THE average age for a child to develop myopia is typically between 8 and 12 years old. However, there is a noticeable trend in Malaysia where children as young as 5 are being diagnosed with the condition.
Paediatric ophthalmologist Dr Norazah Abdul Rahman says the rates of myopia increase rapidly until around 9 years of age, after which the progression slows down.
By the time a child reaches 18 to 21 years old, refractive errors usually become stable.
Several environmental and lifestyle factors are contributing to this earlier onset, she explains.
Children are spending more time engaging in near-work activities such as reading, writing, and using digital devices like tablets and smartphones. Simultaneously, outdoor activities, which are known to delay the onset of myopia, have decreased.
"The reduced exposure to natural sunlight and the shift to more indoor activities play a significant role in the increasing prevalence of myopia among younger Malaysian children," says Dr Norazah.
Children with myopia often require new prescriptions frequently due to the ongoing growth of their eyes.
During childhood, the eyeball continues to elongate, particularly during growth spurts, leading to a worsening of myopia.
This natural growth process contributes significantly to the need for stronger prescriptions over time.
Additionally, children with myopic parents are genetically predisposed to experience faster progression of the condition.
This results in them having to update their spectacles frequently as their vision continues to change during their development.
MANAGING MYOPIA
Dr Norazah says while myopia itself cannot be reversed, there are several strategies that parents can implement to slow its progression.
Increasing outdoor time is one of the most effective methods as exposure to natural light and the opportunity for distance viewing help slow down the elongation of the eyeball.
In addition to lifestyle changes, parents can explore medical interventions such as low-dose atropine eye drops, which have been shown to slow myopia progression when used in the long-term. Corrective lenses are also effective in managing myopia.
If childhood myopia is not properly managed, it can lead to several serious long-term complications.
Dr Norazah says one of the most significant risks is the progression to high myopia, which is defined as a refractive error of -6.00 diopters or more. High myopia greatly increases the likelihood of developing sight-threatening conditions such as retinal detachment, where the retina stretches and thins due to the elongation of the eyeball, potentially leading to blindness.
Other risks include an increased likelihood of developing glaucoma, a condition that causes damage to the optic nerve due to elevated pressure within the eye, and cataracts, which occur earlier in individuals with myopia. Another serious risk is myopic maculopathy, a degenerative condition affecting the retina that can cause severe vision loss.
Optometrist Nadiah Rashidi, co-founder of Nadiah Optometry, adds that there has been a noticeable increase in the onset and progression of myopia, particularly since the Movement Control Order in 2020.
Unfortunately, these early onsets of high myopia often come with binocular
vision issues, such as amblyopia (lazy eye), strabismus, and accommodation problems, frequently linked to excessive digital device usage of up to 8-10 hours a day.
Nadiah says a study conducted in 2021 reported myopia prevalence at 9.8 per cent among 7-year-olds and 34.4 per cent among 15-year-olds. Research also suggests that Southeast Asia, including Malaysia, has the highest rates of myopia among schoolchildren, with prevalence reaching up to 60 per cent.
Continuous near work has been shown to increase myopic progression, she explains, though the frequency of these activities matters less than the duration and intensity of focus.
"The key factor is prolonged focus at a short distance, which is strongly associated with myopia progression."
Taking regular breaks from near work - such as looking at something six metres (20 feet) away for 20-30 seconds every 20-30 minutes - can significantly reduce eye strain.
The key is not to avoid near work activities but to avoid focusing on the material for extended periods without breaks. Regular short breaks are crucial in managing myopia progression.
EYE HEALTH
*Even if a child doesn't show obvious symptoms such as squinting, adopting unusual head postures, or holding objects too close, it's recommended that they have their eyes checked by age 5, especially if one or both parents wear glasses.
*Children should not be left unsupervised with digital devices for long periods. The recommended maximum screen time is 1-2 hours a day.
*Spend more time outdoors and practise good visual hygiene when studying, which includes maintaining good sitting posture, having adequate lighting, and taking breaks by looking away every 20-30 minutes.
*Outdoor exposure stimulates dopamine release, which plays a role in reducing eye strain caused by prolonged near work. While outdoor time can be beneficial, it will not reverse existing myopia.