When Mdm Katherine Yeo’s son, Ryan Tan, was five years old, she grew concerned when she noticed him blinking and squinting incessantly. “My husband and I wear glasses, so I thought Ryan must have inherited our myopia,” she said.
An eye check at
KK Women’s and Children’s Hospital (KKH), a member of the
SingHealth group, confirmed that Ryan was, indeed, myopic. What was more worrying was that his myopia worsened every year, increasing by as much as 100 degrees every six months.
At the age of seven, Ryan was wearing spectacles with 700-degree lenses, while most other children his age still had relatively good vision.
Atropine trial for childhood myopia
The experience affected Ryan greatly. “I felt silly wearing specs,” he said. “I didn’t socialise much in kindergarten because I felt different from my classmates.”
Now an active 12-year-old, Ryan loves to read, solve mathematical problems and play soccer. To prevent his eyesight from getting worse, Mdm Yeo has restricted the time he spends watching TV and playing computer games.
She looked for other ways to curb the problem and eventually found an article about the Singapore National Eye Centre (SNEC) research on atropine, which promises to slow down the progression of myopia in children.
SNEC was testing atropine and needed research subjects. Ryan met all the research criteria and was enrolled in the atropine trial in late 2006.
He had to apply the atropine eye drops nightly and go for an eye check-up every three months. Mdm Yeo carefully recorded every application of atropine, a routine that lasted five years, including a short break in the third year to observe the effects of the eye drops.
“It was challenging, especially when Ryan’s eyes became extra sensitive to light because of the effects of atropine. But the dosage was gradually adjusted and he got used to it,” said Mdm Yeo.
Though the progression of Ryan’s myopia varied throughout the trial, it started slowing down in the fourth year. He still wears glasses today, but his eyesight now deteriorates at a slower rate.
“Before the programme, it was normal for my vision to become blurred every year. Now, I hardly experience any blurring,” he said.
Atropine eye drops: another success story
The atropine trial was conducted on about 400 children, including Nikhil Anggapan, now 15.
His vision started to blur when he was nine. He was diagnosed with mild myopia of 150 degrees, which was attributed to his habit of reading in bed and playing video games.
Less than a year after the diagnosis, his myopia worsened to 250 degrees. “I was in the rugby team and was worried that I wouldn’t be able to see the ball,” said Nikhil.
He was accepted into the atropine programme, which he completed in 2011. After six years of applying atropine, his vision stabilised and the myopia has not worsened.
“I’m very impressed. I can now play rugby without my glasses!” he said.
Myopia prevention in Singapore schools
Up to 65 per cent of Primary 6 children here are shortsighted, compared to 12 per cent of the cohort in Australia and 30 per cent in Britain. Among teenagers here, the prevalence is 70 per cent; and among national servicemen, it is 80 per cent.
“Myopia is the No. 1 visual disability among Singaporeans and the fourth leading cause of blindness here,” said Professor Donald Tan, Medical Director of SNEC and Chairman of the National Myopia Prevention Programme (NMPP).
Launched by the Health Promotion Board (HPB) in 2001, the NMPP promotes good eye-care habits in schools. Teachers are encouraged to allocate more time for outdoor activities and reduce the time pupils spend on nearwork activities. Annual vision screenings were introduced in kindergartens and, between 2004 and 2009, HPB monitored about 20,000 primary school pupils for myopia.
Myopia rates drop among young children
The results were encouraging: There was a 5 percentage point drop (from 38 to 33 per cent) in the number of pupils with myopia between 2004 and 2009.
Prof Tan stressed the importance of stopping the progression of myopia among the young.
“Children with serious myopia – 600 degrees or more – have a high risk of developing retinal detachment in their 20s and cataracts in their 30s. Visual disability, even in its mildest form, can affect their quality of life,” he said.
The SNEC hopes that atropine would prove potent against myopia. Though it is too early to publish conclusive results from the atropine study, Prof Tan is confident the prevalence of serious myopia among children can be reduced by 50 per cent through the joint efforts of SNEC, HPB, schools and the healthcare community.
Children are encouraged to play outdoors more
Children are being advised to play outdoors to reduce the risk of shortsightedness. In Britain, researchers found that for each additional hour spent outside a week, the risk of myopia is cut by 2 per cent. This is apparently because of a greater exposure to natural light and a greater amount of time spent looking at distant objects.
A study on Chinese children in Singapore and Sydney found that 3 per cent of the Australian children have myopia, compared to 29 per cent of the children here. The Australian children spent an average of 14 hours a week outdoors, compared to the three hours a week spent outdoors by Singapore children.
Dr Audrey Chia, Senior Consultant at the
Paediatric Ophthalmology and Adult Strabismus Service, SNEC, said preventing myopia may mean a lifestyle change, such as doing less near-work activity like reading or playing video games. She said, “We should consider moving our kids towards a lifestyle like that of our grandparents... (one) with more outdoor activities.” She also advised parents against unproven “cures”, such as pinhole spectacles, eye massagers, acupressure and health supplements.