱校长表示,每套练习需要5分钟。这种做法源于中医。正如对这种来源的许多补救办法一样,没有确凿的证据表明它有效。

政府可以做得更多。学者认为,农村青少年近视的比例可能比城市地区低5个百分点。这可能是因为他们花更多的时间在户外。但是国际慈善组织“清晰”最近的 的一份报告指出,只有七分之一的农村学童需要戴眼镜。一副便宜的眼镜不到50元(7美元)。然而,许多农村人认为戴眼镜会加剧近视。事实上,斜视不戴眼镜会给眼睛带来更大的压力,并可能导致视力恶化。官员应该更加努力,以抵制错误理念。

杨丽丽是北京一位12岁近视儿童的母亲,她十分庆幸政府正觉察到“近视之毒”,但“目前只触及表面,没有真正的解决问题”。杨女士归咎于整个教育文化。事实仍然是,最好的大学入学需要为一次考试进行紧张的填鸭式考试。学校可以减少家庭作业。但父母“将继续寻找私人家教和任何能让他们孩子有优势的东西“。可能需要另一个计划。

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