Understanding and preventing high myopia in children

As the digital lifestyle becomes the norm, greater understanding
of the risks of myopia helps prevent irreversible eye conditions in children,
such as cataracts and glaucoma, as they go into adulthood.
Issue 6 | September 2024

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The sight of commuters on the MRT, young or old alike, with their eyes glued to screens, is no longer an uncommon one. As digital devices become ubiquitous, offering convenience and constant connectivity, the spike in excessive screen time brings a range of unsightly side effects. Among these, a myopia epidemic sweeping the globe, affecting  children in particular.

According to the International Myopia Institute, it is estimated that half of the world’s population will be myopic by 2050.  Singapore, often called the ‘Myopia Capital of the World’, has seen 65 per cent of children develop myopia by the age of 12, while 83 per cent of young adults are myopic. Meanwhile, up to one in five children  have high myopia — a sharp increase from around 10 per cent a decade ago.

The consequences of high myopia can be severe. “Children with high myopia face an increased risk of eye diseases in adulthood, including myopic macular degeneration, retinal detachment, cataracts and glaucoma, which can lead to vision impairment. Fortunately, reducing myopia by 100 degrees (1D) can lower the risk of these conditions,” says Dr Janice Lam, Consultant, Department of Ophthalmology, National University Hospital (NUH).  

Managing the risks of high myopia

Parents are encouraged to take proactive steps to monitor and manage their child’s eye health

1. What signs should I look out for?

High myopia can lead to retinal breaks or detachments, and if left untreated, permanent blindness. These breaks or detachments occure when the retina separates from its underlying tissue, due to the elongation of eyeball caused by myopia.

Be alert if your child complains of seeing floaters, white flashes of light, and/or experiences part of their vision being obscured by a ‘black curtain’, or if they suddenly lose vision. If any of these symptoms occur, seek emergency medical attention immediately. 

2. What can I do to reduce my child’s myopia?

Although established myopia cannot be reduced per se, delaying myopia onset and its progression can be achieved through lifestyle modifications, optical corrections and pharmacological interventions. Outdoor activities are strongly encouraged, with at least two hours of outdoor time recommended daily. Reducing screen time and encouraging regular breaks during near-work activities, like reading, can help manage myopia. Heed the 20–20–20 rule: for every 20 minutes of near-work, have your child look at something 20 feet (6 metres) away for at least 20 seconds or more. 

If myopia has been established and wearing glasses is unavoidable, parents may enquire about using special myopia control spectacle lenses that have been shown in clinical studies to help with controlling myopia. 

“In addition, parents can also consider consulting their local paediatric ophthalmologist about the suitability of low-dose atropine eyedrops in their children, which have been shown in many clinical studies to effectively slow down myopia progression,” Dr Lam adds.

3. How do glasses and contact lenses for children work to reduce myopia?

Special spectacle lenses like HALT (Highly Aspherical Lenslet Target) or DIMS (Defocus Incorporated Multiple Segments) can help control myopia progression by at least 50 per cent compared to single-vision lenses. For active children aged eight and above, daily disposable soft contact lenses are an option. 

Ultimately, suitability depends on the child’s age, severity of myopia and astigmatism, family history of myopia, as well as their motivation to switch from glasses to contact lenses and their ability to maintain proper hygiene. An optometrist can evaluate whether contact lenses are a good option for your child. Above all, parents should be involved in the process, providing support and close monitoring to ensure adherence to the treatment regime.

Advancing precision medicine to treat retinal diseases

For patients affected by currently untreatable and blinding retinal diseases, Assistant Prof Su Xinyi, Senior Consultant, Department of Ophthalmology, NUH, offers hope.

A/Prof Su’s research shines a light on gene therapy, underpinned by individualised treatments tailored to the unique genetic mutations of each patient, which involves replacing the mutated genes responsible for retinal diseases. By specifically targeting these genetic defects, her research could help restore vision in patients who might otherwise face inevitable blindness.

A/Prof Su also carries out research to advance cell therapy for end-stage age-related macular degeneration (AMD) — the third leading cause of blindness worldwide. One of her research projects involves growing retinal pigment epithelium cells from umbilical-cord-derived stem cells and injecting them into the eye to replace degenerated cells. This method reduces the likelihood of rejection and the need for immunosuppressants, potentially offering a safer and more effective treatment option for patients with AMD.

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