Untreated ‘lao hua yan’(Presbyopia) a major public health concern in rapidly ageing Singapore

Untreated ‘lao hua yan’

(Presbyopia) a major public health concern in rapidly ageing Singapore

https://www.straitstimes.com/opinion/untreated-lao-hua-yan-a-major-public-health-concern-in-rapidly-ageing-singapore

2024-02-01

Professor Ecosse Lamoureux 

Do you find your vision blurry when you try to read your phone screen up close? Does holding the phone farther away help?

There may be many reasons for this long-sight condition, including ageing, as our eyes gradually lose the ability to focus on nearby objects.

Presbyopia (“lao hua yan” in Chinese) usually occurs in individuals in their 40s and affects almost everyone by the age of 50. Yet recent studies in India and Africa have suggested that this condition may be occurring at an earlier age than initially believed, with almost one in seven individuals aged 35 to 39 requiring reading glasses. 

There is speculation that increased screen time, particularly with the prolonged use of smartphones and laptops during both work and leisure hours, may lead to increased eye strain, resulting in an earlier onset of presbyopia. 

These findings underscore the critical importance of early detection and management of this debilitating age-related condition even in younger populations.

Singapore has one of the world’s highest average life expectancy rates, at 83 years, and it is estimated that a quarter of its population will be 65 and above by 2030. The prevalence of presbyopia is therefore expected to rise exponentially over time.

Notably, a recent contemporary population-based study by the Singapore Eye Research Institute and Duke-NUS Medical School from 2017 to 2022 found that approximately a third of presbyopic adults in Singapore do not take measures to correct their declining near vision. The Population Health and Eye Disease Profile, or Pioneer, study involved community-dwelling Chinese, Malay and Indian Singaporeans aged 60 and above.

More importantly, it found that the uncorrected rates of presbyopia were substantially higher in older individuals (38.2 per cent in those aged 80 and above, versus 23.7 per cent in those aged 60 to 69), women and Malays. 

This is worrying because of the longer lifespan of Singaporeans, particularly of women, who are expected to live approximately 85.2 years. 

The ills of presbyopia

Presbyopia is an age-related condition caused by a gradual decrease in the ability of the eye to focus on near objects, resulting in blurred near vision. This inevitable condition, which has a considerable impact on the quality of life of individuals, is estimated to affect 1.8 billion people worldwide, and this figure is likely to increase as the population ages. 

While it can be easily corrected using reading glasses, multifocal contact lenses or refractive surgery, 826 million people worldwide have near-vision impairment because of no or inadequate presbyopia correction, making it an important public health concern. 

Critically, uncorrected presbyopia significantly reduces quality of life, including poor functioning, difficulty performing activities of daily living such as reading, writing and cooking, contributing to disability and dependence, especially in older individuals. Given its deleterious consequences and the fact that it is amenable to interventions, correcting presbyopia so that older adults can maintain their functional independence and age successfully is a key national priority.

With the use of digital devices becoming almost ubiquitous in workplaces now, presbyopia could result in potential productivity losses if left uncorrected.

Furthermore, with the planned raising of the retirement and re-employment ages to 65 and 70, respectively, addressing uncorrected presbyopia is imperative for our seniors to be financially independent and secure.

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Correcting the condition

The high prevalence of uncorrected presbyopia in Singapore, a modern urban society with ready access to optical services, is concerning. 

Screening programmes to detect and manage presbyopia in high-risk individuals, particularly those who are older, Malay, or women, should be implemented to assist these at-risk people to maintain their functional independence well into their golden years and improve their quality of life. 

More work must be done to determine the group of individuals most at risk for government agencies to come up with appropriate strategies to tackle this pervasive issue. 

Some suggested interventions include targeted community eye screening and patient education programmes to improve the use of near-vision correction and reduce quality-of-life deficits.  

At the individual level, eye-care habits such as the 20-20-20 rule could be promoted. This involves taking a break every 20 minutes and looking at something about 20 feet away for at least 20 seconds to help relieve eye strain and improve visual perception.

We must redouble such efforts as Singapore aims to promote good visual health in older adults to align with a contemporary focus on healthy, independent and meaningful ageing.

Professor Ecosse Lamoureux is director of the Population Research and Clinical Epidemiology platform at the Singapore Eye Research Institute, and principal investigator of the Pioneer study. He is also a Duke-NUS Medical School faculty member.

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