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What Do Parents in the Myopia Capital of the World Know About Myopia?

Arief Salim

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July 19, 2022

• Eye Health
• Healthy living

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By Arief Tjitra Salim, BEng and Associate Professor Mohamed Dirani, PhD, MBA, GAICD

The world is currently facing a myopia epidemic, with 5 billion people, or half the world’s population predicted to be myopic by the year 2050.[1] Children are developing myopia at increasingly younger ages and their myopia is becoming more severe, resulting in an increased prevalence of high myopia which can lead to irreversible blindness.

Singapore, the Myopia Capital of the World

Singapore is often considered to be the myopia capital of the world due to its high prevalence of both myopia and high myopia. Research has shown that more than one in ten Singaporean toddlers aged 6 to 72 months has myopia,[2] with the prevalence rising to as high as 70 to 80% in those finishing secondary school or commencing tertiary education.[3] The high prevalence of myopia in Singapore is causing many negative societal effects including reducing quality of life, education and economic participation of those with myopia, greatly increasing the risk of irreversible blindness in millions of people and costing the healthcare system approximately US$755 million every year.[4]

What is driving the myopia epidemic?

It has long been known that our genes play an important role in the development of myopia, with people who have myopic parents and siblings being more likely to develop myopia themselves.[5]  However, myopia is a complex condition and genetic factors only account for some of a person’s risk of developing the condition as well as how rapidly their myopia may progress and to what extent.

Environmental factors such as excessive near work and spending insufficient time outdoors have been found to be major risk factors for myopia, and with the recent smart device and mobile internet revolution, children are engaging in more near work through their use of digital screens and are spending less time outdoors than ever before. The increasing use and exposure of digital screens in Singaporean children are now also becoming more apparent, given that the Ministry of Education in Singapore is now providing all Singaporean secondary school children with a personal laptop or tablet for learning purposes. It is therefore likely that if not intervened early, the device dependency epidemic will become a major driver of the myopia epidemic in the near future.

Why should parents take notice?

In the face of the myopia and device dependency epidemics, parents can protect their children by helping them to do the following good behaviours: i) increasing the time that they spend outdoors exposed to natural light; ii) encouraging them to look far into the distance; iii) taking regular breaks from their device screens; and iv) undergoing regular and timely comprehensive eye check-ups. In order for parents to be able to instil these protective behaviours in children, they must first be aware that there is a myopia epidemic, that unhealthy device use behaviours are likely to be contributing to the problem, and that there are behavioural changes that can be implemented to help children make better choices to protect their eyes.

In Singapore, strategies that include improved education and awareness about myopia’s modifiable environmental risk factors have been successful in reducing the prevalence of myopia by 5% in primary school children [6] and a survey in China found that children had a lower risk of developing myopia if their parents paid attention to their vision from a young age,[7] highlighting how important parental awareness is in managing myopia. However, there has been a paucity of data investigating the awareness and knowledge of myopia and its management strategies amongst parents worldwide, including in Singapore.

How knowledgeable are Singaporean parents on myopia?

Research investigating the level of knowledge and awareness of myopia among Singaporean parents has been sparse. The Singapore-based health technology company, Plano, previously conducted two studies to fill this gap, both of which were published as comprehensive reports and are publicly available online. The first, titled ‘What do Singaporean parents know about myopia?’ was conducted in 2018 and found that, of the 326 parents surveyed, 56% correctly estimated the prevalence of myopia, 43% were aware of how many hours adolescents in Singapore spent using digital smart devices, and two-thirds were aware of the combination of protective behaviours that can be used to reduce the risk of myopia in children.

The second report, titled ‘Parenting in the 21st century: Are parents well informed to manage eye health and smart device use in children?’ was conducted in collaboration with the National University of Singapore Business School and reported that up to 90% of Singaporean parents were unaware that myopia can lead to other sight-threatening eye diseases. Although encouragingly, most were aware of the various management strategies that can be employed to reduce the risk of onset or progression of myopia in children. About one-quarter and one-third, respectively, did not encourage their children to spend time outdoors and did not monitor their children’s screen time, and three-quarters did not take their children for annual comprehensive eye checks. Together, these two surveys illustrate that a significant proportion of parents in Singapore are not equipped with the requisite knowledge and do not behave optimally to mitigate the risk of myopia in their children.

The importance of parental education on myopia

In order to instill good eye care and smart device use behaviours in children, parents need to be well equipped with the necessary knowledge and awareness. The two studies highlighted above provided insights into the knowledge and awareness of myopia and its management strategies among Singaporean parents, as well as parenting habits on managing device use and eye health in children. The results from the two studies suggest that Singaporean parents had a good level of awareness of the different myopia management strategies and they were also aware that excessive smart device use in children is associated with negative eye health consequences.

However, awareness campaigns to better inform and educate the public about the increased risk of developing sight-threatening eye problems associated with myopia, as well as the importance of regular and timely eye examinations in children may be warranted. More research is required to further assess parents’ knowledge and awareness of myopia and its management strategies amongst a larger cohort, which may assist in the development of more targeted public awareness campaigns.

Arief Tjitra Salim, BEng, is the Research and Operations Lead at Plano Pte Ltd.

Mohamed Dirani, PhD, MBA, GCAID, is the Founding Managing Director of Plano Pte Ltd and an Adjunct Associate Professor at the Duke-NUS Medical School. He is also an Adjunct Principal Investigator at the Singapore Eye Research Institute and an Honorary Principal Investigator at the Centre for Eye Research Australia.

You may also find this article at Review of Myopia Management.

References

[1]       B. A. Holden et al., “Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050,” (in eng), Ophthalmology, vol. 123, no. 5, pp. 1036-42, May 2016, doi: 10.1016/j.ophtha.2016.01.006.

[2]       M. Dirani et al., “Prevalence of refractive error in Singaporean Chinese children: the strabismus, amblyopia, and refractive error in young Singaporean Children (STARS) study,” (in eng), Invest Ophthalmol Vis Sci, vol. 51, no. 3, pp. 1348-55, Mar 2010, doi: 10.1167/iovs.09-3587.

[3]       B. Seet et al., “Myopia in Singapore: Taking a public health approach,” (in English), British Journal of Ophthalmology, Review vol. 85, no. 5, pp. 521-526, 2001, doi: http://dx.doi.org/10.1136/bjo.85.5.521.

[4]       Y. F. Zheng, C. W. Pan, J. Chay, T. Y. Wong, E. Finkelstein, and S. M. Saw, “The economic cost of myopia in adults aged over 40 years in Singapore,” (in eng), Invest Ophthalmol Vis Sci, vol. 54, no. 12, pp. 7532-7, Nov 13 2013, doi: 10.1167/iovs.13-12795.

[5]       M. Dirani et al., “Heritability of refractive error and ocular biometrics: The genes in myopia (GEM) twin study,” (in English), Investigative Ophthalmology and Visual Science, vol. 47, no. 11, pp. 4756-4761, November 2006, doi: http://dx.doi.org/10.1167/iovs.06-0270.

[6]       H. P. Board, “Health Promotion Board Annual Report 2009/2010,” Singapore, 2010. [Online]. Available: https://www.hpb.gov.sg/docs/default-source/annual-reports/hpb-annual-report-2010.pdf?sfvrsn=2

[7]       S. Zhou et al., “Association between parents’ attitudes and behaviors toward children’s visual care and myopia risk in school-aged children,” (in eng), Medicine (Baltimore), vol. 96, no. 52, p. e9270, Dec 2017, doi: 10.1097/md.0000000000009270.