Saturday, September 9, 2023

"The World Is Going Blind. Taiwan Offers a Warning, and a Cure"

 From Wired, August 22:

So many people are nearsighted on the island nation that they have already glimpsed what could be coming for the rest of us.

DOING SURGERY ON the back of the eye is a little like laying new carpet: You must begin by moving the furniture. Separate the muscles that hold the eyeball inside its socket; make a delicate cut in the conjunctiva, the mucous membrane that covers the eye. Only then can the surgeon spin the eyeball around to access the retina, the thin layer of tissue that translates light into color, shape, movement. “Sometimes you have to pull it out a little bit,” says Pei-Chang Wu, with a wry smile. He has performed hundreds of operations during his long surgical career at Chang Gung Memorial Hospital in Kaohsiung, an industrial city in southern Taiwan.

Wu is 53, tall and thin with lank dark hair and a slightly stooped gait. Over dinner at Kaohsiung’s opulent Grand Hotel, he flicks through files on his laptop, showing me pictures of eye surgery—the plastic rods that fix the eye in place, the xenon lights that illuminate the inside of the eyeball like a stage—and movie clips with vision-related subtitles that turn Avengers: Endgame, Top Gun: Maverick, and Zootopia into public health messages. He peers at the screen through Coke bottle lenses that bulge from thin silver frames.

Wu specializes in repairing retinal detachments, which happen when the retina separates from the blood vessels inside the eyeball that supply it with oxygen and nutrients. For the patient, this condition first manifests as pops of light or dark spots, known as floaters, which dance across their vision like fireflies. If left untreated, small tears in the retina can progress from blurred or distorted vision to full blindness—a curtain drawn across the world.

When Wu began his surgical career in the late 1990s, most of his patients were in their sixties or seventies. But in the mid-2000s, he started to notice a troubling change. The people on his operating table kept getting younger. In 2016, Wu performed a scleral buckle surgery—fastening a belt around the eye to fix the retina into place—on a 14-year-old girl, a student at an elite high school in Kaohsiung. Another patient, a prominent programmer who had worked for Yahoo, suffered two severe retinal detachments and was blind in both eyes by age 29. Both of these cases are part of a wider problem that’s been growing across Asia for decades and is rapidly becoming an issue in the West too: an explosion of myopia.

Myopia, or what we commonly call nearsightedness, happens when the eyeball gets too long—it deforms from soccer ball to American football—and then the eye focuses light not on the retina but slightly in front of it, making distant objects appear blurry. The longer the eyeball becomes, the worse vision gets. Ophthalmologists measure this distortion in diopters, which refer to the strength of the lens required to bring someone’s vision back to normal. Anything worse than minus 5 diopters is considered “high myopia”—somewhere between 20 and 25 percent of myopia diagnoses around the world are in this category. In China, up to 90 percent of teenagers and young adults are myopic. In the 1950s the figure was as low as 10 percent. A 2012 study in Seoul found that an astonishing 96.5 percent of 19-year-old men were nearsighted. Among high schoolers in Taiwan, it’s around 90 percent. In the US and Europe, myopia rates across all ages are well below 50 percent, but they’ve risen sharply in recent decades. It’s estimated that by 2050, half the world’s population will need glasses, contacts, or surgery to see across a room. High myopia is now the leading cause of blindness in Japan, China, and Taiwan.

If those trends continue, it’s likely that millions more people around the world will go blind much earlier in life than they—or the societies they live in—are prepared for. It’s a “ticking time bomb,” says Nicola Logan, an optometry professor at the UK’s Aston University. She wasn’t the only expert I talked to who used that phrase. Because so much of Taiwan’s population is already living life with myopia, the island nation has already glimpsed what could be coming for the rest of us. And in a rare confluence, the country may also be the best place to look for solutions.

ON THE BULLET train south from Taipei, you can see the smog hanging over Kaohsiung from miles away, blurring the edges of the buildings. During the Japanese occupation, which ended in 1945, what had been a small trading port transformed into one of Taiwan’s biggest cities, a riot of heavy industry and shipbuilding. Over the next four decades, as Taiwan made the rapid transition from a predominantly agricultural economy to a manufacturing powerhouse, the lives of its citizens shifted too. Families flocked into cramped apartment blocks that still make up much of the urban housing. Education for children was mandatory and became increasingly intense. A network of after-school establishments called “cram schools” sprang up, making room for parents to work long hours without the childcare support from elderly relatives they would’ve had in the old society. At the end of the school day, some kids would board a bus, not to go home, but to ride to their cram school, some of which were open until 9 pm.

Pei-Chang Wu was born in Kaohsiung, at the height of the city’s transformation, in 1970. His grandparents, neither of whom were myopic, were farmers in central Taiwan. Both of his parents were teachers, and like many Asian parents, they put a huge emphasis on education as one of the few levers they could pull to move up through society. His father enforced a strict daily routine: up at 5 am for calligraphy and violin practice, school from 7:30 am to 4 pm. Once Wu got home in the evenings he had to complete his schoolwork. On the weekends, he participated in calligraphy competitions. By the age of 9, Wu had been diagnosed with myopia.

Across the modernizing world, this pattern repeated itself. For economies to continuously expand, education had to become central, and as this happened, the rates of myopia started to climb. But hardly anyone noticed, in Taiwan or anywhere else.

Then, during one summer in the early 1980s, a group of incoming college students gathered at Chengkungling, a military training facility in central Taiwan, for a ceremony to mark the beginning of their mandatory national service. The United States had recently cut diplomatic ties with the island and formally recognized the government in Beijing, and cross-strait tensions were high.

At first, the early morning ceremony went smoothly. A single cadet—tall, good posture—received a rifle on behalf of his classmates, symbolizing their duty to defend their country. As the ministers of education and defense rose to deliver their speeches to the young men they hoped would be the future of Taiwan, the sun also rose higher into the sky behind the stage. The government officials were dazzled by the glare reflecting back at them from hundreds of pairs of glasses. The ceremony was the seed for a joke about how to ward off an alien invasion—just ask Taiwanese students to look up—and the spark for the government’s fight against myopia.

The first step was to understand the scope of the problem. The president, alarmed by what had happened, asked health officials to begin a regular survey of myopia rates in Taiwan. It revealed a previously hidden epidemic, which seemed to be getting worse. By 1990, the myopia rate among Taiwanese 15-year-olds had risen to 74 percent.

By the time Wu started medical school in the early 1990s, he was seeing floaters—“strange animals in the sky,” as he called them—when he closed his eyes. At first, he dismissed them and focused on his budding career as an ophthalmologist. But during his residency, Wu examined hundreds of patients with retinal detachments who’d had the same symptoms. He grew worried about his own long-term vision. So he asked one of his professors to examine his eyes. “He found a break in my retina,” Wu said.

He was lucky. It was a small tear, minor enough to be fixed with a laser in five minutes. Shining a light through the pupil creates scar tissue that the retina can reattach to. “The laser saved me,” Wu said. “Otherwise I would be blind in one eye.” Wu decided he had a responsibility to rescue others from high myopia and its potential complications. “If I cannot save myself, we should save our next generation.”

In 1999, the government convened a group of experts in medicine and education to try and fix the problem. Jen-Yee Wu, who worked at the Ministry of Education and had done his doctoral thesis on eyesight protection, was asked to write a set of guidelines for schools to address nearsightedness. Later that year, he published a thin green book full of advice for teachers. It paid careful attention to desk height (to keep texts the right distance from the eyes) and room lighting, and advocated eye relaxation exercises, including a guided massage of points around the eyes and face. The book also advised giving children more space in their notebooks to pen the intricate characters that make up written Mandarin. And it formalized the 30/10 rule: a 10-minute break to stare into the distance after every half hour of reading or looking at a screen.

None of it worked. Nearsightedness rates continued to climb because, as it turned out, Taiwan, and the world, had been thinking about how to address myopia completely wrong....


If interested see also, Feb, 29, 2020's (early covid time):

"Social Responses to Epidemics Depicted by Cinema"

A great resource for portfolio risk managers.

As just one example, what is the trade if the world is confronted by a real-life version of "Blindness (2008, Fernando Meirelles), which deals with a fictional disease that causes epidemic blindness, leading to collective hysteria?"
I mean beyond the simplistic "short Luxottica." Duh.....

From Emerging Infectious Diseases Journal, Volume 26, Number 2—February 2020....