Myopia in Children:
Why It Matters &
What Parents Can Do

Singapore's Myopia Epidemic: The Numbers That Matter

Myopia has become nearly universal among East Asian children. In Singapore, the prevalence is staggering: by the end of primary school, nearly two-thirds of children are myopic. By adulthood, the figure approaches 80%.

This is not simply a coincidence of genetics or a global trend affecting all regions equally. Children in Singapore, Hong Kong, Taiwan, and South Korea experience myopia rates three to four times higher than children in Europe and North America, despite similar genetic ancestry. The difference is environmental: intense academic pressure, long hours of near work, and limited outdoor time during critical years of eye development.

The problem is compounded by a false sense of security. Many parents believe myopia is harmless—a matter of getting the right prescription. The assumption is that once glasses are prescribed, the problem is solved. This misses a crucial point: myopia is not primarily a refractive error that can be corrected by lenses. It is a structural condition in which the eye physically elongates, and this elongation carries lifetime consequences.

Why Myopia Matters Beyond Glasses: The Retinal Perspective

As a vitreoretinal surgeon, my perspective on myopia is shaped by what I see in the operating theatre. I see young adults in their 30s and 40s with myopic eyes suffering catastrophic retinal detachments, or patients in their 50s discovering irreversible central vision loss from myopic macular degeneration. In nearly every case, the disease process began in childhood. Understanding why requires looking at what happens inside a myopic eye.

Axial Elongation: The Core Problem

A normal adult eye measures approximately 23–24 millimetres from front to back. In myopic children, the eye begins to elongate beyond this normal length. For every additional millimetre of length, the eye becomes more myopic by approximately 2.5 to 3.00 dioptres. So a child whose eye is 25mm long has roughly −2.50 to −3.00 myopia; at 26mm, the prescription is around −5.00; at 27mm, −7.00 or higher.

This elongation is progressive during childhood and adolescence. It accelerates in the first decade of life, particularly in children who develop myopia early. Without intervention, a child with −1.00 myopia at age 8 might reach −4.00 or −5.00 by age 16, and possibly −6.00 or beyond by early adulthood—crossing the threshold into pathologic myopia.

Structural Changes and Cascading Complications

As the eye elongates, every tissue inside it is stretched over a larger surface area. The retina, initially designed for a 24mm eye, thins progressively. The macula—the region responsible for central, detailed vision—becomes distorted and its blood supply becomes compromised. The peripheral retina becomes fragile and prone to tears. The optic nerve head, where the nerve enters the eye, becomes increasingly vulnerable to glaucoma.

These are not theoretical risks. They are structural consequences, visible on imaging, that accumulate with each millimetre of additional length. And crucially, they are irreversible. A child whose eye has been allowed to elongate to 27mm cannot have that length reduced. Glasses and contact lenses can correct the focusing error, but they cannot undo the physical changes.

When Does Myopia Become Dangerous?

The threshold for "high myopia" or "pathologic myopia" is conventionally defined as a prescription of −6.00 dioptres or more, or an axial length exceeding 26 millimetres. At this level, the structural changes in the eye become clinically significant and complications begin to appear with measurable frequency.

However, risk does not start at −6.00. It increases progressively. A child with −4.50 myopia is already at elevated risk compared to the general population. By −5.50, the risk rises significantly. And by −6.00 or beyond, the eye enters a category where surveillance and sometimes preventive intervention become important.

For more detail on the complications of high myopia and what to watch for, see our detailed guide to high myopia. The key conditions to be aware of include:

• Myopic Macular Degeneration (MMD) — progressive thinning and atrophy of the macula, leading to irreversible central vision loss. This is the most feared complication and the leading cause of vision loss in high myopia.
• Retinal Detachment — the elongated eye is prone to peripheral retinal tears, which can progress to detachment if untreated. This is a surgical emergency.
• Myopic Choroidal Neovascularisation (CNV) — abnormal blood vessel growth in the layer beneath the retina, causing acute central vision loss.
• Myopic Traction Maculopathy — vitreoretinal traction causing the macula to split or develop a hole.
• Glaucoma — elevated intraocular pressure damaging the optic nerve.

Myopia Control: What the Evidence Shows

The good news is that myopia progression can be slowed. Multiple interventions have strong evidence supporting their effectiveness. The key is to start early—ideally within a year of myopia onset—and to maintain treatment consistently through the childhood and adolescent years. Here are the evidence-based options:

Low-Dose Atropine Eye Drops

Low-dose atropine (0.01% to 0.05%) applied nightly is the most studied and most widely used myopia control treatment globally. Multiple randomised controlled trials, including landmark studies from Singapore and other East Asian centres, show that atropine reduces myopia progression by 50–70% compared to untreated children over a one-year period.

The mechanism is not fully understood but is thought to involve inhibition of axial elongation rather than simple reduction of accommodation. At low doses, side effects are minimal—some children report mild pupil dilation and reduced near focus, but these effects are usually well-tolerated. Atropine does not reverse existing myopia; the child still needs glasses or contact lenses for clear vision. What it does is slow the rate at which the prescription worsens and the eye elongates.

Treatment is typically started at age 6–8 years (or shortly after myopia is detected) and continued through adolescence. The long-term goal is to limit the final prescription and, more importantly, to reduce axial elongation so that the eye does not reach pathologic levels.

Orthokeratology (Ortho-K) Contact Lenses

Orthokeratology uses specially designed rigid gas-permeable contact lenses worn overnight. These lenses temporarily reshape the cornea, allowing spectacle-free or contact-free daytime vision. Beyond the refractive convenience, ortho-K lenses reduce the myopic peripheral defocus that appears to drive axial elongation. Studies show significant slowing of myopia progression—comparable to low-dose atropine—with some studies showing even greater slowing of axial elongation.

Ortho-K is suitable for motivated children, typically from age 8–10 onwards. Success depends on careful lens fitting, strict hygiene protocols, and regular follow-up. The main risk is corneal infection if lenses are not properly cared for, but this is rare with proper compliance. For the right candidate, ortho-K offers an excellent non-pharmaceutical alternative to atropine, with the added benefit of daytime freedom from glasses or standard contacts.

Myopia Control Spectacle Lenses

Several newer spectacle lens designs—such as DIMS (Defocus Incorporated Multiple Segments) lenses and HAL (Highly Aspherical Lenslets) lenses—have been shown to slow myopia progression. These lenses use multiple focal zones or aspheric elements to reduce peripheral hyperopic defocus. A major multicentre trial showed DIMS lenses reduced myopia progression by approximately 60% compared to standard spectacles. These are increasingly available and represent a convenient option for children who prefer standard spectacles to drops or contact lenses.

Outdoor Time: A Protective Factor

Epidemiological research consistently shows that children who spend more time outdoors have lower rates of myopia onset and slower progression. The protective mechanism appears to involve bright outdoor light exposure triggering dopamine release in the retina, which inhibits axial elongation. Importantly, this benefit is seen even in children who spend significant time on near work activities like studying and screen time—outdoor time appears to provide independent protection.

Current evidence suggests that at least 2 hours per day of outdoor time provides meaningful protective effect. This is a simple, free intervention that every parent should prioritise alongside medical myopia control options.

Note: I prescribe atropine and provide retinal surveillance as part of a comprehensive approach to childhood myopia. For orthokeratology and DIMS/HAL lens fitting, I work closely with experienced optometrists—referring patients to trusted colleagues who specialise in these lens-based treatments. For children already under the care of a paediatric ophthalmologist or optometrist, I am happy to collaborate, focusing on the retinal side.

Dr. Wong's Role: The Retinal Specialist's Perspective

A question parents often ask is: "Should my child be seeing a retinal surgeon?" The answer depends on the severity of myopia and whether structural complications are developing.

When to See a Retinal Specialist

A baseline retinal assessment by a vitreoretinal specialist is recommended if:

• Your child's myopia reaches −4.00 dioptres or above, particularly if progression is rapid
• There is a strong family history of high myopia or retinal complications
• Your child has been diagnosed with high myopia (−6.00 or above)
• Structural changes are detected on retinal imaging (retinal thinning, lattice degeneration, posterior staphyloma, etc.)

The retinal specialist will perform a detailed examination including dilated fundoscopy and often OCT imaging to assess the retinal architecture, optic nerve head, and macula. This establishes a baseline and identifies any early structural changes that require ongoing surveillance.

My Full Scope in Childhood Myopia

I manage both myopia progression and its complications. For myopia control, I prescribe atropine and, for lens-based treatments (orthokeratology, DIMS/HAL lenses), I work with optometrists to coordinate fitting and ongoing management. This sits alongside my primary expertise in retinal surveillance and surgical management of complications. For many families, this integrated approach is valuable—atropine and retinal monitoring under one specialist, with lens-based options co-managed with a trusted optometrist.

I diagnose and manage:

• Retinal detachments from myopic tears
• Myopic macular degeneration and myopic CNV
• Myopic traction maculopathy and macular holes
• Optic nerve compression from posterior staphyloma
• Vitreous haemorrhage and other myopia-related complications

My involvement is both preventive and therapeutic—from initiating myopia control early, to baseline retinal assessment, to ongoing surveillance, to managing complications if they arise. For children with high myopia or early signs of structural disease, integrating myopia control with regular retinal monitoring under one specialist offers the most comprehensive protection.

What Parents Should Do Now: A Practical Checklist

You cannot control whether your child develops myopia—genetics and environment both play roles, and the environment in Singapore (academic pressure, near-work culture, limited outdoor time) creates high risk. But you can influence the outcome if myopia does develop. Here is what you should do:

Frequently Asked Questions

If my child's myopia is −3.50, should I be worried yet?

Moderate myopia (−3.50) is not yet in the high-risk category, but it is significant enough to warrant discussion about myopia control, particularly if progression has been rapid or there is a strong family history. A child with −3.50 at age 10 could easily reach −6.00 by adulthood without intervention. This is exactly the population where myopia control is most effective—starting before the prescription becomes very high, while there is still time to influence final elongation.

My child is doing well in school because of intensive tutoring and near work. Can we delay myopia control?

Unfortunately, no. Delaying treatment allows progressive elongation of the eye, and the window for effective intervention narrows with each passing year. By age 12 or 13, some of the elongation has already occurred. The most effective myopia control starts early and continues consistently. It is better to start treatment now and maintain it through adolescence than to delay and find at age 16 that the prescription has reached −7.00 or higher. Treatment can be adjusted if needed, but the fundamental principle is: start early, maintain consistency.

Will glasses or contact lenses alone slow my child's myopia?

Standard spectacles and standard soft contact lenses do not slow myopia progression. Some studies suggest that contact lenses may slow progression slightly compared to spectacles, but the effect is modest. Specific myopia control tools—atropine drops, orthokeratology lenses, or special DIMS/HAL spectacle lenses—are what have evidence for significant slowing. Regular glasses are appropriate for correction but should not be used as a substitute for actual myopia control treatment.

If my child needs myopia control, how long does treatment continue?

Most myopia control treatments are continued from the time of myopia detection through mid-to-late adolescence, typically until age 16–18 when eye growth has largely stabilised. The exact duration depends on the rate of progression and the child's age. For a child with early-onset, rapidly progressing myopia, longer treatment is often needed. For slower progression, shorter duration may suffice. Your eye care specialist will discuss the expected timeline during your consultation.

Is myopia control expensive?

Cost varies depending on which option you choose. Low-dose atropine drops are relatively inexpensive and are subsidised under government health schemes in Singapore. Orthokeratology lenses are more expensive (typically SGD 100–200 per month depending on the clinic and lens type). DIMS/HAL spectacle lenses are more expensive than standard spectacles but less costly than ortho-K. Many parents find myopia control a worthwhile investment given the long-term consequences of untreated high myopia.

What if my child has already reached −6.00 myopia? Is it too late for myopia control?

It is not ideal—ideally myopia control is initiated before reaching high myopia levels. However, myopia can continue to progress even after −6.00, particularly in adolescents. Slowing progression from −6.00 to −7.00 or −8.00 is still valuable; it reduces the final prescription and limits total axial elongation. In this case, starting myopia control immediately is important, and baseline retinal assessment by a vitreoretinal specialist to check for early structural complications is essential.

Can myopia be reversed or cured?

No. Once the eye has elongated, that physical change cannot be reversed by current treatments. LASIK and other refractive surgeries correct the focusing error (so the child can see clearly without glasses), but they do not reduce axial length or reverse the structural vulnerability of the myopic eye. The goal of myopia control is to slow or limit progression, not to reverse existing myopia. This is why early intervention is so important—you want to prevent the eye from elongating excessively in the first place.