While the world battles the Covid-19 pandemic, there is another epidemic that we cannot ignore – childhood myopia. Statistics show that 34 per cent of children in Singapore aged seven to nine are near-sighted, compared to 19 per cent in Taiwan, 12 per cent in Hong Kong, and 7.5 per cent in the US.
Myopia begins developing in young children as early as the age of five and will continue till the eye stops growing in the late teens.
Although glasses help with the correction, myopia can progress and lead to serious eye complications such as blindness, macular myopathy, retinal detachment, and cataract, if left untreated.
The correlation between increasing myopia and vision-threatening complications later in life has been well established. It’s a growing concern for both eye care practitioners (ECPs) and parents worldwide.
So what are the causes of myopia in Singapore children? Well, with the Covid-19 pandemic bringing changes like increased digital screen time from home-based learning and limited outdoor activities, myopia progression in children has aggravated.
Traditional eyeglasses and contact lenses have been the solution for the longest time. However, they only help correct blurred vision and not slow down myopia’s progression.
So what is the solution and how do we ensure our children are better protected?
We spoke to Dr Cheryl Lee, Myopia control specialist and Eye surgeon and Director of The EyeClinic by Dr Cheryl Lee to get the answers.
Here’s an excerpt from our interview.
What Are The Causes Of Myopia In Singapore
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TAP: What is myopia and what is the importance of its early detection?
Dr Cheryl: Myopia is caused by the lengthening of the eyeball (rather like an undesirable growth/height spurt). This unwanted lengthening is preventable when picked up early in its initial stages – this is why I do checks for kids from four years old, twice a year.
Once a certain level of myopia (eyeball length) is reached, it can never be reduced. In other words, the degree of myopia cannot be improved on, we can only maintain it. That is why there is an importance to detecting myopia as early as possible and to stop it from progressing further.
In fact, we are now looking at preventative measures before myopia occurs. I have a seven-year-old and I know that good habits need to be cultivated from a young age.
Causes Of Myopia In Singapore And Its Complications
TAP: How can myopia lead to serious eye complications without proper treatment and care?
Dr Cheryl: Myopia starts at a very early age, usually due to poor outdoor and indoor habits. I have detected myopia in children that are as young as four years old due to these poor habits.
The risks related to myopia are also related to the individual’s eye degree – what that means is that there are risks of
developing retinal detachment, glaucoma, cataracts that are affected by the level of myopia. The higher the level of myopia, the higher the risk of blindness.
Hence, it is important to stop myopia from progressing. While it is not possible for all kids to have perfect eyesight, but we need to fight to keep the level of myopia as low as possible.
I talk to each child and their parents to enquire into their lifestyle so I can also help in introducing ways to change poor reading, device, or outdoor habits.
Early Detection Makes All The Difference In Myopia Treatment
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TAP: At which stage should the child be treated for myopia?
Dr Cheryl: From the minute children are diagnosed with myopia, the level of myopia can increase by 100 degrees per year, if not controlled. The younger the age of the child when myopia develops, the worse the prognosis.
That’s why kids must be screened early and regularly. With my son, I have been checking his vision since he was three and a half years old, and continue to once every six months.
The minute I detect myopia, I would start him on treatment to manage this.
TAP: What is the frequency of follow up/eye examination for the child?
Dr Cheryl: I would recommend for parents to send children for eye examinations starting from four years of age.
Additionally, depending on what optometrists find during check-ups, the frequency of follow-ups can be done anytime between three to 12 months on a regular basis.
Parents should also not forget that myopia can occur at any time. Hence, regular check-ups and follow-ups are important. It does not mean myopia is absent if it does not show up during a single check-up session.
Much like how adults have to do check-ups regularly for blood pressure or diabetes, the same should be for children and eye examinations.
Children And Contact Lenses: Are They Safe?
Image Source: Dr Cheryl Lee
TAP: Are contact lenses safe for children?
Dr Cheryl: Some contact lenses such as the MiSight 1 day lenses have been made for children to control myopia. However, I would still assess the child’s motivation and personality, and if they would be able to take proper care.
What is also important to note is that kids respond differently to different eye products.
For example, atropine eye drops may not work on a particular child. Similarly, this would also mean that different would fare differently with contact lenses.
Starting on contact lenses for a child or an adult is a commitment. There are ways to prevent problems rather than treating them when it occurs.
Efficacy Of Myopia Treatment Through Lenses
TAP: What is the compliance level of children with contact lenses?
Dr Cheryl: We have a trial session with children who want to try out contact lenses. And during this time my team will teach them how to put on and care for their eyes and lenses.
Through this session, we are also able to predict the issues each child might have.
The children under our care are also highly motivated as we educate them on myopia control and why taking care of their eyes is important.
This emphasises having the child placing his/her eyes in their own care and teaches
them to be responsible and to take ownership of their lenses.
TAP: What is the efficacy of myopia treatment with contact lens?
Dr Cheryl: Most doctors say that most myopia treatment reduces myopia progression by 50 per cent, which would equate to lowering the increase of at least 50 degrees a year.
However, I personally feel more we can do more to improve the efficacy of myopia management and treatment.
Children respond differently to different forms of myopia control. Some children do well with atropine eye drops but some do not.
This must be picked up quickly before myopia worsens, and I would often see the children every three months to assess if atropine is working before advising them to start on contact lenses.
Some children need both contact lenses and atropine. The advantage for families with children managed at an eye clinic is that we are able to take action quickly should we need to add atropine eye drops in addition to using the myopia control contact lenses.
What Can Parents Do Help Children With Myopia
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TAP: How can we get parents involved in managing myopia progression?
Dr Cheryl: Parents need to be aware that myopia can be controlled, and should act now as it can only get worse. Myopia is not just about needing to wear glasses but is a disease that is irreversible.
Parents can also find out more about myopia and myopia control that I share via my website.
Parents should also watch the study done by stand-up comedian Hossan Leong who also has myopia. It’s both fun and educational, and I insist my patients watch it together as a family to learn more about it.
Parents also need to find a balance between studies and outdoor time. Children should take breaks from doing near work every 20 minutes for 20 minutes, and engage in an activity that does not involve seeing close up.
Parents need to be creative to allow their children to spend time outdoors, which I understand might not be easy for some.
My husband and I both work full time and have had to think of ways to strike that balance.
Causes Of Myopia In Singapore During COVID-19
TAP: How to protect eye health in the long run and any eye care tips to counter lifestyle
changes brought about by Covid-19?
Dr Cheryl: During the first circuit breaker a year ago, we have seen children visit our clinic where their myopia worsened significantly, with an increase of as much as 100 degrees within three months.
The time spent outdoors has reduced significantly with Covid-19.
However, these are some tips that I can share with parents to help ensure that children adopt positive eye care habits and for early intervention and management for myopia:
1. Go outdoors where it is safe
Parents should try to spend at least two hours outside per day, where possible. Given the flexibility of home-based learning, children should strive to take an outdoor break when there is sunshine.
2. Setting time limits with digital devices
With home-based learnings already conducted on devices, parents should make an effort to avoid recreational screen time. With my son, Mark, we play sports and ball games with him at home instead.
3. Regular eye examinations and myopia treatment should continue
As myopia is irreversible, it is crucial that regular eye examinations and follow-ups continue as scheduled. The pandemic has also caused a myopia boom due to the increase in screen time, and I would strongly encourage parents to not have a lapse in treatment, as early intervention is key to not allow myopia to progress further.
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