Myopia or short-sightedness has been a growing concern globally as the prevalence of myopia has been on the rise. It is predicted that half of the world’s population (five billion people) will be myopic by 2050, of which approximately one billion are at risk of sight threatening eye conditions. Singapore has projected that approximately half the population will have high myopia (>500 degrees) by 2050. 

We have yet to find a way to stop and reverse myopia, but research collaborations have produced multiple avenues that eye care practitioners can provide to slow down the rate of myopia progression. I hope that in this guide, you’ll come to have a better understanding of myopia, and what options you have available in Singapore for controlling myopia progression in your child’s eyes.

What causes Myopia?

After years and years of research, there are two predominant theories for the cause of myopia namely, genetic and environmental conditions. 

Genetics

From both personal experience and published research data, children are at a higher risk of developing myopia when either one or both parents have it. Studies looking at twins found that identical twins are likely to have similar prescriptions/spectacle degrees than non-identical twins. These studies have estimated that the heritability of myopia to be as high as 91%. That being said, it is not impossible for a child with non-myopic parents to develop myopia. Hence, genes are not the only determining factor, which leads us to the next theory which is environmental factors.

Environment

There has been consistent proof that environmental factors play a role in the development of myopia. For example, children who spend more time outdoors are less likely to become myopic. Interestingly, extended outdoor time have shown to be an effective measure to prevent the onset of myopia in children. Therefore, I encourage parents to allow more time outdoors for their children, especially when they are young and have yet to develop myopia. Researchers have observed a trend in Hong Kong where children were developing myopia believed due to their high population density, constricted living spaces and highly academic culture. This could explain the upward trend of myopia in Singapore as well.

What options do I have to slow down myopia in my children?

In one of my previous articles, I have covered special eye drops that can slow down myopia progression by 50-60%. These eye drops help relax the eye muscles, allowing our eyes to ‘relax’  thereby reducing the stimulus to the onset of myopia in children. The strength of these eye drops differ based on the dosage prescribed by your eye doctor. With the highest dose at 1%, the ability to slow myopia progression increases at the cost of undesirable side effects. As such, doctors often start at the lowest dosage first, and only increase it when necessary. At the lowest dose of 0.01%, the drops have proven to be able to reduce the rate of myopia progression of 50-60%.

However, I have encountered parents who are hesitant at using these eye drops. Reasons such as difficulty putting in the eye drops regularly, afraid of any side effects (usually minimal), and ultimately, the child refusing to use the eye drops due to fear are all valid reasons and I completely understand. Therefore, I usually advise parents of the other options available in Singapore for their consideration.

Miyosmart spectacle lenses

MiSight soft contact lenses

Working by the same defocus theory behind the Miyosmart lenses, MiSight soft contact lenses by Coopervision, is the first FDA approved contact lenses for myopia control. These lenses are daily disposables which rules out the need for cleaning and storing of lenses. Hence, the likelihood of any infections from the contact lens is reduced significantly. Like the Miyosmart lenses, there are zones on the lenses that cause peripheral defocus which helps slow down myopia progression by 50-60%. This option for responsible children between the age of 8 to 12 years is also available at my clinic.

In summary,

I have gone through with you 3 safe and proven options of myopia control in Singapore. Should you be interested to find out more and to see if your child is suitable for any of these options, my clinic and my team will gladly assist you and work together with you in combating childhood myopia. 

One last thing, all the above methods have proven themselves to be capable of reducing myopia progression, but they will not be as effective if your child forgets about good eye care habits! Good near work and eye care habits are still essential. 

Just a recap of some good near work and eye care habits for myopia:

  1. Maintain full arms’ length from the device to the eyes to prevent myopia.
  2. Maintain a good posture when doing near work.
  3. Ensure good lighting in the surroundings.
  4. Take frequent breaks by looking out the window at a faraway object every half hour.
  5. Avoid reading in a moving vehicle.
  6. Encourage more outdoor play (10-14 hours per week) and exposure to natural sunlight.
  7. Limit screen time (outside of schoolwork) to 1 hour per day

References:

  1. Chamberlain, P., Peixoto-de-Matos, S. C., Logan, N. S., Ngo, C., Jones, D., & Young, G. (2019). A 3-year randomized clinical trial of misight lenses for myopia control. Optometry and Vision Science, 96(8), 556–567. https://doi.org/10.1097/opx.0000000000001410 
  2. Choi, K. Y., Yu, W. Y., Lam, C. H., Li, Z. C., Chin, M. P., Lakshmanan, Y., Wong, F. S., Do, C. W., Lee, P. H., & Chan, H. H. (2017). Childhood exposure to constricted living space: A possible environmental threat for myopia development. Ophthalmic and Physiological Optics, 37(5), 568–575. https://doi.org/10.1111/opo.12397 
  3. Dirani, M., Chamberlain, M., Shekar, S. N., Islam, A. F., Garoufalis, P., Chen, C. Y., Guymer, R. H., & Baird, P. N. (2006). Heritability of refractive error and ocular biometrics: The genes in myopia (gem) twin study. Investigative Opthalmology & Visual Science, 47(11), 4756. https://doi.org/10.1167/iovs.06-0270
  4. Dirani, M., Tong, L., Gazzard, G., Zhang, X., Chia, A., Young, T. L., Rose, K. A., Mitchell, P., & Saw, S.-M. (2009). Outdoor activity and myopia in Singapore teenage children. British Journal of Ophthalmology, 93(8), 997–1000. https://doi.org/10.1136/bjo.2008.150979 
  5. French, A. N., Morgan, I. G., Mitchell, P., & Rose, K. A. (2013). Risk factors for incident myopia in australian schoolchildren. Ophthalmology, 120(10), 2100–2108. https://doi.org/10.1016/j.ophtha.2013.02.035 
  6. Holden, B. A., Jong, M., Davis, S., Wilson, D., Fricke, T., & Resnikoff, S. (2015). Nearly 1 BILLION Myopes at risk of MYOPIA‐RELATED Sight‐threatening conditions by 2050 – time to act now. Clinical and Experimental Optometry, 98(6), 491–493. https://doi.org/10.1111/cxo.12339
  7. Chia, A., Chua, W. H., Cheung, Y. B., Wong, W. L., Lingham, A., Fong, A., & Tan, D. (2012). Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology, 119(2), 347–354. https://doi.org/10.1016/j.ophtha.2011.07.031
  8. Lam, C. S. Y., Tang, W. C., Lee, P. H., Zhang, H. Y., Qi, H., Hasegawa, K., & To, C. H. (2021). Myopia control effect of Defocus incorporated multiple SEGMENTS (dims) spectacle lens in Chinese CHILDREN: Results of a 3-year follow-up study. British Journal of Ophthalmology. https://doi.org/10.1136/bjophthalmol-2020-317664 
  9. Wolffsohn, J. S., Calossi, A., Cho, P., Gifford, K., Jones, L., Li, M., Lipener, C., Logan, N. S., Malet, F., Matos, S., Meijome, J. M., Nichols, J. J., Orr, J. B., Santodomingo-Rubido, J., Schaefer, T., Thite, N., van der Worp, E., & Zvirgzdina, M. (2016). Global trends in myopia management attitudes and strategies in clinical practice. Contact Lens and Anterior Eye, 39(2), 106–116. https://doi.org/10.1016/j.clae.2016.02.005 
  10. Yam, J. C., Li, F. F., Zhang, X., Tang, S. M., Yip, B. H. K., Kam, K. W., Ko, S. T., Young, A. L., Tham, C. C., Chen, L. J., & Pang, C. P. (2020). Two-Year clinical trial of The LOW-CONCENTRATION Atropine for myopia Progression (lamp) Study. Ophthalmology, 127(7), 910–919. https://doi.org/10.1016/j.ophtha.2019.12.011