Op-ed: A letter from Chinese eye doctors

The following is a letter by Chinese ophthalmologists at Dr. N.D. Abdulla Abdul Hakeem Ophthalmology Center (China-Maldives Ophthalmology Centre) to the Maldivian citizens.

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Dear Maldivian citizens,

June 6, 2023 marks the 28th "Sight Day" in China, with the theme of "Prioritizing universal eye health". This year's focus will be on two key population groups: children and adolescents, as well as the elderly. The diseases of focus are myopia and other refractive errors, cataracts, and retinal diseases (including diabetic retinopathy and macular diseases). By targeting these important eye diseases, the aim is to enhance overall eye health throughout the entire life cycle.

We are Chinese doctors stationed at the Dr. N.D. Abdulla Abdul Hakeem Ophthalmology Center from China's most renowned Zhongshan Ophthalmic Center, Sun Yat-sen University. In patients visiting the Dr. N.D. Abdulla Abdul Hakeem Ophthalmology Center, we have found that children, adolescents, and the elderly populations require special attention in ophthalmology. This is similar to our observation in China.

In the Maldives, some children and adolescents have not developed good habits, and they excessively use electronic devices in their daily lives and studies, leading to a high prevalence of myopia. Additionally, many myopic children have not received proper medical refraction and standard optical correction, which severely disrupts their physical and mental well-being.

The Maldives, located in the tropical region, is exposed to intense ultraviolet radiation. The strong ultraviolet radiation and high proportion of sugar-rich foods in the daily diet contribute to a high prevalence of blinding eye diseases, such as cataracts and diabetic retinopathy, among elderly Maldivians. Furthermore, many elderly people are unaware of the importance of regular eye examinations. As a result, many patients do not receive timely medical care, leading to permanent visual impairments.

On the eve of China's "Sight Day," we write this letter to convey an important message - to focus universal eye health as a priority. From the perspective of eye disease prevention and treatment, we sincerely offer the following professional recommendations to our fellow Maldivians:

Recommendations for Prevention and Control of Myopia in Children and Adolescents:

1. The clinical studies conducted internationally focusing on children and adolescents have indicated that outdoor activities can help reduce the incidence of myopia among them. It is recommended that children and adolescents should have at least 2 hours of outdoor activities every day.
2. Develop good habits and reduce the use of electronic devices. When reading, it is recommended to follow the "20-20-20" rule, which suggests that for every 20 minutes of close-up reading, you should take a break and look at something at least 20 feet away for a minimum of 20 seconds.
3. Improve the lighting environment. When there is insufficient natural daylight, turn on reading lights for adequate illumination. When reading in the evening, it is recommended to use both a desk lamp and overhead room lighting to enhance the lighting conditions.
4. For children and adolescents, it is advisable to have two comprehensive eye examinations at a reputable ophthalmic clinic each year. These examinations should include assessments of visual acuity, axial length measurement, and medical refraction. Children with an axial length of 26.5mm or more should undergo regular monitoring of their eye health, including retinal examinations, at least every six months.
5. If there is a refractive error present, it is important to seek timely medical care at an ophthalmic clinic/hospital and obtain the proper prescription of eyeglasses through standard refraction assessment.

Recommendations for Prevention and Control of Age-related Eye Diseases:

1.  Adopting a healthy lifestyle is crucial, which includes engaging in regular physical activities, maintaining a balanced diet, and controlling the intake of sugar and high-calorie foods.
2. Avoid prolonged and excessive exposure to ultraviolet (UV) radiation. When exposed to strong sunlight or participating in outdoor activities, it is important to wear sunglasses that offer effective UV protection.
3. Regular comprehensive health check-ups are important to detect and treat conditions such as diabetes, cardiovascular diseases, and hypertension at an early stage. Maintaining good control of blood sugar, blood pressure, and blood lipids can help prevent the occurrence of diabetic retinopathy or slow down its progression.
4. The best approach to prevent diabetic retinopathy is through early screening, diagnosis, and treatment. Once type 2 diabetes is diagnosed, it is crucial to undergo a comprehensive initial eye examination as soon as possible. The first eye examination should be conducted at an ophthalmic clinic/hospital. If the results are normal, subsequent diabetic retinopathy screenings can be scheduled every 1-2 years by an ophthalmologist or endocrinologist.
5. For early-stage diabetic retinopathy, oral medications can be prescribed to improve retinal microcirculation. In severe cases, options such as retinal laser treatment, intravitreal injections, or vitreoretinal surgery may be considered.

Dr. N.D. Abdulla Abdul Hakeem Ophthalmology Center is jointly established by the Chinese and Maldivian governments and equipped with advanced ophthalmic instruments. Our dedicated team of Chinese ophthalmologists in the Maldives is fully committed to delivering comprehensive eye care services. We extend our heartfelt wishes for the everlasting friendship between China and the Maldives!

Professor Chen Weirong and all members of the Chinese Ophthalmic Medical Expert Group in Maldives,

Dr. N.D. Abdulla Abdul Hakeem Ophthalmology Center (China-Maldives Ophthalmology Centre), Hulhumalé Hospital, Hulhumalé, Maldives,

On the eve of Chinese Sight Day in June 2023.