Commentary: It’s not enough to count on glasses or Lasik to fix short-sightedness
A common misconception about myopia is that it cannot be managed after diagnosis. On the contrary, it is crucial to actively ensure the condition doesn’t worsen, says an optometrist.
SINGAPORE: There’s a silent epidemic in Singapore that affects up to eight out of 10 children by the time they are in Primary 6. It could have lifelong consequences, but parents are generally unaware of how to reduce its impact.
This epidemic is no stranger to any of us – it’s known as myopia.
Myopia is so prevalent in Singapore today that it’s hard to find a child who is not myopic. Our children now spend so much time on computers and mobile devices for leisure and schooling that myopia is an unavoidable reality for most of them.
But should we accept it passively by letting our children’s myopia progress over the years? Is there nothing that can be done about myopia beyond correcting our children’s near-sightedness with spectacles?
MYOPIA SHOULD BE MANAGED, NOT JUST CORRECTED
You might be wondering why there’s a need to be concerned about your child’s myopia when there are tried and tested ways to correct their vision.
As an optometrist, I have observed that when a child is diagnosed with myopia, the default response from parents is to fit the child with spectacles and hope that when they’re adults, they can undergo Lasik to permanently correct their vision.
While spectacles and Lasik are effective in helping a myopic sufferer see clearly, we need to differentiate between myopia management and myopia correction.
Blurred vision of faraway objects is the most immediate and visible consequence of myopia, but myopia is much more than simply not being able to see far. It is a chronic, progressive eye disease, characterised by excessive elongation of the eyeball, such that light rays focus on a point in front of the retina, rather than directly on its surface. This elongation of the eye is irreversible.
If it develops into high myopia, defined as 500 degrees and above in each eye, it could lead to sight-threatening conditions such as myopic macular degeneration and retinal detachment.
Young children who develop myopia before the age of 12 are more at risk of developing high myopia and, as a result, are vulnerable to developing complications later in life.
Spectacles act as a tool to correct vision but have little bearing on the progression of one’s myopia. Similarly, the Lasik procedure affords clear vision by removing a part of the layer of the cornea to neutralise myopia and astigmatism, but this does not treat the health risks which occur in eyes that have developed high myopia. This means patients can have 6/6 perfect vision after Lasik, but still be susceptible to developing myopia-related issues.
Therefore, it’s essential for parents not to merely correct the symptom, but to manage the disease itself.
MANAGE MYOPIA BY SLOWING ITS PROGRESSION
A common misconception about myopia is that it cannot be prevented or managed after being diagnosed. Its onset and progression can indeed be slowed down before it becomes high myopia.
The most effective way of delaying the onset of myopia in children is to increase the time they spend outside. A study found that children who are outdoors 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 myopia.
This is partly because bright outdoor light, which cannot be replicated indoors, provides a protective effect even if you’re wearing sunglasses or are under an outdoor shelter. Therefore, you should actively involve your child in regular outdoor activities such as sports, games and walking. One small and achievable lifestyle habit is to take your family out on daily outings so your child spends more time away from screens and even books indoors.
Another thing you can do is to start your child on optical intervention treatments available in Singapore. These include myopia control daily contact lenses worn in the daytime, spectacle lenses with a design that creates peripheral defocus, and orthokeratology, also known as ortho-K lenses. Ortho-K 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.
These treatments are safe for children and have been proven effective in slowing down myopia progression.
Children whose myopia can be controlled when at a low degree will enjoy more freedom from impaired vision. As reducing the rate of myopia progression could cut the prevalence of high myopia by up to 90 per cent, it is essential for every parent to actively manage your child’s eye health as early as possible.
If you’re unsure of how to get started, a crucial first step would be to take your child to the optometrist for regular eye checks to assess the progression of their myopia and discuss best methods for managing it.
The earlier we start, the higher the chance our children will enjoy good eye health for the rest of their lives.
Edith Ho is an optometrist and Assistant Manager of Professional Development, Vision Care at Johnson & Johnson Vision.