Myopia and daylight in schools: a neglected aspect of public health?

Dr Richard Hobday, Independent Researcher

What have you been working on?

I’ve been researching the impact of building design, in particular, hospitals and schools, on peoples’ health.

Educational philosophy and medical thinking have historically had a major influence on the layout of school buildings and from the end of the 19th and into the 20th century, children’s visual health was of particular concern. I conducted a historical review to find out what went on in the past.

So what’s the background?

A century ago, it was widely believed that school children who spend more time outdoors had lower levels of short sight, or myopia, and that high daylight levels in classrooms could prevent their eyesight from deteriorating.

So education departments built classrooms with large windows to try to stop children becoming short-sighted. In fact, there was a statutory requirement to provide high levels of light in classrooms, as well as a great deal of emphasis on outdoor activities.

This continued until the 1960s, when medical thinking changed. Myopia was thought to be an inherited condition, so less was done to prevent it. Since then myopia rates in the UK have doubled.

What else have you found?

Worldwide, myopia has become a major public health problem in countries that put pressure on children to achieve high academic standards. It has reached epidemic levels in east Asia.

Rates are now as high as 80-90 per cent among children leaving secondary schools in Taiwan, Singapore, Hong Kong and elsewhere. As many as a fifth of them may have severe myopia and so are at high risk of losing their sight later in life. Also, the age at which children are becoming short-sighted is falling. The earlier the onset of myopia, the more rapidly it progresses and the more severe it gets.

Why is it important?

It is now recognised that children’s education has a far greater impact on their sight than genetic factors. The longer a child spends at school, the greater the risk of becoming short-sighted.

And new research on myopia supports the old idea that spending time outdoors prevents it.

Against this background, making children do close work at a young age may be unwise. And they should spend more time outdoors.

What do you hope it will achieve?

More research is needed. Over the past 150 years, many theories have been put forward to explain why children’s eyesight gets worse as they go through school.

Too much close work is one of the more popular ones, while heredity is another. Both have been hotly debated down the years.

Evidence that daylight in classrooms prevents myopia is lacking. Because it has been assumed since the 1960s that it’s an inherited condition, the link between the built environment and short-sightedness has not received sufficient attention.

But parents and teachers should be made aware of the harm that school attendance can do to children’s eyesight. Any level of myopia, whether mild, moderate or severe, significantly increases their risk of developing sight-threatening conditions in later life. There is no safe threshold; and the more severe the myopia, the greater the risk of eye diseases becomes.

Education policy must change. Otherwise myopia will become even more common than it already is. The social and economic cost of this epidemic should be more widely recognised.

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