Childhood Myopia in Singapore: Causes, Treatment and Control
Myopia is one of the most common eye conditions affecting school-age children in Singapore, with around 65 per cent of children myopic by Primary 6. For parents who have noticed changes in their child’s vision, or whose child has been flagged at a school screening, understanding what myopia is and how its progression can be managed is an important first step.
What Is Childhood Myopia?
Myopia occurs when the eyeball grows slightly too long from front to back, causing light from distant objects to focus in front of the retina (the light-sensitive layer at the back of the eye) rather than directly on it. The result is that distant objects appear blurred, while near objects remain clear.
In children, the eyeball is still growing, which means childhood myopia can progress relatively quickly. Onset most commonly occurs between the ages of six and 12, and progression typically continues until the late teens when the eye stabilises. This window of active growth is also the most important period for myopia control.
How Common Is Childhood Myopia in Singapore?
The rates of childhood myopia in Singapore are among the highest in the world, which is why early detection is a clinical priority here.
According to the National Myopia Prevention Programme (Health Promotion Board), around 65 per cent of children in Singapore are myopic by Primary 6. By the age of 18, 80% are myopic.
Signs and Symptoms of Myopia in Children
Signs that your child may be developing myopia include:
- Squinting to see the whiteboard at school or the television at home
- Sitting closer than usual to screens or holding books very close to the face
- Frequent eye rubbing or blinking, particularly when looking at distant objects
- Complaints of headaches, especially after school
- Tilting the head or closing one eye to see more clearly
- A drop in school performance that coincides with difficulty seeing the board
When to Book an Eye Check
Book an eye assessment if your child shows any of the signs above, has been flagged at a school vision screening, or if one or both parents are myopic.
The recommended age for a first comprehensive eye examination is around three to four years, before the child starts formal schooling. If myopia is already present, earlier and more frequent review is recommended. The sections below explain what a paediatric myopia assessment involves and what to expect at each stage.
What Causes Childhood Myopia?
There is no single established cause of childhood myopia. Current evidence points to a combination of genetic and environmental factors, and the balance between the two varies between individuals.
Genetic Factors
Genetics play a significant role in childhood myopia. If one parent is myopic, a child’s risk of developing myopia is significantly higher than average. If both parents are myopic, the risk is higher still. Children with two myopic parents are more likely to develop myopia earlier and to a greater degree, which makes early monitoring particularly important for these families.
Environmental and Lifestyle Factors
Beyond genetics, the way a child spends their time has a measurable effect on myopia progression. Sustained near work and limited time spent outdoors are two of the most significant modifiable risk factors for myopia onset and progression in children.
Children in Singapore, especially those who spend more time on academic work and less time outdoors, are at higher risk of earlier onset and faster progression.
Reading, writing, and screen use at close range are associated with faster progression, while exposure to natural light and the visual experience of looking at distant objects outdoors may help slow eye elongation.
Understanding these risk factors is important because they also point to where intervention can help, both through clinical treatment and through everyday habits at home.
Why Childhood Myopia Is a Cause for Concern
Mild myopia is manageable and does not typically threaten long-term eye health. However, high myopia, generally defined as a prescription of -6.00 diopters (600 degrees) or more, is associated with a significantly raised lifetime risk of serious eye conditions.
Most adults with high myopia developed it in childhood, which is why slowing progression during the school years has long-term consequences beyond the prescription itself.
Eye Conditions Linked to High Myopia
The higher a child’s myopia, the greater the physical elongation of the eye. This stretching places structural stress on the retina, the optic nerve, and the lens.
Conditions associated with high myopia include retinal detachment, myopic maculopathy, glaucoma, and cataract, each of which carries a meaningfully raised lifetime risk for those who develop high myopia in childhood:
- Retinal detachment (separation of the retina from the back of the eye), which can cause sudden and permanent vision loss if not treated promptly
- Myopic maculopathy (damage to the central part of the retina), which can cause permanent loss of central vision if left unmanaged
- Glaucoma (a condition in which raised pressure or structural changes damage the optic nerve), for which people with high myopia carry a higher lifetime risk
- Cataract (clouding of the lens), which tends to develop earlier in people with high myopia
How Childhood Myopia Is Diagnosed and Monitored
A paediatric myopia assessment at Asia Pacific Eye Centre begins with a history-taking consultation, where your doctor will ask about your child’s vision concerns, family history of myopia, and daily habits such as screen time and outdoor activity.
From there, the assessment covers the specific tests needed to measure how the eye is currently performing and how it is changing over time. At the end of the appointment, your doctor will explain the findings, whether treatment is recommended, and what the plan is for monitoring your child’s eyes going forward.
Cycloplegic Refraction
Children’s eyes have a strong ability to accommodate (adjust their focus), which can cause a standard refraction test to underestimate the true degree of myopia.
Cycloplegic refraction involves instilling dilating drops to temporarily relax the focusing muscles, allowing a more accurate measurement of the underlying prescription.
The drops take around 20 to 30 minutes to take effect, and your child’s vision may remain blurred and sensitive to light for several hours afterwards. Sunglasses and a plan for a quiet afternoon are advisable on the day.
Axial Length Measurement
Alongside spectacle power, axial length (the physical length of the eyeball from front to back) is the key measure of myopia progression. A growing axial length means the eye is elongating, even if the prescription appears stable.
At Asia Pacific Eye Centre, axial length is measured at each review visit so that progression can be tracked against age-matched norms and treatment adjusted accordingly.
How Often Should a Child Be Reviewed?
A child on active myopia control is typically reviewed every three to six months, depending on their age, rate of progression, and treatment response.
A child who is being observed but not yet on treatment may be seen every six to 12 months. More frequent visits may be scheduled if the prescription is changing rapidly, if the child is very young, or if axial length measurements indicate faster-than-expected progression.
Once a treatment plan is in place, the options below give an overview of what myopia control may involve and how each approach works.
Childhood Myopia Treatment and Myopia Control Options
Myopia in a child cannot be reversed, and treatment focuses on slowing the rate at which the eye continues to grow. The clinical goal of myopia control is to reduce the final degree of myopia the child reaches in adulthood and lower their long-term risk of related eye conditions. An eye specialist will recommend a plan based on your child’s age, rate of progression, and lifestyle.
Atropine Eye Drops for Myopia in Children and Myopine
Atropine eye drops for myopia in children have been used in Singapore since the 1960s, alongside Myopine, to slow the rate of progression. Studies have shown that atropine eye drops can reduce myopia progression by more than half compared to no treatment over two years, with higher concentrations showing greater reductions.
How Low-Dose Atropine Works
Atropine is an anticholinergic agent (a medication that blocks certain nerve signals) that is thought to slow eye elongation by acting on receptors in the retina and sclera (the white outer coat of the eye). It is available in concentrations of 0.01%, 0.025%, and 0.05%.
Lower concentrations are now favoured in clinical practice because they produce fewer side effects while retaining meaningful efficacy. Children typically use the drops once nightly, and treatment is generally continued for two years or more, with regular review to assess response.
Side Effects and What to Expect
The most common side effects of low-dose atropine are mild light sensitivity and a slight reduction in the ability to focus on very close objects. These are generally well tolerated at the lower concentrations in current use. Sunglasses during the day and good lighting for reading or homework help manage both effects.
When atropine is stopped, some children experience a temporary rebound effect in which myopia accelerates briefly before stabilising. Your doctor will advise on how to taper the drops gradually to reduce this risk.
Myopia Control Spectacle Lenses
Myopia control spectacle lenses are designed differently from standard single-vision glasses. Rather than simply correcting blurred distance vision, they incorporate a peripheral defocus design or similar optical feature intended to reduce the stimulus for eye elongation.
Clinical studies suggest these lenses can meaningfully slow myopia progression compared to standard single-vision lenses, though efficacy varies over time and between individuals. They are a practical option for younger children or those not yet ready for contact lenses.
Soft Dual-Focus Contact Lenses
Daily disposable dual-focus contact lenses are designed to correct distance vision while simultaneously providing a myopia control effect.
They are suitable for children who are mature enough to handle and care for contact lenses, typically from around eight to ten years of age, depending on the child. Lens hygiene and responsible daily disposal are essential requirements. Soft contact lenses can be used alongside atropine drops for children who need a combined approach.
Orthokeratology (Ortho-K)
Orthokeratology, commonly called Ortho-K, involves wearing specially designed rigid contact lenses overnight. The lenses gently reshape the front surface of the cornea (the clear window at the front of the eye) during sleep, providing clear daytime vision without glasses or contact lenses.
The effect is temporary and reversible, and the lenses must be worn every night to maintain it. Ortho-K requires a motivated child and parent, as the lenses must be handled carefully and follow-up visits are important. Evidence suggests Ortho-K can slow axial length progression meaningfully in school-age children.
Single-Vision Glasses: What They Do and Do Not Do
Standard single-vision glasses correct blurred distance vision and reduce the eye strain that comes from trying to see clearly without them. They do not, on their own, slow myopia progression.
If your child has been prescribed glasses, it is important that they wear them consistently. A common concern among parents is that wearing glasses will make their child’s eyes dependent on them. This is not the case. Glasses correct the focusing error that already exists in the eye.
Not wearing prescribed glasses does not protect the eye. It means the child is seeing less clearly than they should be, and is gaining no additional benefit from doing so.
Everyday Habits That Support Myopia Control
While there is no guaranteed way to prevent myopia in a child entirely, lifestyle habits play an important part in a myopia control plan and can meaningfully slow progression.
The following recommendations are consistent with guidance from the Singapore National Eye Centre (SNEC) and the Health Promotion Board.
Outdoor Time and Screen Breaks
Spending at least 80 to 90 minutes outdoors each day is associated with a lower risk of myopia onset and slower progression. Outdoor time does not need to be vigorous exercise; the benefit appears to come from exposure to natural light and the visual experience of focusing at distance.
For near work, encourage your child to take a five to ten minute break for every 30 minutes of reading or screen use. The 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds) is a simple version of this that older children can apply themselves.
Reading and Screen Distances
Keeping reading and screen materials at an appropriate distance reduces the intensity of near work on the developing eye. The recommended distances are:
- Reading materials and handheld devices: 30 centimetres
- Computer screens: 50 centimetres
- Television: at least 3 metres
Encourage your child to read upright rather than lying down, and to avoid using phones or tablets in a dark room, particularly at night. Good lighting during all reading and screen activities is recommended.
Childhood Myopia Care at Asia Pacific Eye Centre
Families who are concerned about their child’s eyesight can book a paediatric eye assessment at Asia Pacific Eye Centre.
Assessments include cycloplegic refraction, axial length measurement and a specialist consultation to discuss findings and treatment options. Myopia control options available at APEC include atropine and Myopine eye drops, with treatment plans reviewed regularly and adjusted based on the child’s response and progression.
For families seeking a comprehensive eye screening, our team can advise on the most appropriate package for your child’s age and needs.
Our Paediatric Eye Specialists
Paediatric myopia assessments at Asia Pacific Eye Centre are conducted by our team of registered ophthalmologists.
- Dr Lee Hung Ming, Senior Consultant and Eye Surgeon, MBBS (Singapore), M.Med (Ophth), FRCS (Edinburgh), FAMS (Ophth). Subspecialty: cataract and refractive surgery.
- Dr Tan Yar Li, Senior Consultant and Eye Surgeon, MBBS (Singapore), M.Med (Ophth), MRCSEd (Ophth), FAMS (Ophth). Subspecialty: glaucoma, cataract and refractive surgery.
- Dr Wong Chee Wai, Senior Consultant and Eye Surgeon, MBBS (Singapore), M.Med (Ophth), FAMS (Ophth), PhD (Utrecht). Subspecialty: surgical retina.
- Dr Gillian Teh, Senior Consultant and Eye Surgeon, MBBS (London), M.Med (Ophth), FAMS. Subspecialty: oculoplastic, cataract and comprehensive ophthalmology.
Frequently Asked Questions
Can childhood myopia be reversed?
No. Childhood myopia cannot be reversed because the physical lengthening of the eyeball that causes it is permanent. However, progression can be slowed significantly with myopia control treatment, which reduces the final degree of myopia the child reaches and lowers their long-term risk of related eye conditions.
Can a child outgrow myopia?
No. Myopia does not resolve with age. It typically progresses throughout childhood and adolescence, then stabilises in the late teens or early twenties. The goal is to minimise how much myopia develops before progression slows naturally.
Why is myopia in children in Singapore so common?
The high rates of myopia in children in Singapore are attributed to a combination of factors: a population with a higher genetic predisposition to myopia, an education system that places high demands on near work from an early age, and lifestyles that involve limited outdoor time.
Is myopia inherited from the mother or the father?
Myopia is not inherited from one parent specifically. Either parent being myopic raises a child’s risk. Having two myopic parents raises it further. The inherited component relates to a tendency for the eye to elongate more readily, but environmental factors also play a significant role in whether and how quickly that tendency is expressed.
At what age should my child start myopia control?
Myopia control is considered as soon as myopia is confirmed and showing signs of progression. There is no fixed minimum age. A six-year-old with progressing myopia may benefit from treatment earlier than a 12-year-old whose myopia is stable.
This is particularly important between the ages of six and 12, when the eye is growing most rapidly and progression tends to be fastest. Your child’s eye specialist will advise based on their individual measurements and rate of change.
How fast does myopia progress in children?
In untreated Singapore schoolchildren, myopia typically progresses by around -0.50 to -1.00 diopters per year, though progression is often faster in younger children and in those with earlier onset. Children who develop myopia before the age of eight tend to reach higher final prescriptions than those who develop it later, making early intervention particularly important for this group.
Book a Paediatric Myopia Assessment at Asia Pacific Eye Centre
Bringing your child in for an eye assessment gives you a baseline of their current spectacle power and axial length measurement, so that any progression can be tracked against real measurements.
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