Refractive errors are common vision problems in children. They occur when the eye cannot properly focus light onto the retina, the light-sensitive layer at the back of the eye, resulting in blurred vision. Refractive errors can affect daily activities, learning, and overall quality of life if left uncorrected.
Changes in the length of the eyeball, the curvature of the cornea, or the focusing power of the crystalline lens can cause refractive errors. Among these, myopia (short-sightedness) is the most common in children in Singapore, and its prevalence has been increasing in recent years.
To understand refractive errors, it helps to know how light enters the eye:
If light is not focused correctly on the retina, images appear blurry. Refractive errors are classified into three main types: myopia (short-sightedness), hyperopia (long-sightedness), and astigmatism (distorted vision).
Myopia occurs when light rays focus in front of the retina instead of on it. This can happen due to a longer eyeball or excessive focusing power. As a result, distant objects appear blurry while near objects remain clear.
Progressive myopia in childhood can lead to high myopia later in life, increasing the risk of:
Keeping the degree of myopia lower can also allow children some degree of spectacle independence for activities like sports.
Myopia can develop even at an early age and often progresses through childhood. Managing myopia includes providing good functional vision for the patient as well as making sure that myopia does not progress rapidly. We also treat pre-myopia, a condition where children are at risk of developing myopia, to delay the onset of myopia or even preventing it completely.
Vision correction with glasses or contact lenses improves clarity. This is important especially in the context of schooling. Some children may seem to be myopic but are not actually myopic yet, due to their over-focusing during the eye testing. We are able to determine the real refractive status of the child by doing cycloplegic refraction (dilating eye drops involved).
There are now several types of myopia progression treatment options for children. The effectiveness and suitability of each option can vary depending on the child’s age, degree of myopia, lifestyle, and eye health.
Atropine eye drops are a clinically proven method to slow the progression of myopia in children. Its use is widespread internationally with good efficacy and safety profile in both short and long term. Atropine, at the highest dose, can cause the side effects of blurring of near vision and glare when outdoors. There are many formulations available for treatment, including the ultra-low dose range (0.01% – 0.05%) which allows myopia control with less side effects.
There are many spectacle lens technologies available on the market that have two functions: one, it can correct the patient’s vision like a normal lens and two, it can reduce myopia progression with long term wear. It is important to get a recommendation for lenses that have proven effectiveness in myopia control.
There are two types of myopia control contact lenses that are used to slow myopia progression in children.
In patients who have suboptimal control with just one therapy, combination therapy using Atropine and either myopia control glasses or contact lenses may be ideal for better control.
No single method is suitable for every child. A personalised approach, often combining vision correction with myopia control strategies, is important for achieving the best long-term outcomes.
Pre-myopia is the condition in which the child is at high risk of developing myopia in the next couple of years. Often, pre-myopic patients will still have good vision without any visual aids. Therefore, regular school screening will not pick up pre-myopia.
Once a child turns myopic, it is not possible to reverse the eyeball growth to become not myopic. Treating patients at risk of developing myopia can delay the onset of myopia, not only leading to better eye health in the long run but also increasing the chances of being spectacle-free.
Pre-myopia is diagnosed by cycloplegic refraction with your specialist. Based on the data, the child’s risk of developing myopia in the next two years can be stratified.
Atropine eyedrops or use of myopia management glasses have been shown to be effective in delaying the onset of myopia when used in pre-myopic patients.
Hyperopia occurs when light rays focus behind the retina due to a shorter eyeball or insufficient focusing power. Both near and distant vision may be blurry.
While myopia makes distant objects blurry, hyperopia may affect both near and far vision. Early detection through an eye exam is key to preventing vision-related learning difficulties.
Mild hyperopia in young children is often compensated naturally by the eye’s focusing ability (accommodation).
Moderate to high hyperopia may require glasses, especially if associated with eye misalignment (squint) or lazy eye (amblyopia).
Astigmatism occurs when the cornea is curved unevenly, causing light rays to focus at multiple points on or around the retina. This results in distorted or blurred vision at both near and far distances.
Spectacles or contact lenses can correct astigmatism and help children see clearly. Regular monitoring ensures that any changes in vision are addressed promptly.
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Early identification of myopia, hyperopia, and astigmatism in children is essential to:
Regular eye exams from a young age help catch refractive errors early and allow timely intervention to support normal visual development. Uncorrected refractive disorders leading to poor vision in children have also been associated with behavioral issues, poor academic performance and reduced self-esteem.
How often should my child have an eye exam?
Children should have a comprehensive eye exam at least once by age 3–4, before school, and then regularly if glasses are prescribed or vision changes.
Can my child outgrow myopia or hyperopia?
Hyperopia may improve as the eye grows, while myopia usually progresses in childhood and stabilizes in late teens.
Are myopia control treatments safe?
Yes. Low-dose atropine, myopia management spectacle lenses and contact lenses (e.g. orthokeratology) are widely used and safe under specialist supervision. Research has shown that there are no adverse long term effects for childhood use of atropine.
Can astigmatism lead to lazy eye?
Significant astigmatism, if uncorrected, can cause amblyopia in young children, making early detection important.
How does low dose atropine work for myopia control?
It slows the progression of myopia in children with minimal side effects on vision or pupil size, making it easier for daily life activities and reading.
Medical Director, Consultant Ophthalmologist
Senior Consultant Ophthalmologist
Senior Consultant Ophthalmologist
Disclaimer:
The information on the The Children’s Eye & ENT Centre website is intended for educational use. It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.