Smartphones and the Childhood Epidemic of Myopia

Time indoors looking at screens can cause eyeballs to elongate, leaving kids nearsighted for life.

Parents and politicians are waking up to how social media and smartphones can harm young people’s mental health. How many realize that staring at screens all day can make kids literally shortsighted?

Representational image.

Ophthalmologists are raising alarms about an epidemic of childhood myopia. Nearsightedness typically develops between ages 3 and 10, when the eyeballs are rapidly growing, though it can progress during adolescence and young adulthood.

While genetics plays a role, spending more time focusing on things up close—whether reading books or watching YouTube videos—significantly increases the risk. It causes the eyeball to grow longer from front to back, making it harder to focus farther away. Ever wonder why children who buried their heads in books were more likely to wear glasses? Now you know.

Studies have found that the more time kids spend outdoors, the less likely they are to become nearsighted. Sunlight stimulates the release of dopamine in the eye, which slows lengthening. Alas, children these days spend many of their waking hours indoors, fixated on screens.

The incidence of myopia is highest in Southeast Asia—maybe not surprising given the heavy cultural emphasis on academics—where an estimated 80% of students who complete 12 years of school are myopic. Rates are somewhat lower in the U.S.—41% in urban areas and 16% in rural areas—but have increased following the Covid school shutdowns.

For most people, having to wear glasses is merely an annoyance. But myopia also increases the risk of cataracts, glaucoma, retinal detachment and other eye diseases later in life.

A surge in pediatric myopia prompted governments in China, Taiwan and Singapore to limit screen time for kids and recommend that schools increase time students spend outdoors. In 2018 Chinese President Xi Jinping declared that increasing myopia posed a threat to the country’s future that required comprehensive social and government responses.

Severe myopia can be a disqualifier for Chinese air force pilots, which made recruitment a challenge. The Chinese Communist Party proposed a five-year plan to reduce the prevalence of myopia among children by at least 0.5% annually by 2023. Its goal is to keep prevalence of myopia at less than 38% among primary-school pupils and 70% in high school.

The government recommended that schools limit electronic-device use to 30% of instruction time and provide two hours of outdoor activity a day. This month Beijing proposed a ban on smartphones, computers and other screens for children up to 3 and required schools to conduct vision tests twice a semester.

Early diagnosis is critical since medical relief is possible. Atropine eye drops are typically used to dilate the pupil before eye exams. Studies from Singapore and Hong Kong in the early 2000s showed a low dose of atropine administered before bedtime could also reduce myopic progression.

The Food and Drug Administration hasn’t approved atropine for this use, but ophthalmologists sometimes prescribe a very low dose off label. Some pharmacies can produce the drug in-house, known as compounding, but the consistency varies and the acidity causes eyes to sting. The FDA has documented quality-control problems at multiple compounding pharmacies that make atropine products.

Enter U.S. biotech firm Sydnexis, which developed a safer atropine formulation with fewer side effects. In a four-year trial, the Sydnexis drug dramatically slowed progression—by more than 50% in children who exhibited the fastest disease progression and were at the highest risk of severe myopia. Yet even though the drug met all the FDA’s previously agreed-on benchmarks, the agency rejected it this fall.

The FDA claimed it wasn’t persuaded by the data, though the European Union and U.K. approved Sydnexis’ drug this year. The U.S. is a global outlier, as there are approved versions of low-dose atropine in all other major markets. China approved a home-grown pharmaceutical company’s low-dose atropine drops last year.

This Sydnexis rejection fits an FDA pattern this year of blindsiding companies by arbitrarily changing standards for approval. Chief Medical Officer Vinay Prasad has taken the shortsighted view that many medications that slow disease progression aren’t worth their cost to the healthcare system.

Given the large potential market for Sydnexis’ eye drops, might cost considerations have influenced the FDA’s decision? Just asking, as FDA Commissioner Marty Makary and his boss, Robert F. Kennedy Jr., like to say. Pediatric ophthalmologists are urging the FDA to reconsider and look at the big picture.

Children would be better off if they spent more time running around outside. But some would still become nearsighted, and treating the condition early can prevent major eye problems in the future. China hasn’t lost sight of that.