Limit screen time, take regular eye breaks, and spend some time outdoors every day. Most of us may be familiar with these good eye care habits that can help prevent myopia, or nearsightedness, which affects more than four in five young adults in Singapore.

However, adhering to these ideal practices may be easier said than done due to lifestyle changes as a result of the COVID-19 pandemic.

“Shifts towards working from home, teleconferencing and home-based learning have inevitably resulted in an increase in exposure to digital devices and a corresponding reduction in outdoor activities for all,” said Dr Wong Chee Wai, Consultant, Surgical Retina Department, Singapore National Eye Centre (SNEC).

For eye experts like Dr Wong, the increased screen time and reduced outdoor activities are worrying trends that do not bode well for myopia control.

“This is an area of particular concern for children. We know that spending time outdoors can prevent myopia onset and progression, but some of their recreational outdoor time may have been substituted with indoor screen time,” said Dr Wong.

For the elderly, increase in screen time may also imply a more sedentary lifestyle, which can lead to undesirable health consequences, including developing conditions such as cardiovascular disease or diabetes. These chronic conditions can have an indirect and negative impact on eye health, he said.

Not just blurry vision

Singapore’s myopia rate is among the highest in the world, affecting 65 per cent of children by 12 years old and 83 per cent of young adults. About one in 10 have high myopia, which is defined as myopia of 500 degrees or more in each eye.

There is a misconception that myopia merely leads to blurred vision that can be corrected using optical aids, such as spectacles and contact lenses. In reality, it can lead to higher risk of eye complications later in life, including conditions like retinal detachment and myopic macular degeneration, which can lead to vision loss.

In Singapore, SNEC found that the prevalence of myopic macular degeneration was 7.7 per cent among low to moderate myopic individuals and 28.7 per cent among highly myopic individuals. In general, the risk of these conditions increases with age and the severity of myopia. “People who are short-sighted also tend to develop cataracts at an earlier age and may require cataract surgery, which further increases their lifetime risk of developing retinal detachment,” said Dr Wong.

While spectacles, contact lenses and Lasik surgery can give good vision to people with myopia, they do not alter the abnormal elongated shape of the myopic eye.

“Over time, this elongated shape of the eyeball imposes biomechanical stress on the internal structures of the eye, including the retina and optic nerve head. This can lead to various retinal and optic nerve complications associated with high myopia,” he said.

Early intervention

There are several intervention methods to slow down myopia progression in children, such as low-dose atropine eyedrops, orthokeratology lenses, and multizone soft contact lenses.

The optimal choice of treatment depends on the child’s age, severity of myopia, and specific needs. Therefore, a thorough examination and discussion of benefits and risks of each treatment with a qualified eyecare professional is of paramount importance.

As myopia progression in adulthood is unusual, the worsening of vision in an adult with myopia should never be attributed simply to an increase in myopia without a comprehensive assessment by an eye specialist.

Dr Wong advises that adults should have their eyes screened for common complications associated with high myopia and be aware of the visual symptoms related to these conditions. Early detection is vital for good treatment outcomes.

Here are some ways that parents can help their children cultivate healthy habits for the use of digital devices.

1 Do a digital detox. Restrict the total screen time spent per day or per session.

2 Supervise the consumption of digital content to ensure that the time spent on devices is maximised for positive learning experiences. Guiding the child improves his or her ability to effectively process and interpret digital content, thereby decreasing the overall time spent online.

3 Schedule allocated time for specific activities. This helps set boundaries on when and where digital devices can be used while building routine and discipline.

4 Parents should be role models by reducing their own recreational digital device usage. They can engage children in offline playtime and non-digital activities, such as arts and craft or board games.