Childhood Myopia

Childhood Myopia, also known as short-sightedness, occurs when the eyeball becomes too long (long axial length). As a result, distant images fall in front of the retina while near images are focused on the retina. The longer the axial length, the more severe the myopia. Development and progression of myopia is irreversible.

Globally, myopia rates are increasing. It is estimated that approximately 30% of the world are myopic, and this will increase to 50% by 2050. In Singapore, about 10% of Primary 1 students, 60% of Primary 6 students and 80% of 18-year olds are myopic. By 2030, it is expected that 80% of our population will be myopic with 20% being highly myopic (i.e. with myopia greater than -5D).

Myopia is a concern as it increases the risk of future blinding eye diseases later in life, such as:

1. Early onset cataracts
2. Glaucoma or optic neuropathy
3. Retinal tears and detachment
4. Myopic maculopathy

The last three conditions are associated with irrecoverable visual loss/ blindness.

How do I know if my child has myopia?

Common symptoms include:

• Unable to see the whiteboard at school
• Squinting while doing homework, reading or watching TV
• Frequent rubbing and/or blinking of eyes
• Eye fatigue
• Abnormal head posture
  
  

What causes childhood myopia?

Childhood myopia is caused by:

• Increasily urbanised lifestyle
• Too little outdoor activities
  
• Increase intensive near work 
• Genetics (i.e. myopic parents are more likely to have myopic children)
  
  

​In children, we specialise in the management or control of myopia progression. Our service includes comprehensive assessment, education and counselling.

During each visit, we assess: 

1. Glasses power (refractive error with/without cycloplegic eye drops) and +/- eye ball size (axial length)
   
2. Myopia progression is plotted and possible treatment or treatment combinations are discussed.
   

Following on, the child will be monitored biannually to annually for myopia progression.

In view of the rapidly rising prevalence of childhood myopia in Singapore, many new myopia control treatment modalities have been developed and are now available such as:

• Environmental: Good eye care habits
• Pharmacological: Atropine eyedrops
• Glasses: Peripheral defocus myopia control glasses
• Myopia control contact lenses
  

To counter myopia development, the Health Promotion Board (HPB) recommends these good eye care habits for children: 

• Spend at least 2 hours per day outdoors
• Decrease intensive near work (take frequent eye breaks)
• Increase indoor lighting
  

There is no evidence that any dietary supplements, acupuncture or magnetic therapy, eye exercises, vision therapy, blue filter lenses or pinhole glasses help to slow down myopia progression. 

Laser refractive surgery (e.g. LASIK) is possible once a child's myopia has stabilised (late teens/early 20s), but although this means the person does not need to wear glasses, it does not decrease the risk of myopia related complications associated with increased axial length (which remains unchanged) such as early onset cataracts, glaucoma, retinal tears/detachment and myopic macular degeneration. 

 

Case Illustrations

Case presentation 1:
Daren has been myopic since he was 7 years old. At 8 years, he was started on low dose atropine once per day in both eyes. The response in his left eye was good, but his myopia continued to progress in his right eye. Subsequently, his drops were then increased to twice a day with good effect. Following on, his drops were taper slowly from 11 years old, and stopped when he was 14. At review at 15, myopia had stabilised naturally off treatment. He was advised, however, to continue good eye habits till he was 20 years old.

Note: Atropine treatment can be tailored as needed. Some children will require higher doses of atropine than others. Younger children with myopic parents often need higher doses. Once the child is older and myopia is stable, medications can then be tapered and stopped.

Lucy was noted to have -2.0D of myopia at 6 years of age. She was initially started on atropine eye drops, but parents found it difficult to administer drops regularly. Her myopia continued to progress, and she was started on myopia control glasses (with peripheral lenslets) at age of 9 years with good effect.

Note: Different treatments may suit different children better. For example, some children may be afraid or have irritation to eye drops or keep forgetting to administer their eye drops, hence other treatments can be tried. However, glasses may not be suitable for children with eye misalignment or not available if myopia or astigmatism is too high. Similarly, children with eye allergies, frequent lid infections, dry irritable eyes or poor hygiene should not be fitted with contact lenses due to the increased risk of potentially blinding contact lens-related infections.

Different treatments may also work better at different ages or in different children. It is sometimes necessary to monitor, adjust or combine treatments. 

Types of myopia treatment:
https://www.snec.com.sg/patient-care/specialties-and-services/clinics-centres/myopia-centre/myopia-treatment-available

https://www.snec.com.sg/patient-care/specialties-and-services/clinics-centres/myopia-centre/evaluating-myopia-treatments

Myopia Clinical Trials - For Public:
https://www.snec.com.sg/research-innovation/clinical-trials/clinical-trials-for-public