Myopia in Children

What is Myopia in Children?

Myopia is an optical condition in which light is refracted in front of the retina instead of on it, causing distant objects to appear blurry. The condition occurs when the eye’s length changes for various reasons, shifting the focus in front of the retina. It is also common in many children in Singapore, with more than half developing myopia by age 12. The exact cause is still unknown, but it is believed that lifestyle changes, including spending more time indoors and higher use of screens, are contributing to higher myopia rates.

In children, the eyes steadily grow as they age before stabilising in their teenage years. However, myopia causes their eyes to grow too quickly, leading to a gradual decline in vision that persists through the teenage years and into early adulthood.

What Causes Myopia in Children?

Studies have found that childhood myopia occurs when the eye grows too rapidly, even when it should slow or stop growing. Part of this may stem from genetics, as parents who have myopia are more likely to pass it down to their children. Environmental and lifestyle factors may also play a role, as there may be a tentative link between long-term indoor activities and digital screen use and the development of a young child’s eyes. However, further research is still needed to understand the actual mechanisms behind myopia progression in children.

Other factors that could cause myopia in children include reading books up close (with their eyes very close to the pages) and reading or using digital screens in a dim or dark room. Children are also advised to keep at least 20 cm between their eyes and any book, digital screen, or device.

Why Does Childhood Myopia Progress?

The eyes of children grow rapidly which is a natural occurrence and continue into their teenage years when it starts slowing down. By the time they reach 20, it would have stopped growing, and their myopia may begin to stabilize. As the eye grows, it will change shape and this will usually lead to the condition worsening.

As the eyeball continues to elongate, light focuses further in front of the retina rather than directly on it, causing distant vision to become progressively blurrier. As a result, children may require stronger spectacle or contact lens prescriptions over time. This is why early myopia management is important, as it can help slow myopia progression and reduce the risk of developing high myopia and its associated eye complications later in life.

Signs & Symptoms of Myopia in Children

If your child is experiencing any of the following signs and symptoms, it may be time to schedule an appointment with an optometrist.

Difficulties seeing objects or people from a distance
Frequent eye squinting when looking at something
Periodically rubbing or blinking their eyes
Holding books or digital screens close to their eyes
Regular headaches (due to eye strain)
Watery eyes

Why Early Myopia Control is Essential

Early myopia control is important not only to preserve your child’s overall visual acuity as they grow older, but also to reduce the risk of future eye conditions that could impact their daily life. Untreated myopia could increase the risk of potential long-term complications, including early onset retinal detachment, glaucoma, cataracts, and myopic macular degeneration.

Retinal detachment

This is when the retina detaches from its original position at the back of your eye. It is a serious medical condition that will need immediate attention or you may end up with permanent vision loss. For those with severe myopia, the risk of developing this condition is higher than those who have low myopia.

Glaucoma

Glaucoma is when the optic nerve that connects the eye to the brain is damaged. Along with retinal detachment, this condition can lead to permanent vision loss and will need immediate medical care.

Myopic macular degeneration

A longer eyeball can stretch the retina, causing tears in the macula that lead to bleeding beneath it. People who have this condition will need to have it monitored regularly to watch for signs of worsening or new symptoms.

Cataracts

People with myopia may have a higher risk of developing cataracts earlier in life, particularly when the myopia becomes more severe. Cataracts cause the eye’s natural lens to become cloudy, resulting in blurred vision and reduced visual clarity. Learn more in our article, “What Do You Need to Know About Cataracts?“

The earlier myopia is detected and managed, the better the chances of slowing its progression and reducing the risk of these long-term eye complications. Regular eye examinations enable your optometrist to monitor changes in your child’s vision and recommend suitable myopia management strategies to help protect their long-term eye health.

How is Myopia Diagnosed in Children?

Early vision testing is important for detecting myopia progression in children, allowing for timely intervention and ensuring they receive appropriate treatment to slow its progression. Regular eye tests at specific points in a child’s life are conducted to check for normal eye development and detect problems early to allow for prompt intervention to reduce the risk of future complications.

Around age 3 to 5, your child will need to undergo a visual acuity test by reading alphanumeric characters on an eye chart. Each character on the chart is arranged in decreasing size and placed about 3 to 6 metres apart. How well your child can see each character on the chart will determine whether vision correction is needed and inform the appropriate level of support.

Additional diagnostic tests may be needed if your child struggles with the eye chart, as they can help identify specific issues that may necessitate early intervention strategies to slow myopia progression. Follow-up checks for children aged 5 and above will also be conducted to assess visual acuity and alignment and detect potential vision issues or other complications.

It is important to remember that the sooner myopia is detected, the sooner preventive care can help prevent it from worsening.

Myopia Management Options for Children

While there is no known cure for myopia, the condition can still be managed to slow its progression. A qualified optometrist will be able to provide prescriptions to support your child’s vision correction.

Eyeglasses & Contact Lenses

Eyeglasses and contact lenses work by refracting light so that it focuses correctly onto the retina, correcting myopia. While eyeglasses are worn on your face to correct vision, the disc-like contact lenses gently rest on the surface of your child’s eyes to correct vision. Your child may need to wear them for certain activities, such as reading or watching screens, or throughout the day for more severe cases. They are often available in single-lens, bifocal, or multifocal lenses to address different vision needs and potentially correct other refractive errors, such as astigmatism. Both will also require regular cleaning, but contact lenses require more frequent cleanings to reduce the risk of eye infections.

Atropine Eye Drops

These eye drops are prescribed to help manage myopia by dilating the pupil and pausing the eye’s focusing mechanism. It is generally prescribed at low concentrations (typically 0.01%-0.05%) and used once daily at night. Side effects may potentially include eye redness or itchiness.

Orthokeratology (Ortho-K)

Ortho-K uses custom-made rigid contact lenses worn overnight that gently reshape the cornea as you sleep. You do not need to wear them during activities, as they are only worn overnight while you rest. The lenses will apply gentle pressure to your eye to ensure that light is refracted onto your retina. The benefits of ortho-K are temporary and require regular wear (typically every few days) to maintain their effectiveness in managing myopia.

Lifestyle Changes

Various lifestyle arrangements can help to slow down myopia progression and maintain your child’s eyesight.

Limit their use of digital screens and devices. One way is to introduce a short 20-second break every 20 minutes, during which your child will look at something at least 20 feet away (not on a digital screen or device).
Keep digital screens and devices at least 20 cm or more away while your child uses them to minimise their glare on your child’s eyes.
Ensure there is sufficient indoor lighting when your child is reading or using digital screens or devices.
Include more time for outdoor activities in the park. Ongoing research shows that regular exposure to natural light may help to reduce the risk of myopia.
Monitor your child’s eye health and ensure they wear their prescribed glasses or contact lenses regularly to slow the progression of myopia.
Continue taking your child for regular eye exams to stay on top of their eye health.

Clear Vision Begins with Personalised Eye Consultations

Concerned about your child’s vision? At Philip D. Izaac, we provide personalised eye examinations and myopia management plans tailored to your child’s needs. Contact us today to book an appointment.