Myopia in the Middle Kingdom

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Latest chapter of the perpetual litany against the epidemic of nearsightedness in the homeland of sinograms:

"China rolls out mandatory national standards to prevent myopia among students", Zhang Jinruo, People's Daily (3/16/21)

The abnormally high incidence of myopia among Chinese children has been noted and bemoaned for decades. Governments have repeatedly declared war on nearsightedness.  Here's today's installment:

A set of mandatory national standards on juvenile myopia prevention was put into practice in China since March 1, requiring all school supplies to meet myopia prevention criterions, from paper materials such as text books, to classroom lighting and multimedia teaching systems.

All schools supplies produced, manufactured, operated and provided by enterprises, primary and middle schools, vocational high schools, kindergartens and after-school training institutions, must comply with the standards.

According to the World Report on Vision released by the World Health Organization last year, myopia affected about 2.6 billion people around the world, and its penetration among children and adolescents was kept rising. In China, around 60 percent of children and over 90 percent of adolescents suffer from this common refractive error.

Myopia rates among Chinese primary, middle school and high school students rose 15.2 percent, 8.2 percent and 3.8 percent, respectively in the first half of 2020 compared with those at the end of 2019, said a survey done by the Ministry of Education that investigated students in nine Chinese provinces.

These alarming statistics and rising rates are nothing new.  They have been decried year after year after year.  Laws, decrees, and regulations are passed, but nothing changes.  It only gets worse.

The newly implemented standards will prevent and control myopia from multiple aspects, said the State Administration for Market Regulation.

For instance, the standards have different requirements on the font sizes adopted by textbooks for different grades. Textbooks for first- and second-graders must be printed with characters not less than point size 16, and those for third- and fourth-graders must be printed with characters not less than point size 14. The font size for fifth- to ninth-graders, as well as high school students must be equal to or larger than point size 12, while that for preschool materials must be not less than point size 16.

The standards also request textbooks and exercise books to be neatly printed without any visible smudge. Ink on study-use paper must be evenly distributed. Blurry prints and obvious watermarks are not tolerated.

Besides, flickering of multimedia teaching systems shall be imperceptible, and the systems shall comply with blue light protection requirements and offer suitable screen brightness.


In my estimation, all such ophthalmological handwringing misses the main two points:

1. Sinograms by nature are highly demanding of visual acuity to differentiate among the thousands it is necessary to know for literacy.

2. The extraordinary emphasis on high examination scores (starting from a tender age through college) to get into the best schools and go abroad means that students are compelled to study a maximum number of hours per day, getting little exercise and time outside.

Of course, there are many other factors, such as the habit of reading outside of school in poor lighting, even when lighting in the classroom is adequate, which is not always the case.  Still, if the government wants to lower the myopia rates in China, they need to face these two issues and take appropriate steps to improve the situation.

I'll believe it when I see it.


Selected reading

  • "The causes of myopia" (7/5/19)
  • "Myopia in East Asia" (1/31/15)
  • "Chinese characters and eyesight" (11/12/14)
  • "An Eighteenth-Century Japanese Language Reformer" (4/23/15) — fascinating comments on the Sinographic writing system and comparison with alphabetic writing in India and Holland.  "Only China concocted a cumbersome system, so things are disorderly there and everything is troublesome."  An argument for writing in kana.
  • "Sinophone and Sinosphere" (11/8/12)
  • "The Sinophone" (2/28/19)
  • "Writing Sinitic languages with phonetic scripts" (5/20/16)
  • "Writing characters and writing letters" (11/7/18)
  • "Learning to write Chinese characters" (7/29/17)
  • "Writing Chinese characters as a form of punishment " (11/1/15)
  • "Copying characters" (2/11/13) — begins with a photo that brings tears to my eyes
  • "The cost of illiteracy in China" (3/31/12)  — The strained look of the little girl in the photograph accompanying the post speaks volumes! One often sees exactly that look (note especially the pinched brow) on the faces of children (and even adults!) who are trying to extract sounds and meanings from the densely packed, complicated strokes of the morphosyllables on a page. This is not to mention that the texts children are asked to read at a young age are poorly written, employ an execrable style (too wooden and grown-up, semivernacular-semiclassical, etc.), and are on dull subjects that are completely inappropriate for elementary and middle (junior high) school pupils.
  • Magistry,  Pierre,  Fabre,  Murielle,  and  Goudin,  Yoann  (2017).  Indicesphonologiques des sinogrammes: de l’étude de l’acquisition à la modélisationpour l’apprentissage. Traitement Automatique des Langues, 57(3):39–63
  • Wang, Ilaine (2017).  "Syntactic Similarity Measures in Annotated Corpora for Language Learning:  Application to Korean Grammar".  See passim for "sinogram", "sinogrammic", etc.

[h.t. Jim Fanell]


  1. Keith said,

    March 16, 2021 @ 1:02 pm

    I seem to remember reading about a study into the problem of myopia in schoolchildren in the PRC a while ago, that studied the rates of myopia in populations of ethnic Chinese children in Australia and in Singapore (if I remember rightly).

    The study suggested that the biggest environmental difference between the children in Australia and those in Singapore was that the Australian children spent much more time each day outdoors in natural light, and that exposure to UV light signalled to the eyeball to stop growing. In the Singaporean children, lack of exposure to UV light meant that their eyeballs continued to grow, increasing slightly the distance between the cornea and the retina, causing the myopia.

    An internet search throws up a few papers that might match my recollection, but many seem to requite an academic subscription to be able to read them.

    "Myopia, Lifestyle, and Schooling in Students of Chinese Ethnicity in Singapore and Sydney", published at the link below looks like a likely candidate.

  2. David C. said,

    March 16, 2021 @ 7:12 pm

    Prevalence of myopia in children and young adults is also high in South Korea, where one does not need to deal with highly demanding sinograms.

    A summary of studies here:

    Learning in large, crowded classrooms, where students are expected to spend hours copying the teacher's writing on the blackboard, often at quite a distance, must somehow play into all of this as well.

    In mainland Chinese classrooms, students have to do compulsory eye exercises (massaging of areas around the eyeballs; 眼保健操) with the purported aim of preventing or slowing incidence of myopia. With myopia rates climbing after decades of these exercises, there's now a lot more skepticism about them.

  3. alex wang said,

    March 16, 2021 @ 9:03 pm,each%20day%20in%20their%20childhood.

    I had to laugh and cry when I read this post. You could not believe the arguments ive had with the in-laws over this issue.

    My kids love reading and they have had a fair amount of screen time due to great learning apps like khan academy and educational cartoons so they can have an English environment beyond me. My younger eyes are worse than the older one due to significant piano time due to reading sheet music.

    Personally I have had glasses since the 3rd grade and am blind without my contacts/glasses.

    The in-laws would say the kids shouldn't read so much as they value eyes over brain development I guess. As do many parents in the garden. My view is science will take care of poor vision within 20 years but learning while young is a window. I always ask the parents "Is it because you want your kids to grow up to be hunters?"

    To Professor Mair's point ive pointed out to inlaw's, wife and parents perhaps they shouldn't spend so much time writing and reading Chinese! As I have written before having kids write Chinese characters in tiny 9 mm by 9 mm boxes is the meaning of punishment. I think how in the movies they have kids write on the wall 50 times I will not talk in class, here in China the elementary kids do it daily as homework writing the more difficult characters 20 times.

  4. sigh said,

    March 16, 2021 @ 10:18 pm

    what about Japanese?

  5. Bathrobe said,

    March 17, 2021 @ 12:34 am

    what about Japanese?

    Google it: you'll find it's very bad.

    I think the problem is the system of schooling that forces children to do huge amounts of study instead of playing outdoors.

  6. C Baker said,

    March 17, 2021 @ 12:37 am

    @Alex Wang: Everything in moderation – including study. You might be interested to know that time outside improves focus and learning.

  7. Antonio L. Banderas said,

    March 17, 2021 @ 2:29 am

  8. Chris Partridge said,

    March 17, 2021 @ 3:15 am

    One of the main causes of myopia is genetic, which obviously cannot be treated (so far anyway). The authors of The Glass Bathyscaphe argue that one of the reasons why glass was not adopted widely in China was that scholars could do without spectacles because you can still read despite acute close sight. In Europe, however, the careers of many scholars were cut short because increasing long sightedness as you get older makes you effectively blind. So when lenses became available in the West they were eagerly adopted.

  9. alex said,

    March 18, 2021 @ 10:02 pm

    @C Baker said

    "Everything in moderation – including study. You might be interested to know that time outside improves focus and learning"

    What is considered moderation changes as society changes. That said I do believe in exercise and play for my kids.

    tennis and swimming and just running around.

    That said to become better than average at anything requires consistency and more time.

    the key is try to make it fun, That's for the other blog post on crash to earth

  10. alex said,

    March 18, 2021 @ 10:05 pm

    @Chris Partridge

    "One of the main causes of myopia is genetic,"

    I do believe this to be true but its the magnitude that genetics plays is up to question. I wonder if there has been any twin studies on eyesight and time focused on things that require focused close vision

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