Commentary: If your child’s myopia keeps getting worse, having new spectacles isn’t enough

Commentary

Slowing the progression of myopia in children early may matter far more than we realise for their lifelong eye health, says Dr Foo Li Lian.

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05 Jun 2026 06:00AM

(Updated: 05 Jun 2026 06:14AM)

SINGAPORE: When I tell parents that their young child’s spectacle prescription has increased again within a year, they are sometimes almost too calm about it. They see it as simply “updating glasses” annually and making the child sit farther from the television or reducing screen time.

This reaction is understandable in Singapore, where myopia is so common that it is seen as an ordinary part of childhood for many, harmless besides the need to wear spectacles. But this normalisation is a concern.

Nearly 60 per cent of 12-year-olds and 80 per cent of teenagers in Singapore are short-sighted. Although the rate of myopia in Primary 1 children has recently dropped to 26 per cent, there is still a significant number of children between 7 and 17 years with high myopia coming in for professional consultations.

We experience myopia as blurred vision, but there is actually a structural change happening: The eye is elongating abnormally. Earlier onset of myopia gives the eye more time for the eye to continue elongating abnormally.

This increases the risk of a more severe version, called high myopia. In my practice, I have seen young patients with mild myopia develop high myopia within just a year or two. Families may assume this is simply growing up, until they learn how this also increases their risks of serious eye diseases later in life, including retinal detachment and glaucoma, which can lead to vision loss. A stronger prescription may sharpen vision, but it does not address the underlying progression.

MYOPIA IS A CHRONIC CONDITION

Myopia care has evolved in the past decade, from simply correcting vision to actively managing its progression. This may seem small, but it is an important nuance.

It doesn’t stop at making a pair of spectacles. Treatment needs to be tailored to the child’s age, rate of progression, lifestyle, eye condition and needs. This requires monitoring over time, identifying risk factors and measuring axial length (the length of the eye from front to back).

Axial length reflects how the eye itself is growing. Two children may have similar spectacle prescriptions, but very different patterns of eye growth and long-term risk profiles.

That’s why myopia should be managed over time, like any other chronic condition, with regular follow-ups and early intervention to help improve outcomes.

WHAT EVIDENCE-BASED MANAGEMENT LOOKS LIKE

There is no “one-size-fits-all” solution for myopia. A younger child with fast progression may require a different approach from an older child whose myopia is stabilising. Practical considerations - lifestyle, affordability, family support, maturity of the child, and adherence to the treatment plan - also matter.

Lifestyle habits remain foundational. Where possible, children should be encouraged to spend around two hours a day outdoors, and practice balanced near-work habits beyond school requirements.

Pharmacological treatment, most commonly low-dose atropine eye drops, is an established option for some children. However, close monitoring is generally needed due to potential side effects.

Optical interventions have also become increasingly important, including specialised spectacle lenses, soft contact lenses and orthokeratology lenses that are designed specifically to slow progression.

In Singapore, new consensus guidelines for the management of childhood myopia were published in May. These were developed by clinicians, public health professionals and researchers and among other things, assessed the quality of evidence supporting the various treatment options.

As an example, the guidelines recommended myopic control spectacle lenses as first-line optical interventions for children aged six to 16 years. These use technologies, such as the Defocus Incorporated Multiple Segments (DIMS) or the Highly Aspherical Lenslet Targeted (H.A.L.T.), which work by creating a specific pattern or volume of non-focused light in front of the retina. As a non-invasive option, they are easier to integrate into daily routines and use as recommended.

Its efficacy is supported by clinical studies conducted across different populations. Research in China showed an average 67 per cent reduction in myopia progression among children compared with single-vision lenses, while a US clinical trial reported a 71 per cent reduction. These findings formed part of the evidence reviewed by the US authorities when it granted market authorisation for the lens technology as a myopia management option for children.

However, not every product marketed for “myopia control” is backed by robust scientific evidence. Parents should seek guidance from certified eye‑care professionals and rely on clinically validated solutions.

WHY WAITING IS NOT A NEUTRAL CHOICE

One common misconception is the belief that myopia can simply be “fixed” later. Refractive surgery such as LASIK may reduce dependence on glasses in adulthood, but it does not reverse eye elongation that has already occurred.

Those who already had high myopia before surgery remain at higher risk of myopia-related eye disease later in life, even after surgery.

In very high myopia, refractive surgery may also be less suitable as higher correction requires more corneal tissue removal, which can affect corneal strength and increase surgical risk.

This is why waiting should not be seen as a neutral choice. By the time a child reaches high myopia, some lifelong risks may already be locked in.

Singapore has made great strides in raising awareness of childhood myopia. The next step is to move beyond awareness towards active management.

Parents can start by asking three questions at their child’s next eye check: How fast is the myopia progressing? Should axial length be measured? What evidence-based options are suitable for my child?

These questions move the conversation beyond stronger glasses towards protecting children’s long-term eye health.

We may not be able to eliminate childhood myopia, but we should no longer accept rapid progression as inevitable or treat repeated prescription changes as the full extent of care.

In a country where myopia is so common, the greatest risk may be that we have become too used to it.

Dr Foo Li Lian is Head and Clinical Director of the Myopia Service at the Singapore National Eye Centre and Clinical Assistant Professor at Duke-NUS Medical School. She also serves as President of the Myopia Society of Singapore.

Source: CNA/zw(sk)