surgery on The back of the eye is a bit like laying down new carpet: You have to start by moving the furniture. separation of the muscles that hold the eyeball within its socket; Make a precise cut in the conjunctiva, the mucous membrane that covers the eye. Only then can the surgeon rotate the eyeball to reach the retina, the thin layer of tissue that translates light into color, shape and movement. “Sometimes you have to pull it off a bit,” Bai-Chang Wu says 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 years old, tall and slender, with thick dark hair and a slightly stooped gait. Over dinner at the swanky Grand Hotel in Kaohsiung, he leafs through the files on his laptop, showing me pictures of eye surgery — the plastic rods that hold the eye in place, xenon lights that illuminate the inside of the eyeball like a stage — and clips from the movies. With subtitles related to the vision that transforms Avengers: Endgame, Top Gun: MaverickAnd Zootopia In public health messages. He stares at the screen through the lenses of cola bottles that protrude from thin silver frames.
Wu specializes in retinal detachment repair, which occurs when the retina becomes separated from the blood vessels inside the eyeball that provide it with oxygen and nutrients. To the patient, this condition first appears as light or dark spots, known as floaters, that dance across their vision like fireflies. If left untreated, small tears in the retina can progress from blurred or distorted vision to complete blindness – blocking all eyes.
When Wu began his surgical career in the late 1990s, most of his patients were in their 60s or 70s. But in the mid-2000s, he began to notice an alarming change. People on the operating table are getting younger. In 2016, Wu performed scleral buckling — a strap around the eye to hold the retina in place — on a 14-year-old girl, a student at an elite high school in Kaohsiung. Another patient, a prominent programmer who worked for Yahoo, suffered two severe retinal detachments and was blind in both eyes when he was 29 years old. Both conditions are part of a broader problem that has been growing across Asia for decades and is quickly becoming a problem in the West as well: an explosion of myopia.
Nearsightedness, or what we commonly call myopia, occurs when the eyeball becomes too long — it distorts from a football to a soccer ball — 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, the worse the vision. Ophthalmologists measure this distortion in diopters, which indicates the lens strength required to return a person’s vision to normal. Anything worse than -5 diopters is considered “extreme myopia”—between 20 and 25 percent of myopia diagnoses worldwide fall into this category. In China, up to 90% of adolescents and young adults are nearsighted. In the 1950s, it was as low as 10 percent. A 2012 study in Seoul found that 96.5% of 19-year-old men were nearsighted. Among high school students in Taiwan, this percentage is about 90 percent. In the United States and Europe, rates of myopia at all ages are less than 50%, but they have risen sharply in recent decades. It is estimated that by 2050, half of the world’s population will need glasses, contact lenses or surgery to see across a room. Severe myopia is now the leading cause of blindness in Japan, China and Taiwan.
If these trends continue, it is likely that millions of people around the world will become blind much earlier in their lives than they – or the societies in which they live – are prepared for. It’s a “time bomb”, says Nicola Logan, professor of optics at Aston University in the UK. She wasn’t the only expert I spoke to who used the phrase. And because so many of Taiwanese are already living nearsighted lives, the island nation has been able to see what can happen to the rest of us. In a rare confluence, the country may also be the best place to look for solutions.
on the bullet By train south from Taipei, you can see smog hanging over Kaohsiung from miles away, blurring the edges of buildings. During the Japanese occupation, which ended in 1945, what had been a small trading port was transformed into one of Taiwan’s largest cities, with heavy industry and shipbuilding riots. Over the next four decades, as Taiwan rapidly transformed from a predominantly agricultural economy to a manufacturing powerhouse, the lives of its citizens changed as well. Families flocked to the cramped apartment buildings that still make up much of urban housing. Children’s education was compulsory and became increasingly intensive. A network of after-school establishments called “intensive schools” emerged, allowing parents to work long hours without the childcare support of elderly relatives that they would have received in the old society. At the end of the school day, some of the children would take the bus, not to go home, but to go to their own school, some of which were open until 9 p.m.
Bai Chang Wu was born in Kaohsiung, at the height of the city’s transformation, in 1970. His grandparents, none of whom were nearsighted, were farmers in central Taiwan. His parents were teachers and, like many Asian parents, placed great emphasis on education as one of the few levers they could utilize to rise in society. His father imposed a strict daily routine: getting up at 5 am to practice calligraphy and violin, and school from 7:30 am to 4 pm. Once Wu got home in the evening, he had to complete his homework. And on weekends, take part in calligraphy competitions. At the age of nine, Wu was diagnosed with nearsightedness.