In an article I wrote a couple of years ago about tackling the myopia epidemic, I missed one key insight. Struck by the record-breaking trends predicting that half of the world’s population would be myopic by 2050, my attention focused on the research and myopia management opportunities, and in that, I overlooked the importance of advocacy.
Advocacy as a change-catalyst
When it comes to tackling childhood myopia, we must see beyond research, awareness, education, and eye care solutions. We must develop a complete “anti-myopia ecosystem.” With that perspective, advocacy becomes a key component in the overall strategy to empower change.
The recent report from The Lancet Global Health Commission on Global Eye Health (2021) highlights the life-transforming impacts of eye care and the need to inform governments and stakeholders about the path forward. Advocacy is – and will remain – a change catalyst of this transformation.
Implicitly, advocacy for global eye health includes uncorrected myopia – an increasing public health issue.
Addressing myopia as a public health issue
Myopia is a major challenge that puts a growing burden on public health services. According to the World Health Organization (WHO), people with high myopia have an increased risk of developing severe ocular diseases, which may lead to blindness. Moreover, myopia tends to have an adverse effect on one’s quality of life, affecting his or her productivity, mobility, and activities of daily living, with broader societal and economic outcomes.
Uncorrected myopia and myopic macular degeneration were responsible for approximately US$250 billion in global productivity loss in 2015. The global cost of myopia will continue to rise as the number of myopic people increases. Reducing the growing societal burden of uncorrected myopia requires concerted strategies, combining preventive methods with enhanced capacity to deliver high-quality, affordable, and equitable services.
Evidence-based advocacy is central to creating an enabling ecosystem, one that assists policymakers in making informed decisions about public health policies. Such policies would prevent and reduce myopia progression and benefit both the individual and the broader society.
Alleviating modifiable myopia risk factors
Although more than 200 genes have been associated with myopia, genetics is only one of the risk factors. Lifestyle, along with insufficient outdoor time and intensive near work activity (including screen time), are major environmental risk factors for myopia onset and development in children.
Alleviating the modifiable risk factors, balancing outdoor time and near activity, can help delay or even prevent myopia onset. Advocacy strategies can vary to suit local situations and cultures while also garnering support from families, communities, governments, health, and educational bodies.
Reinforcing our focus on myopia during the COVID-19 pandemic
The COVID-19 pandemic has deeply affected education worldwide. In January 2021, according to UNICEF, approximately 825 million learners, about 47 percent of the world’s school population, were still affected by school closures.
As COVID-19 spread throughout the world, lockdowns and school closures resulted in limited outdoor time and exacerbated the use of screens at home. Recent evidence from China reported that home confinement during the COVID-19 pandemic negatively affected myopia progression in children from 6-8 years old.
Within the context of this global pandemic, education disruptions and the acceleration of childhood myopia elevate the need for reinforced advocacy. All stakeholders should be informed about the increasing risks. Concerted initiatives should be in place to avoid delays in interventions and treatments.
At home, if confinement is necessary, parents should control the children’s screen time as much as possible and increase the allowable outdoor activity while applying safe social distancing.
Building evidence, partnerships, and coalitions
At the Vision Impact Institute, myopia has always been a key focus. With nearly 200 myopia publications and several co-funded myopia white papers curated on our website, we are building the evidence needed to raise awareness and recognize myopia as a growing public health issue.
Giving myopia a voice means collaborating with global organizations and coalitions such as the Global Myopia Awareness Coalition (GMAC). Multiple voices sharing the same message increase our opportunities to empower eye care practitioners, researchers, innovators, advocacy organizations, and national governments to advance changes and make a greater impact.
Focusing on local needs
As we continue raising awareness and empowering advocates at global and regional levels, we must also keep our work tied to local needs. The magnitude of uncorrected childhood myopia varies between regions, and the dynamics of COVID-19 also play a role. I see this in my role in Africa and Europe.
In many African countries: The recovery from COVID-19 will remain slow. With a young (median age 19.5) and fast-growing population, eye health challenges are increasing. Africa has a relatively low myopia prevalence, but in some cases, it faces enormous unmet needs in eye care, especially in children.
Before the pandemic, advocacy helped many governments work on the integration of eye health into national strategic health plans and the deployment of school eye health programs.
With the onset of COVID-19, the widespread closure of schools has hindered that process.
Almost all of Africa’s 253 million pupils live in countries that at some point closed schools. Kenya closed classrooms for nine months in 2020. Many students did not come back when schools reopened, and most of those not returning are girls. The World Bank estimated that about seven months of closures could cost African children US$500 billion in lifetime earnings.
Advocacy’s role in this context is to reinforce national governments’ focus on eye health – included in universal health coverage – and support stakeholders, eye health workers, the private sector, and NGOs to ensure continuum in service delivery, access to affordable care, health promotion, and policy change.
The prevalence of myopia is approximately 31% in adults aged ≥25 to ≤ 90 years and 47.2% in the 25–29 years age group. Myopia is a predominant and growing vision health issue among children. Many still live with undiagnosed vision disorders even in the highest-income countries. Childhood myopia is not just another “refractive error,” so we must continue prioritizing children’s vision, building evidence, and raising awareness to reinforce myopia as a public health issue.
Engaging advocacy groups at European and national levels unlock many opportunities to address remaining barriers and ensure that countries have, not only policies and recommendations but also actionable resources and tools to manage interventions.
As a change-catalyst, advocacy is essential to eye health, and everyone has a role to play in making myopia correction and prevention accessible to every child.
Eva Lazuka-Nicoulaud is the Director– Europe-Africa at the Vision Impact Institute, working with governments, key opinion leaders, and non-governmental organizations to raise awareness for healthy vision through advocacy initiatives in these regions.