Did you know that half of the world’s population is projected to be myopic by 2050¹, and Singapore’s myopia figures are even higher than that?
Often known as the myopia capital of the world, eight out of 10 children in Singapore are likely to be myopic by Primary 6². Myopia is so prevalent here that it is hard to find a child who is not myopic, and yet parents are generally unaware of the long-term impact of myopia on their child’s health and how to manage it.
But why should we be concerned about myopia and how can we manage it? Let’s first take a look at how myopia occurs.
Myopia is a disease that has long-term implications
Myopia is sometimes called “nearsightedness”, but it is much more than that. It is a chronic and progressive eye disease where the eyeball is elongated so that light rays focus incorrectly on a point in front of the retina instead of directly on its surface. This results in one having clear vision for nearby objects but blurred vision for faraway objects – for example, you could read a book up close but struggle to read road signs.
Myopia is commonly caused by genetics and environmental factors. As myopia tends to run in the family, if one of the parents is myopic, the chances of the child being myopic is doubled. If both parents are myopic, then the chances of the child getting myopia will be 3.4 times more³.
Additionally, children tend to prefer staying indoors due to Singapore’s humid weather. This increases the time that they spend doing near work such as reading and using digital devices for play and study, and in turn increases their chances of developing myopia.
Young children who develop myopia before the age of 12 are at heightened risk of developing high myopia4, defined as 5.00 diopters (500 degrees)5 and above in each eye. If a child’s myopia progresses into high myopia, they are vulnerable to developing sight-threatening complications such as such as myopic macular degeneration6 and retinal detachment7.
It is essential to manage myopia, not just correct it
Do you perceive myopia as a condition that is beyond your control? If yes, you are not alone. Most parents share this misconception and do not know how to intervene to slow down its progression. As a result, correcting their child’s blurred vision with spectacles is often the go-to solution for parents.
Spectacles and other forms of correcting a child’s vision are effective in helping myopia sufferers see clearly, but they are only temporary solutions that do not impact the progression or condition of one’s myopia. Vision correction differs from myopia management, where the progression of myopia is controlled to prevent high myopia from developing.
It’s essential for parents not to merely correct the symptom, but to take action in managing the disease itself.
Slowing down the progression of myopia
The most effective way of delaying the onset of myopia in children is to increase the time that they spend outdoors. A study8 found that children who spend 200 minutes or more every day are less likely to be, or to become, myopic regardless of how much near work they do or whether they’re genetically inclined to be myopic. This is partly because bright outdoor light, which cannot be replicated indoors, provides a protective effect to prevent myopia onset and progression even if you’re wearing sunglasses or are under an outdoor shelter9.
It’s advisable to make it a habit to actively involve your child in regular outdoor activities such as sports, games and walking. Try your best to take your family out on daily outings so that your child spends more time away from screens and books indoors, and benefits from outdoor light.
Another solution is to start your child on optical intervention treatments10 available in Singapore that are safe for use in children and have been shown to be effective in slowing down myopia progression.
- Myopia control daily contact lenses worn in the daytime
- Myopia control spectacle lenses with a design that creates peripheral defocus
- Orthokeratology, also known as ortho-K lenses, which are CE cleared for myopia control. Ortho-K lenses, such as the ACUVUE®Abiliti™ Overnight Therapeutic Lenses, are hard lenses worn at night while the child is sleeping to reshape their cornea and provide clear vision the next day so that they don’t need to wear spectacles or contact lenses.
Children whose myopia can be controlled when it is at a low degree will enjoy more freedom from impaired vision for the rest of their lives. As reducing the rate of myopia progression could reduce the prevalence of high myopia by up to 90%, it is essential for every parent to actively manage your child’s myopia and eye health. A crucial first step that you should take is to bring your child to the optometrist for regular eye checks to assess the progression of their myopia and discuss the best treatment for managing it.
There is no ‘safe’ level of myopia and it is never too early to start, so take action to protect your child’s eye health so that they can see better for the rest of their lives.
This article was contributed by Ken Tong, President of the Singapore Optometric Association.
¹ 5 Holden BA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology 2016;123:5:1036-42
² SNEC Article on Childhood Myopia
3Jang X, Tarczy-Hornoch K, Cotter SA, Matsumura S, Mitchell P, Rose KA, Katz J, Saw SM, Varma R; POPEYE Consortium. Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age. JAMA Ophthalmol. 2020 May 1;138(5):501-509.
4 Hu Y et al. Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol. 2020;138:1–6.
5 Holden BA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmol 2016;123:1036-42.
6Ohno-Matsui K, Lai TY, Lai CC, Cheung CM. Updates of Pathologic Myopia. Prog Retin Eye Res 2016;52:156-87.
7Mitry D, Charteris DG, Fleck BW et al. The Epidemiology of Rhegmatogenous Retinal Detachment: Geographical Variation and Clinical Associations. Br J Ophthalmol 2010;94:678-84.s
8French AN, Ashby RS, Morgan IG, Rose KA. Time outdoors and the prevention of myopia. Exp Eye Res. 2013 Sep;114:58-68. doi: 10.1016/j.exer.2013.04.018. Epub 2013 May 2. PMID: 23644222.
9Carla Lanca, Aaron Teo, Ananthan Vivagandan, Hla M. Htoon, Raymond P. Najjar, Daniel P. Spiegel, Suan-Hui Pu, Seang-Mei Saw; The Effects of Different Outdoor Environments, Sunglasses and Hats on Light Levels: Implications for Myopia Prevention. Trans. Vis. Sci. Tech. 2019;8(4):7. doi: https://doi.org/10.1167/tvst.8.4.7.
10Wildsoet CF, Chia A, Cho P, Guggenheim JA, Polling JR, Read S, Sankaridurg P, Saw SM, Trier K, Walline JJ, Wu PC, Wolffsohn JS. IMI – Interventions Myopia Institute: Interventions for Controlling Myopia Onset and Progression Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M106-M131. doi: 10.1167/iovs.18-25958. Erratum in: Invest Ophthalmol Vis Sci. 2019 Apr 1;60(5):1768. PMID: 30817829.
11Holden et al. 2017, The impact of myopia and high myopia: report of the Joint World Health Organization–Brien Holden Vision Institute Global Scientific Meeting on Myopia, https://www.who.int/blindness/causes/MyopiaReportforWeb.pdf