Ask the experts: Childhood Myopia
Experts: Yap Tiong Peng and Rachel Kelly, Senior Consultants, Paediatric Optometry PL, IGARD Group, Singapore
1. What factors increase the risk of children developing myopia?
There are 3 main factors:
• Family history. Myopia tends to run in families. If one parent is already wearing glasses, the child’s risk for developing myopia is increased. This risk is even higher if both parents are myopic. Even though there is a large genetic component in myopia development, research shows that there is no genetic link between high and low myopia. This is because ENVIRONMENTAL factors, such as near work, plays a larger role in myopia.
• Prolonged near work. People who spend a lot of time reading or using computers/devices may be at increased risk of myopia. It most frequently occurs and develops during school-going age and itsprevalence is particularly high in secondary/tertiary school students. Children needs to take a break at regular intervals to avoid the detrimental effects of eyestrain that is induced by excessive efforts in focusing up-close (technically called ‘accommodation’). It is believed that this leads to a build-up in pressure in the eye which consequently results in thelengthening of the eyeball (technically called the ‘axial length’).
• Other environmental conditions. Children who spend all their time indoors are at risk. Research suggests that a lack of outdoor activities increases the risk for developing myopia. It will be beneficial for children to spend 2 to 3 hours outdoors each day. This is particularly important for young children, because those who develop myopia early are most likely to progress to more severe cases. Parents should put in measures to protect their children’s eyes from harmful UV rays if they choose to spend more time outdoors.
2. What signs/symptoms should parents be aware of that indicate their child has myopia?
Children do not often complain that they can’t see and parents/ caregivers/ teachers are often the first to notice that the child is facing challenges with their vision. Hence, it is advised for children to get their eyes checked at least once during kindergarten and also yearly for school-aged children. It is also possible to get toddlers and babies to get their eyes checked by an optometrist too!
These are some of the possible signs/symptoms:
• Difficulties copying from the whiteboard in school
• Persistent need to squint or partially close eyelids to view
• Eyestrain, visual discomfort and headaches
• Child moving too close to the TV
• Holding books too close while reading
• Not able to notice distant objects
• Blinking or rubbing eyes frequently
• Head tilt or head turn to view sideways
3. Finally, do you have any advice for parents to reduce the likelihood of their child developing myopia?
Children needs to take a break at regular intervals to avoid the detrimental effects of eyestrain that is induced by excessive efforts in focusing up-close. It is believed that this leads to a build-up in pressure in the eye which consequently results in the lengthening of the eyeball. Research suggests that a lack of outdoor activities increases the risk for developing myopia. It will be beneficial for children to spend 2 to 3 hours outdoors each day. This is particularly important for young children, because those who develop myopia early are most likely to progress to more severe cases. Parents should put in measures to protect their children’s eyes from harmful ultraviolet (UV) rays if they choose to spend more time outdoors.
In addition, parents can guide their children in adopting good visual habits at home. Ensure that the child sits upright while reading; maintain a reading distance of at least 35cm; use a desk lamp when reading; avoid playing with the tablet/smartphone in the dark; take a break every 20min from reading/computer; get a balanced diet.
Besides taking these preventive steps, school-aged children needs to get their eyes checked at regular intervals too. Preschoolers should get their eyes checked at least once when they are still in kindergarten. This is especially so for those who are genetically predisposed to myopia. If the child already need glasses, they can explore various options to help to control their progression of myopia. Rather than jumping straight ahead into a quick fix, parents should spend time to discuss with their optometrist and to explore intervention strategies, which may include special glasses, contact lenses or eye drops. Furthermore, it may be beneficial to take a holistic approach by striking a balance between early interventions and adopting good visual habits.
Name of expert: Yap Tiong Peng, Senior Consultant, Paediatric Optometry PL, IGARD Group Singapore; BSc(Hons) Optometry (University of Manchester, UK), MSc (University of London – Imperial College), DIC (Imperial College London, UK), PhD(c) (University of New South Wales, Sydney, Australia); Accredited in the UK in Behavioural Optometry and Neuro-Optometric Vision Rehabilitation/Therapy
Senior Consultant Yap Tiong Peng is best known locally for his work on vision therapyand myopia control. Qualified since 1998, he has been in private practice for many yearsand also concurrently holds part-time academic and research positions. He has a special interest in paediatric and behavioural optometry. Their team has helped many children including those with special-needs, including Down’s syndrome, autism, dyslexia, dyspraxia and developmental delays. Tiong is a clinical supervisor and lecturer for many years. He taught the Master of Optometry degree at the National University of Malaysia (UKM) and the Bachelor of Optometry programme at the University of Manchester and Singapore Polytechnic. His current research uses ‘brainwaves’ to investigate children with Lazy Eyes (Amblyopia) at the University of New South Wales, Sydney, Australia. He was formerly a Research Fellow, Ophthalmology and Visual Science, Alexandra Hospital, Singapore.
Name of expert: Rachel Kelly, Senior Consultant, Paediatric Optometry PL, IGARD Group Singapore; BSc(Hons) Optometry (Glasgow Caledonian University, Scotland, UK), MSc (City University, London, UK), MCOptom (British College of Optometrists) Originally from Ireland, Rachel Kelly has many years of clinical experience in ocular diagnostics and therapeutics in London. She previously worked at Moorfields Eye Hospital and has been the President of the North London Association of Optometrists. Rachel has been in Singapore for six years and she has been very popular with the expat community and locals alike. Her special interest is inorthokeratology refractive therapy for myopia control and she is a strong advocate for vision therapy. Together with Yap Tiong Peng, she has often raised red flags in local media over the potential ill-effects of smartphone to the eyes and the excessive use of artificial 3D technology at home.
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