Deep Dive: Myopia rising in Hong Kong children due to more screen time, changing habits during and after pandemic

The number of children aged six to eight in Hong Kong suffering from nearsightedness reached record-high levels during the Covid-19 pandemic. Experts pointed to a growing reliance on screens as a factor.

A Chinese University (CUHK) study released last month found the proportion of children aged six to eight in the city suffering from nearsightedness reached a record high of 36.2 per cent between March and December 2021. This was when the city relaxed some pandemic rules and face-to-face classes were being held.

Nearsightedness is also called myopia.

Dr Jason Yam Cheuk-sing is the study’s lead author and an associate professor of ophthalmology and visual sciences at CUHK. Yam said the increase in myopia was because children were spending less time outdoors, changing their reading habits, and using screens more often.

The researchers behind the study also warned that nearsightedness could still be common even in the future.

Langton Cheung Yung-pong is the honorary chairman of the Aided Primary School Heads Association. Cheung said that even after online learning during the pandemic, pupils would continue using devices for their studies.

“Classes still feature lots of digital learning platforms that require the use of computers,” the educator said. Cheung explained that some schools required pupils to read an online article written in Chinese every day to build up their comprehension skills.

But he also said that the increase in screen time was not only because of school. Cheung pointed out how some parents might use digital devices as “electronic pacifiers” to keep their children quiet. He added that many children used electronic devices when travelling or eating out. These could potentially be other reasons causing more children to have myopia.

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Other places also saw more children with nearsightedness during the pandemic.

A study by mainland Chinese researchers in 2021 found that the rate of myopia increased during pandemic lockdowns, but then it slowed down after rules were relaxed. Academics in South Korea also published a paper in 2021 that pointed to a strong increase in the progression of nearsightedness during the pandemic.

Yam encouraged parents to increase the time that children spend outdoors to two hours a day. He also stressed the importance of good reading habits – for example, not reading for more than 30 minutes at a time and keeping your eyes at least 30cm away from the book or device you are staring at.

The professor added that you should avoid reading in a dark environment, and that it would be best to keep desk and ceiling lights on while you are reading.
Staff writers

Question prompts

1. What are the factors that have likely contributed to the increase in myopia in Hong Kong children?
(1) schools encouraging more frequent use of electronic devices
(2) changes in reading habits
(3) children spending more time indoors
(4) parents using electronic devices to keep children occupied

A. (1), (2) and (4) only
B. (1), (3) and (4) only
C. (2), (3) and (4) only
D. all of the above

2. What is one common finding in the studies published in Hong Kong, mainland China and South Korea?

3. “Schools can help prevent myopia by reducing the amount of time that students spend using digital devices.” To what extent does News support this statement? Justify your answer.

Question prompts
1. What is the child in the illustration doing?
2. What advice would you give the child based on Jason Yam’s suggestions in News?

• The girl used red light therapy treatment after her eyesight worsened in the nine months after the pandemic broke out

• “If we do not do something drastic now to reduce the progression of myopia, these children will have serious problems in many years to come,” one of the researchers said

One of the children who took part in CUHK’s study on myopia was 10-year-old Kate Law Hiu-ching. She joined the researchers last month as they revealed the report’s findings on nearsightedness.

Kate’s father, Law Chi-kuen, said he had felt shocked after discovering his daughter’s eyesight had deteriorated in the nine months after the pandemic broke out in 2020. His daughter’s existing myopia worsened during that time from -0.25 dioptres in both eyes to -1.75 dioptres in her right eye and -1.00 dioptres in her left eye.

The father said his daughter had typically spent up to two hours a day outdoors until the pandemic, when measures such as closing public parks were introduced. He believed her eyesight had rapidly worsened due to increased screen time and fewer opportunities to go outside, he said.

The 10-year-old was later prescribed atropine eye drops but her condition had continued to worsen, even with a change in dosage.

“We were quite worried. We used corrective glasses; we used eye drops. What else could we do?” her father said. “If the myopia worsened by -1.00 dioptres every year, it would be -4.00 to -5.00 dioptres by the time she is in Primary Five or Six.”

Researchers said the deterioration of the girl’s condition had slowed down after doctors used a device that helps control myopia with low-energy red light, but they noted such treatments were not widely available in the city and were only introduced locally this year.

The research team said they were recruiting people to join a study that tested combining atropine eye drops with red light therapy.

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Professor Clement Tham Chee-yung, a member of the research team, said the issues stemming from lifestyle changes and the increase in nearsightedness among youngsters had been “overlooked” as authorities tackled other long-term effects of the Covid-19 pandemic.

Additional complications could take up to 40 years to present themselves, including conditions such as detached retinas, macular haemorrhage and glaucoma, he added.

“If we do not do something drastic now to reduce the progression of myopia, these children will have serious problems in many years to come,” Tham said.
Staff writer

Question prompts

1. What happened to Kate during the pandemic?
(1) Her myopia in both eyes worsened.
(2) She developed myopia.
(3) The myopia in her right eye showed some improvement.
(4) Her eyesight deteriorated rapidly.

A. (2) and (3) only
B. (4) and (2) only
C. (1) and (4) only
D. (4) and (3) only

2. What reason is given in Issue as to why myopia is a critical issue that needs to be addressed?

3. What measures are mentioned in Issue to address myopia and how effective are these overall in reducing the incidence of nearsightedness in Hong Kong children? Explain using News and Issue.

Question prompts
1. Identify TWO trends in the table.
2. Based on your answers above and News, provide ONE reason for each trend.

1. atropine eye drops: a medication in the form of eye drops that helps to slow down the progression of myopia in children and teenagers

2. detached retina: when the retina (a light-sensitive layer of tissue in the back of the eye) is pulled away from its normal position. It can lead to vision loss if it is not treated.

3. digital learning: use of websites or apps to teach and learn

4. dioptre: a unit of measurement used to describe the strength of a lens. It uses negative numbers to indicate myopia. The severity of myopia increases with the dioptre number.

5. glaucoma: a condition in which the eye either makes too much fluid too quickly, or the fluid drains away too slowly. This increases eye pressure, which can lead to optic nerve damage. It can lead to vision loss if it is not treated.

6. macular haemorrhage: an eye condition in which blood leaks into the macula, the part of the eye that gives us sharp vision. It can lead to vision loss if it is not treated.

7. myopia: also called nearsightedness. It is a vision condition in which people can see close objects clearly, but objects further away appear blurred. Studies find that smart device exposure might be associated with an increased risk of myopia.

8. red light therapy: delivers light directly to the retina for short periods. Some studies show this is effective and safe for controlling myopia.

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News
1. D
2. They all found a rise in the cases of myopia in children during Covid-19.
3. The article supports the statement to a certain extent. It cites a study conducted by Chinese University that found a link between increased screen time and the development of myopia in children, and that the pandemic has accelerated the development of digital learning in schools, hence contributing to increased screen time for children. However, an educator said that the increase in nearsightedness was not entirely due to studies, but also the increased use of digital devices for other purposes, such as gaming and watching videos. As such, schools can play a part in preventing a further rise in myopia but parents and carers also have a role in ensuring that children limit their screen time.

Illustration
1. He is using his phone in a dimly lit room.
2. He should keep at least 30cm away from his phone and keep the ceiling lights on using his device.

Issue
1. C
2. Children who develop myopia are also at risk of having additional complications later in life such as detached retinas, macular haemorrhage and glaucoma.
3. The measures include using atropine eye drops, low-energy red light therapy and possibly a study that combines both. These are corrective measures targeted at slowing down the deterioration of the eye condition but they might be limited in their effectiveness in reducing the incidence of nearsightness in children, especially since they are not widely available in Hong Kong. Instead, preventative measures are crucial, such as increasing the time children spend outdoors and promoting good reading habits.

Table
1. The incidence of myopia has been increasing in Hong Kong children over the past six years. / The incidence of myopia increases with age in children. (accept other reasonable answers)
2. The pandemic and the increasing adoption of digital learning in Hong Kong schools have led to an increase in the incidence of myopia in children over the past six years. / The incidence of myopia increases with age in children because as they get older, they tend to spend more time using digital devices, such as smartphones, tablets and computers. This increased screen time can put them at greater risk of developing myopia. (accept other reasonable answers)