Singapore is often called the “myopia capital of the world.” Myopia, more commonly known as nearsightedness, is a refractive error that causes distant objects to appear blurry while close objects remain clear. This issue has become a public health concern in the nation, affecting a large portion of the population from a young age.
The Scale of Myopia in Singapore
Myopia rates in Singapore are among the highest globally. By age 12, about 65% of Singaporean children are myopic, and this figure climbs to 83% among young adults. Projections suggest that by 2050, between 80% and 90% of all Singaporean adults will be myopic, with a portion of them developing high myopia.
A combination of environmental and genetic factors contributes to this high prevalence. The country’s intense academic culture necessitates long hours of near work, such as reading and screen time, which are known contributors to myopia development. This educational pressure starts from a very young age.
The highly urbanized lifestyle in Singapore also limits the time children spend outdoors. There is a recognized genetic predisposition to myopia within East Asian populations, and while genetics are not the sole cause, the environment in Singapore appears to amplify this susceptibility.
Management and Treatment Options
The most common corrective measures are spectacles and contact lenses, which provide clear distance vision. These devices work by refocusing light directly onto the retina, compensating for the elongation of the eyeball that characterizes myopia. While effective for vision correction, they do not slow the progression of the condition itself.
To address the progression, particularly in children and adolescents, several specialized treatments are widely used:
- Low-dose atropine eye drops: A primary pharmacological intervention. Research, including major studies conducted in Singapore, has shown that atropine can effectively slow down myopia progression by up to 60%. These daily drops are generally well-tolerated, with lower concentrations minimizing side effects like light sensitivity.
- Orthokeratology (Ortho-K): This method involves wearing custom-designed rigid gas-permeable contact lenses overnight. These lenses temporarily reshape the cornea, allowing for clear vision during the day without the need for glasses. Ortho-K has also been shown to reduce the rate of eyeball elongation, thereby controlling myopia progression.
- Specialized myopia control spectacle lenses: Lenses with Defocus Incorporated Multiple Segments (DIMS) technology are designed with a central zone for clear distance vision and a peripheral zone that creates myopic defocus. This peripheral defocus is thought to signal the eye to slow its growth, helping to manage the progression of nearsightedness.
National Prevention Strategies and Initiatives
Singapore has implemented national strategies to combat myopia, led by the Health Promotion Board (HPB) in partnership with the Singapore National Eye Centre (SNEC). The National Myopia Prevention Programme, launched in 2001, aims to delay the onset of myopia and slow its progression through public education and early detection.
A key part of the strategy is encouraging children to spend more time outdoors, with the HPB recommending at least two hours per day. Sunlight is believed to stimulate the release of dopamine in the retina, a neurotransmitter that can inhibit the axial elongation of the eye. School-based programs are designed to promote this habit.
The program also emphasizes good eye care practices, such as taking regular breaks from near work and ensuring adequate lighting. Annual vision screening is conducted in schools to detect myopia early, allowing for timely intervention and referral for further management.
The Risks of High Myopia
Managing myopia is about more than correcting blurry vision; it is also about preventing the long-term health risks associated with high myopia. High myopia is generally defined as a prescription of -6.00 diopters or more and is a risk factor for several serious, sight-threatening eye diseases.
The physical elongation of the eyeball in high myopia stretches and thins the retina, making it more vulnerable to damage. This increases the risk of retinal detachment, a condition where the retina pulls away from its normal position, and myopic maculopathy, a degenerative disease affecting sharp, detailed vision.
Individuals with high myopia are also at an elevated risk for developing glaucoma and cataracts. Glaucoma involves progressive damage to the optic nerve, while cataracts tend to develop earlier in people with high myopia. These potential complications underscore the importance of effective myopia management.