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A Closer Look at Myopia in Children

Wednesday, 18.05.2016

Myopia, which means near sightedness, is the most common visual problem for children. Most children start out with good eyesight; however, the environment children frequently find themselves in alters their visual acuity quite dramatically. 

Unfortunately, young children are not mindful enough to take care of their eyes, but this is where parents can play a key role. 

Does my Child Need Glasses?

If your child is displaying tell-tale signs that points towards vision impairment, the first thing to do would be to consult your local optometrist and have your child’s eyes checked before deciding on whether or not glasses or any other forms of vision correction is needed, advises Titus Wu, master of optometry (M.Optom), fellow in the International Academy of Orthokeratology (FIAO), optometrist and orthokeratologist at Titus Eye Care.

The most common vision issue for children in Singapore is myopia, with about half of all school going children aged seven to 16 being affected. This is also the age where myopia progression is the highest.

There are signs that parents can simply observe from a child’s daily habits to assess whether the child has myopia. A few common behaviours such as squinting, closing one eye to see, sitting close to the TV or lowering his head while reading a book are symptoms of myopia.

According to Wu, most of the time, symptoms of vision impairment can be picked up from daily behavior when you spend time with your child. However, sometimes they might go unnoticed and young children generally do not let their parents know when they are experiencing eye problems.

Having an eye examination conducted by an optometrist is the best way to find out if your child needs glasses or other forms of vision control.

Vision Control

Glasses only correct symptoms of vision impairment, explains Wu. They do not control myopia progression or improve the condition over time. This is why glasses need to be changed regularly, about once a year or so, to keep up with deteriorating eyesight.

One method that has been proven to be one of the most effective ways to reduce myopia progression is Orthokeratology (or Ortho-k). The best way to describe it is “braces for the eyes”, where the child wears a specially designed pair of corneal molds during sleep and is able to see clearly after removing them the next morning, without the need for glasses or contact lenses. Studies have shown that it can reduce progression of myopia by 50 to 100 per cent. This is especially effective during the school-going years where myopia progresses the most. 

Naturally, the main concern of these lenses will be the risk of infection. Therefore, it is important to go to a practitioner who specialises in Orthokeratology to ensure that the lenses are fitted well so that the eyes are healthy and the myopia is well controlled.

Basically, while there is no cure for myopia, there are ways to control it and reduce the discomfort of wearing glasses throughout the day.

Going for an Eye Exam

Exactly how often should kids have an eye examination? Well, it depends on the age and daily activities that your child engages in.

In Singapore, the Health Promotion Board conducts vision checks in pre-schoolers from five years of age as well as in primary school. However, if there are no problems, a yearly check is quite sufficient.

With that said, can vision screening or a paediatrician exam substitute for a comprehensive eye examination? Well, not really. A comprehensive eye examination, however, not only checks for vision, alignment, refractive error, but also involves dilating the eye to check form “front to back” to look for any structural abnormalities, explains Dr Inez Wong, senior consultant ophthalmologist, director of Paediatric Ophthalmology & Strabismus Service, Eagle Eye Centre and also visiting consultant, National University Hospital Singapore.

The Causes of Myopia

“If you’re wondering why kids get myopia, the role of “nature versus nurture” has long been debated. Genetics certainly play a part. If one parent is short –sighted, there is 60 per cent chance that a child will become short-sighted, and it goes up to 80 per cent if both parents are affected,” explains Dr Wong. 

However, the role of the environment is now increasingly recognised as an important factor. The relative lack of sunlight and outdoor activity has been shown in large studies to contribute to the development of myopia.

Kids in Singapore have a higher prevalence of myopia than those in Australia for example, who spend a lot more time outdoors, even correcting for other confounding factors such as the amount of near work. We encourage children to spend 11 - 14 hours a week outdoors during daylight hours. 

As for environmental factors, we know that near work is associated with myopia progression. The ones who start having myopia early - in kindergarden - are mostly the ones who love to read.

So it appears that is a combination of genes, too much near work, and too little sunlight exposure, says Dr Wong. In general, taking a break from near work after 30 to 40 minutes helps to avoid eye discomfort from eye strain. 

Controlling the Progression of Near Sightedness  

Apart from good eye care habits as outlined above, several studies have now shown evidence that an eyedrop called atropine can slow down the rate of progression of myopia, explains Dr Por Yong Ming, consultant eye surgeon, Mount Elizabeth Novena Hospital. There are also many published studies which show evidence that Ortho-K lenses may have an effect on slowing the progression of myopia. 

Ortho-K/CRT is one among many different options for the correction of myopia, advises Dr Por. Like each method, it has its pros and cons. Ortho-K works best in people with myopia. Patients and practitioners have to be disciplined in lens care practices. Ortho-K does not permanently alter the corneal shape, so there is a regression of effect once the lenses are not worn for a period of time. With high spectacle powers sometimes this regression can be apparent during the course of a day. 

As parents we know that having good vision is one of our most treasured assets. We should not wait until serious problems beset our children's eyes or even our own before we begin to take care of them. Let’s make a start now to take better care of our eyes.

THE TRUTH ABOUT SCREEN TIME

Is watching TV linked to near sightedness?

It all depends on the amount of time the child spends watching TV and how much it affects the other aspects of his life. For example, if a child watches an hour of TV and then spends the rest of the day outdoors, then it will have no influence on the development of myopia. The light emanating from the TV, or the act of watching images on a screen, does not influence the development of myopia in itself.

However, explains Dr Por, if the child spends the whole day in front of the TV, neglects to spend time in the sun, then watching TV would be linked to near sightedness.


About the Author

Titus Wu (邬颂仁) – Bsc.Optom (USA), M.Optom (Aust), FIAO

Titus graduated as an Optometrist in Singapore before completing his Bachelor degree in Optometry from Salus University (USA). He then went on to further his education and was awarded a Masters of Optometry from University of New South Wales (Aust). He was largely involved in advanced contact lens studies, advanced clinical optometry, ocular therapeutics and dry eye management, . He also completed a preceptorship in LV Prasad, Hyderabad – India, one of the busiest eye institutes worldwide, where he concentrated on anterior and posterior eye complications, as well as advanced specialty contact lenses to treat cornea diseases. 

Titus is an Associate Lecturer at Ngee Ann Polytechnic, guiding and supervising final year Optometry students with their clinical skills. Titus is also a member of the American Academy of Orthokeratology and Myopia Control (AAOMC), International Academy of Orthokeratology (IAO), Scleral Lens Education Society (SLS) and Singapore Optometric Association (SOA). His expertise in Orthokeratology allowed him to obtain his Fellowship from the International Academy of Orthokeratology (FIAO). Orthokeratologists who have successfully attained the rank of FIAO have demonstrated a commitment to excellence in the field of Orthokeratology.

His area of clinical interests include myopia control for children and cornea and vision rehabilitation. He has since devoted his practice to the field of specialty contact lenses and primary eye care.


Special thanks to Singapore Optometric Association for contributing this article.

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