Severe myopia cases among children in Singapore almost doubled in past decade

SINGAPORE: When Asher Gan was in Primary 1, he could not see the whiteboard clearly even when sitting at the front of the classroom. 

His parents also noticed he would squint and bring his books close to his eyes.

“We realised that it's quite serious and we actually took it upon ourselves to get him checked, even though we know that the schools were having education about myopia.

“But I don't think the kids themselves know what myopia is,” said Asher’s father, Mr Gavin Gan.

Mr Gan thinks his son’s deteriorating eyesight is due to exposure to screens and devices. Asher also likes to read and does not ensure he has enough light to do so.

The boy – now aged nine – is among the 80 per cent of Singaporeans aged 18 or below who have nearsightedness, or myopia. This means they can clearly see objects that are near, but objects that are further away become blurry.

According to the Singapore National Eye Centre (SNEC), up to 20 per cent of children now have high myopia – defined as more than 500 degrees in each eye. This is compared to just around 10 per cent a decade ago.

SNEC is also seeing children as young as six years old having to wear glasses. A decade ago, the average age was around 12.

PANDEMIC, LACK OF OUTDOOR TIME

Associate Professor Marcus Ang, who heads the corneal and refractive surgery departments at SNEC, said one of the major risk factors is a lack of outdoor time.

The senior consultant noted that more children are using digital devices and indulging in more screen time. This comes as schools are incorporating such devices into their curriculum.

“These educational pressures lead to kids spending more time, perhaps in tuition, perhaps in studying, instead of playing outdoors. So I think this is probably the main cause of this recent increase,” Assoc Prof Ang said.

The COVID-19 pandemic also accelerated the situation, he added, with parents and children being even more comfortable with being on Zoom and using laptops or iPads.

“I think that behavioural change is perhaps a little bit more disturbing and alarming, rather than the actual use of digital devices,” he said.

“We’ve done surveys in Singapore, pre- and post-pandemic, showing that children are definitely spending more time (on screens) and definitely having slightly more myopia than before.”

Assoc Prof Ang added that while Singapore has always had a very high rate of myopia, he expressed concern that more children are getting it at an earlier age. This also means that they already reach high levels at around ages eight to 12.

The impact of this problem does not come until much later, he warned. An adult with high myopia has a much higher risk of complications that can lead to blindness, for example, cataracts and glaucoma.

“Kids with high myopia at 12 to 16 years old, they will not feel the impact of any of this until they’re maybe 30 or 40 years old,” Assoc Prof Ang elaborated.

NEW WAYS TO CONTROL MYOPIA

On the bright side, he noted that in recent years, many new and effective ways of controlling myopia have appeared in the market.

These range from specialised glasses and contact lenses, to eye drops that can slow myopia progression in children.

Singapore and the region have also developed tools, including the use of artificial intelligence, to help predict which child is at risk of developing myopia in the near future. These are now being used in myopia screening programmes.

Ms Dorothy Chan, a senior practising optometrist at Spectacle Hut, said the latest solution in the market is a kind of lens that has been proven to slow down myopia progression by 67 per cent if worn by a child for at least 12 hours a day.

She added: “When we started having this as an option two years ago, we have seen many successful cases where the kids come in every six months … and you see their myopia progression has been drastically reduced. Some of them may not even have any increment on a year-on-year basis.”

Parents should take their children for an eyesight check every six months to know if their degree is stable, and start doing so from around the age of five, Ms Chan said.

For Asher, the boy who was diagnosed with myopia in Primary 1, spectacles are now part of his daily outfit. 

His father said they might consider other forms of treatment, like myopia control contact lenses, in the future.

 “He actually thought he was growing up, like becoming a big boy wearing glasses, because his brother (wears them), but we told him … it’s not a good thing for him to be wearing glasses,” Mr Gan quipped.

“Sometimes, he forgets that he needs to wear glasses. He runs around without them. But we can see there is a big improvement – he doesn’t really squint his eyes, that’s the most obvious thing.”