Preventing myopia in children is a critical focus for many parents, especially in Singapore where it is very common. In fact, studies show that about 60% of children are myopic by age 12, and this rises to around 80% by age 18.
While glasses can correct vision, what many parents may not realise is that myopia itself cannot be reversed once it develops. This makes identifying the stage known as pre-myopia—where a child still has normal vision but is at a high risk of developing the condition—a vital window for early intervention.
The good news is that there is currently more understanding about pre-myopia, which is when a child may still have good vision but is at risk of developing myopia in the near future. Understanding this stage and taking action early can make a significant difference to a child’s long-term eye health.
Dr Loh Kai-Lyn, Senior Consultant Ophthalmologist at The Children’s Eye & ENT Centre, explains how parents can identify risk early and take steps to help preventing myopia in children.
What is Myopia?
Myopia, also known as short-sightedness, is a condition where distant objects appear blurry while near objects remain clear. It develops when the eye grows longer than normal during childhood.
“Myopia occurs when the eyeball grows longer than the usual shape,” explains Dr Loh Kai-Lyn. “The longer the eyeball, the higher the myopia.”
While glasses or contact lenses can help children see clearly, they do not change the underlying structure of the eye.
Dr Loh explains that, “when the eyeball is long, the internal structure of the eye is stretched out and leads to a higher chance of certain serious eye diseases, such as glaucoma, later in life. In order to maintain good eye health, we should try to prevent myopia and myopia progression.”
What Is Pre-Myopia?
Pre-myopia refers to a stage where a child is at risk of developing myopia but may still have normal vision.
This means that children at this stage may not show any obvious symptoms, and their vision may appear perfectly normal during routine checks.
Because the condition has not yet developed into myopia, this stage provides a valuable window where preventive measures may help delay or reduce the risk of myopia onset.
Why Early Action Matters
One of the key challenges with myopia is that once it develops, it cannot be reversed. This is why identifying children who are at risk early is so important.
During childhood, the eyes are still developing. If excessive elongation occurs, it can lead to permanent structural changes in the eye.
By identifying children who are at risk of developing myopia, doctors can monitor eye development closely and introduce strategies that may delay its onset. Early action can therefore play an important role in protecting a child’s long-term vision.
Who Is at a Higher Risk of Developing Myopia?
Some children are more likely to develop myopia than others due to a combination of genetic and lifestyle factors. Understanding these risk factors can help parents take early steps to protect their child’s vision.
Children who may be at higher risk include those who:
- Have one or both parents who are myopic
- Have parents with high myopia (600 degrees or more)
- Spend long periods doing near work, such as reading or using digital devices ● Have high amounts of screen time
- Spend limited time outdoors during the day
Dr Loh highlights that children with a family history of myopia should have their eyes assessed earlier. “Ideally children should start having their risk assessed in pre-school years, around 5 to 6 years old,” she says. “This is particularly true for children who either have one or both parents being myopic, and especially so if there is high parental myopia.”
How Is Pre-Myopia Risk Assessed?
Pre-myopia cannot be detected through simple vision checks alone. Instead, a more detailed eye assessment is required to evaluate a child’s risk.
One of the key tests used is cycloplegic refraction, which involves using special eye drops to temporarily relax the eye’s focusing muscles.
“Cycloplegic refraction is a specialised test where a child receives dilating eye drops and then undergoes a refraction test,” explains Dr Loh.
During the assessment, the doctor will also review the child’s medical history and family history, and conduct a comprehensive eye examination.
In some cases, additional tests may also be performed. “There may also be investigations such as axial length measurement, an easy process to measure a child’s eyeball length, in order to objectively assess progression,” she says.
These tests allow doctors to better understand how a child’s eyes are developing and whether they may be at risk of developing myopia.
Why School Screenings and Optical Shops Can’t Detect Pre-Myopia
Many parents rely on school vision screenings or optical shop tests to monitor their child’s eyesight. However, these checks are designed to detect existing vision problems, not the risk of developing myopia.
Because pre-myopia occurs before vision becomes blurry, standard screenings may not identify children who are at risk. “Cycloplegic refraction is the most accurate way of determining the hyperopic reserve, or how much eye growth there is before myopia occurs. The lower the hyperopic reserve, the more imminent the risk”, Dr Loh explains.
This is why specialist assessments are important when parents want to evaluate their child’s risk early.
Pre-Myopia Management & Intervention Options For Children
If a child is identified as being at higher risk of developing myopia, early management can help delay or preventing myopia in children. Some commonly recommended pre-myopia management options include:
- Low-dose atropine eye drops – These medicated drops have been shown to help delay or reduce the risk of myopia developing in children.
- Myopia control glasses – Spectacles specially designed at zero degrees may help manage how the eye focuses and reduce the likelihood of myopia developing.
- Healthy eye habits – Encouraging more outdoor time and limiting prolonged near work can support better eye health during childhood.
The goal is to slow down eye elongation during the years when the eyes are still developing.
For children who are considered high risk, regular monitoring is also important to track how their eyes are developing and to see how well interventions are working. “They will then be assessed every 3-6 months to monitor for response," Dr Loh says.
How to Prevent Myopia in Children?
While medical assessments are important, parents can also play a key role in encouraging healthy eye habits at home. According to Dr Loh, daily habits can make a meaningful difference and ways to prevent myopia in children.
Some simple steps parents can encourage include:
- Spend more time outdoors – Children are encouraged to have at least two hours of outdoor activity each day, as natural light and distance viewing may help support healthy eye development.
- Take regular breaks during near work – When reading, doing homework, or using digital devices, children should take a break about every 30 minutes to give their eyes a rest.
- Ensure good lighting – Activities such as reading or homework should be done in a bright, well-lit environment rather than dim lighting.
- Maintain a proper reading distance – Children should keep books, tablets, or phones about 30–40 cm away from their eyes to reduce eye strain.
Encouraging these healthy habits early can support better eye development and may help reduce a child’s risk of developing myopia as they grow.
A Proactive Approach to Children’s Eye Health
Myopia has become increasingly common among children today, but awareness of pre-myopia is giving parents a valuable opportunity to act earlier.
Because children at risk may still have perfectly good vision, many parents may not realise there is an underlying concern. By understanding risk factors and encouraging healthy visual habits, parents can take meaningful steps to support their child’s eye health.
Early assessment, combined with good daily habits, can help delay or even prevent the onset of myopia, giving children a better chance at maintaining healthy vision as they grow.