There is no cure for childhood myopia, but simple measures can control it.
Chun Yu’s vision was not saved by expensive new treatments, but by a new hobby, table tennis. The 10-year-old started wearing glasses to correct his mild short-sightedness in kindergarten. By the time he entered Primary 2, his myopia was more than 200 degrees.
This prompted his father, Mr Lam Seng Yew, to take him to Singapore National Eye Centre (SNEC) to see a specialist. Mr Lam said: “I was really worried that his eyesight was deteriorating by 100 degrees every nine months. Imagine what his vision would be like by the time he enters secondary school! I felt I had to do something.”
A worrying trend
Chun Yu is not alone – about 30 per cent of Primary 1 children in Singapore have myopia – but his condition had been deteriorating quicker than most. On average, myopia increases 75 to 100 degrees a year, with deterioration picking up speed as the child grows.
In Singapore, 60 per cent of Primary 6 children and 70 to 80 per cent of 18-year olds are short-sighted, which is due to the elongation of the eyeball because Chun Yu’s myopia was increasing rapidly, Dr Quah Boon Long, Senior Consultant, SNEC, considered using a treatment to slow myopia progression that is still being tested.
To make sure Chun Yu was a suitable candidate for this treatment, Dr Quah monitored his myopia progression. In early June 2009, his myopia had increased to almost 400 degrees, but at his next appointment in March this year, things took an unexpected turn. Chun Yu’s myopia had increased by only 50 degrees. Having studied the progression of myopia in children extensively, Dr Quah sensed that something must have changed with the boy’s lifestyle. He was right.
Mr Lam said: “Chun Yu joined the table tennis team when he entered Primary 3. Practice took up four afternoons after school each week. I didn’t mind because it gave him the opportunity to be more active.” This meant that Chun Yu was spending less time at home doing near work activity.
“More research needs to be done, but there is already some indication that near-work activity, such as reading, can contribute to myopia. In Chun Yu’s case, there was a strong argument that it had an effect,” said Dr Quah.
According to the Sydney Myopia Study, children who spend more time on nearwork activity like using the computer, reading or writing – common in societies which place heavy emphasis on education – have a higher chance of developing or increasing their myopia.
The study, which ran from 2003 to 2005, involved more than 4,000 children between the ages of six and 12 from various ethnic groups.The typical outdoor Australian lifestyle was found to be an important factor in protecting against myopia.
Dr Quah said: “This is just one of the environmental factors, but there is the possibility that outdoor natural light may also have a protective effect that can reduce myopia and slow its progression.”To better understand the role of environmental factors and different types of activity on myopia, Singapore Eye Research Institute (SERI), the research arm of SNEC, intends to set up a study over the next couple of years. Researchers at SERI believe that a significant number of myopia cases can be prevented through a change in lifestyle.
The lack of conclusive evidence aside, Mr Lam has noticed the benefits his son has enjoyed since taking up table tennis. He said: “He is healthier, can focus better at work and is no longer as reserved as he used to be.”
Common yet complex
It may be the most common eye problem in the world, but Dr Quah noted that myopia is also a condition for which there is no current cure. “It is a very complex condition, with numerous genetic and environmental factors showing various effects in its development in different children,” he said. For now, the best way to deal with myopia is to detect it early. The earlier appropriate action is taken, the sooner it can be controlled, reducing the risk of future complications.
Severe myopia can lead to potentially blinding eye conditions later in life, such as cataracts (when the eye lens becomes opaque), glaucoma (when there is abnormal fluid pressure in the eyeball), macular degeneration (when the sensitive part of the retina is damaged) and retinal detachment (when the retina detaches from the eyeball).
Undetected myopia before the age of six can also lead to amblyopia (lazy eye) which can eventually cause blindness in the affected eye. Fortunately, in Singapore, by the time a child is four years old, early childhood developmental assessments are able to pick up the condition. “This doesn’t mean parents have to wait until then. They can look out for signs of straining and squinting when their child is looking at objects. The important thing is to get an accurate assessment. No child is too young for us to spot myopia,” said Dr Quah.
A few drops away from slowing myopia
A local study completed in 2003 by Singapore Eye Research Institute (SERI), the research arm of Singapore National Eye Centre (SNEC), found that a new treatment, atropine eye drops, slowed the progression of
myopia in about 70 per cent of the children in the study.
“The therapy can take between two and three years, and during that time, the children’s pupils become dilated and their near vision is blurred. So they need protective photo-chromatic spectacles (similar to glasses with transition lenses) to protect against light sensitivity. It can be an inconvenience,” said Dr Quah Boon Long, Senior Consultant, SNEC. To see if some of these unwanted side effects can be eliminated, SERI started a second study in 2008, which is in its final stages and involves several hundred children aged six to 11 years. The aim is to decrease the dosage of atropine administered by half, to reduce the side effects and allow more myopic children to benefit from the therapy. Pending an announcement of the study’s findings later this year, the initial results are promising.