In the foyer of the Optometry Centre at Peking University People’s Hospital children line up to have their eyes tested.
A nurse in a starched paper cap and microphone headset points at three-pronged symbols on large chart.
One by one the children step forward and squint at the shapes.
“Up,” guesses a boy of about seven as he strains to focus on a downward facing “E”.
“Not clear,” says a girl of about five, already in glasses, as the nurse gestures to large symbol towards the top of the chart.
China is in the grip of a myopia epidemic that threatens to undermine its social and economic development.
About 47 per cent of schoolchildren under the age of 15 are short sighted as result of long hours studying, not enough exposure to sunlight and too much screen time. Among university students that figure rises to 86 per cent, according to health ministry statistics.
The Communist-led government is so worried about the nation’s eyesight that last week it announced plans to add juvenile myopia rates to the list of things provincial governments are assessed on in their annual report.
“Levels of short-sightedness are high and rising,” said the Ministry of Health when it announced its new action plan. “They have become a concern for the future of the state and the nation.”
Forty years ago China’s myopia levels were largely in line with those of the West – about a third of the population were short sighted.
But once the economy took off and people began to move to the city in large numbers at the turn of the last millennium, things began to change rapidly.
Today myopia levels in China rival those found in highly-developed, urban neighbours Singapore or South Korea, and looks set to surpass them.
The fear for Chinese leaders is that high-levels of short sightedness will have a double-whammy effect on the economy. Firstly, that it will be a burden to public health system as this demographic ages – people with severe myopia are more likely to develop other problems that can lead to blindness.
Secondly, that the county will not have enough well-educated, able-sighted people to help fulfil the next stage of its economic transformation — to become a global leader in cutting edge technology by 2035.
Already the Peoples Liberation Army is complaining that its own modernisation drive is hitting a block because it is struggling to find healthy, educated recruits who can operate advanced weapon systems and fly its supersonic fighter jets.
"There is no doubt that high rates of myopia are affecting national security," wrote Dai Xu a senior air force officer in the Global Times last month.
The government’s new action plan seeks to cut rates of juvenile myopia by at least 10 percentage points by 2030 by reducing the amount of homework schools give, increasing the amount of sport children play outside and educating parents about the dangers of too much screen time.
Cities such as Beijing and Shanghai – where the problem is worse – will be expected to cut their rates faster than other regions, it said.
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But ophthalmologists wonder whether the new plan will work. For years they have been warning of the dangers of children straining their eyes. Often it is parents who push their children to start learning early or take on extra-curricular studies so they can get ahead in life.
China’s smog problem doesn’t help either. Even if parents and schools made enough time for children to play outside, this would risk hurting their lungs for the sake of their eyes.
Bright sunlight is believed to help guard against myopia by getting the eyes to release a chemical called dopamine that shortens the length of the eyeball. Short-sightedness is caused by the eyeball becoming too long in relation to the cornea, meaning the light rays converge or focus before they reach the sensors at the back of the eye.
The positive effects of sunlight are part of the reason rural Chinese children have lower myopia rates than urban Chinese youngsters, said Dr Kai Wang, assistant dean of Peking University’s Optometry College.
He also believes that research shows East Asians have a greater genetic predisposition towards myopia, meaning environmental factors have greater impact.
Others contest that view and say the high prevalence of short-sightedness in the region is due to lifestyle – especially the emphasis placed on academic achievement.
Wu lihe, the mother of a seven-year-old girl getting glasses at the Optometry Centre, says genetics, homework and the pollution combine to produce the perfect storm.
“Her father and I didn’t start wearing classes till we were older, but she needs them now.”
She said that in her daughter’s first year of school almost all the children got glasses.
“We don’t see children’s eyes developing normally anymore,” said Dr Kai.