Smartphone use increases at an early age, and more children play computer games, read at close range, and watch TV. All these have combined to raise red flags for children's eye health, and Korea tops the list of Asian countries with the highest increase rate of myopia.

Experts say that if left untreated in childhood, myopia increases the chances of developing blindness-causing diseases, such as glaucoma and macular degeneration, in adulthood. So, they emphasize the need to systematically manage it at the national level by, for instance, introducing educational curricula in schools to slow the progression to high myopia.

According to the Health Insurance Review and Assessment Service, 1,145,321 people were treated for myopia in 2023. Of these, 22 percent were under 9, and 58 percent were under 19, meaning six in 10 children and teenagers are myopic.

“Myopia in children is irreversible once it occurs. It is a progressive chronic disease that continues to worsen throughout the growth period until the eye stops growing, i.e., until the child reaches adolescence,” said Professor Paik Hae-jung of the Department of Ophthalmology at Gachon University Gil Medical Center in a recent interview with Korea Biomedical Review. “It has a huge impact on the quality of life and the country's healthcare finances, so the government should take action to manage it throughout the life cycle.”

Professor Paik also serves as the president of the Korean Society for Pediatric Ophthalmology and Strabismus and the Korean Society of Pediatric and Adolescent Myopia Research,

“In the past, we didn't think of myopia as a disease. We thought we could just put on our glasses and see,” Park said. “However, myopia that occurs during childhood and adolescence can affect social and emotional development and lead to eye diseases, such as glaucoma and macular degeneration, so it is necessary to treat it early to mitigate its progression to severe or high myopia.”

She said excessive studying is threatening the eye health of our children, emphasizing the need for educational curricula in elementary schools to increase outdoor activities.

Question: People who suffer from nearsightedness usually wear glasses to correct their vision. Even so, we haven’t considered it a disease.

Answer: What is a disease? It is something abnormal going on in our bodies. And what should we do if something goes wrong? We should receive treatment to reverse what is wrong, shouldn’t we?

Myopia is a condition in which the focal point that should be on the retina is in front of it, making it difficult to see faraway objects and easy to see near objects. Myopia occurs when the length of the front and back of the eyeball (the axis of the eye) is longer than normal, preventing objects from focusing on the retina (a thin membrane of nerve cells).

Myopia is diagnosed by measuring the refractive power of the eye in diopters. There are three types: mild myopia (-3 diopters or less), moderate myopia (-3 diopters to -6 diopters), and severe myopia (-6 diopters or more).

As myopia progresses, the prevalence of adult ophthalmic diseases increases, especially diseases of the optic nerve of the retina, such as glaucoma, retinal detachment, and macular degeneration. There is a difference in the prevalence of glaucoma between low and high myopia levels, with studies showing that a decrease in myopia of even - 1 diopter is associated with a significant decrease in the prevalence of glaucoma.

Q: Does this mean that myopia is not just a vision problem?

A: Myopia is most common in childhood. If we can slow down the progression of myopia, we can help people live a more stable life as adults. This will prevent the development of eye diseases. In a way, it’s even more important than taking care of the disease.

Q: So, when is the right time to treat myopia?

A: Myopia treatment should be started when the eye's refractive power is more than -1 diopter, and there are indications that myopia has progressed between the first and the following appointments. If there is an indication, the rate of progression of myopia, the child's lifestyle, and the parents' disposition should be considered when deciding whether to treat it.

The sooner myopia is treated, the better. So it is often possible to prevent it from progressing to myopia by treating it before it becomes myopia. However, treating myopia in the pre-myopia stage can lead to overtreatment, so the medical team should agree upon it.

Q: What causes myopia?

A: The cause of myopia is still not clearly understood, so it can’t be completely prevented. The goal of treatment is to minimize it as much as possible.

The eye's numerical value is determined by three factors: the length of the eyeball (axial length), the lens's numerical value, and the cornea's numerical value. While the thickness and optical properties of the cornea and the lens's optical properties do not change much, the eye's axial length changes in small ways, including a slight flattening of the curve or a flattening of the thickness during the neonatal period and infancy. It measures between 17 and 21 millimeters as a newborn, but it grows explosively by age 13. As the eyeball grows, so does the length of the eyeball. So, slowing the progression of myopia until growth stops can slow the progression to severe or high myopia. Therefore, treatment for myopia focuses on controlling the length of the eye axis.

Q: What are the ways to treat myopia?

A: There are two main types of myopia treatment: optical treatment with glasses or special lenses and non-optical treatment with medication. The first type of optical treatment is using glasses with concave lenses. These glasses allow you to see objects clearly because they’re well-formed on the retina. Corneal refractive lenses, also known as dream lenses, have become popular in recent years. The idea is that the center of the lens is flatter than the periphery, so it presses on the center of the cornea when you sleep, reducing the refractive power. Non-optical treatments include atropine, a controlled paralytic eye drop. Used in low concentrations, it inhibits the growth of the eyeball's length, slowing myopia's progression. They're convenient but they don't correct vision and require glasses to be worn.

Q: In recent years, glasses for myopia treatment have become available. How do contact lenses and glasses treat myopia?

A: The first way to monitor the effectiveness of myopia control is to wear glasses or lenses for a period and see if the eye axis has increased. If the eye's axis increases by more than 0.15 millimeters per year, myopia is progressing. The glasses or lenses are working if they’re less than or equal to that. However, when comparing glasses and lenses, glasses are less effective than lenses. However, when comparing glasses and lenses, glasses are less effective than lenses.

Q: When has it been determined that myopia treatment is necessary?

A: If a child's myopia progression indicates that they will become highly myopic, the answer is to be proactive. Family history is important because myopia has a genetic component. If only one parent is myopic, the child is three times more likely to develop hypermetropia than a child who is not. This increases to 8-10 times if both parents are myopic.

The textbooks say to come back in three months to see if myopia has progressed and then start treatment. Still, in this case, the child is currently mildly myopic but is likely to progress to hyper-myopia, so if the parents want, they can start treatment right away.

After family history, the next thing to consider is the child's lifestyle. Children who spend a lot of time indoors at close range, such as playing games or reading books, are more likely to develop myopia, so it's important to discuss this with their parents and decide whether to treat them.

Q: You said that the earlier, the better, but there must be an age at which it's appropriate to treat myopia.

A: Doctors seem to be confused about when it's appropriate to start wearing dream lenses or soft lenses, but it's clear that the earlier, the better if the child can take care of them themselves or with their parents. However, wearing lenses for a long time can cause problems with the cornea, so it's better to judge the situation rather than stick to the age.

The mandatory age for eye health checks is three years old. If the first check is below 0.5 in kindergartens, the child is referred to a hospital. Many of the children who are referred have abnormalities, and more than 80 percent of them have refractive errors.

At three, they can put on glasses and start treatment. However, the older they get, the easier it is for parents to care for them, so it's best to judge based on the situation.

Q: You said that Korea has one of the highest rates of myopia in the world. What is the reason for the high rate of myopia?

A: It is due to high study fever. Many children stay indoors due to excessive academic craze, and they do only short-distance activities. According to statistics, the average time spent on cell phones by children and adolescents is about six hours, which is why myopia is increasing. Parents' desire for early detection also plays a role.

However, this is not just a Korean phenomenon. It is common in East Asian countries, such as Singapore, Malaysia, Taiwan, and Hong Kong. These countries also have similar educational systems, which means that there are many myopia patients.

Q: You pointed out that the government should recognize myopia as a disease and take policy measures to manage it.

A: I would like more physical education time in school programs so that children can run outside and expand their vision. Even if it's just a quick trip to the school when they get home, the curriculum should include time to play in the playground to keep our children's eyes healthy.

Q: Does this mean reducing indoor concentration time is the way to curb myopia?

A: At the recent Asia-Pacific Myopia Management Symposium, I was quite impressed by a speaker from Taiwan. In Taiwan, decorating classroom walls to resemble a forest and changing the ceiling to glass windows to allow light has been shown to reduce myopia.

Q: To get the government's attention, such as the Ministry of Health and Welfare and the Ministry of Education, the related societies must speak up more as professional organizations. What are your plans to improve awareness of myopia in the future?

A: We will continue to raise awareness of the importance of eye healthcare, including myopia, so that patients and their caregivers, as well as medical professionals, will be interested in and make efforts to prevent and manage myopia. We will also continue to raise our voices as experts at the national level by, for instance, introducing educational curricula in schools to curb myopia progression so that pediatric eye health can be supported.