Myopia in Singapore: Why It Happens, Who It Affects, and What's Being Done

MyopiaTracker | Evidence-based myopia education | All statistics sourced from peer-reviewed research

Singapore has some of the highest myopia rates ever recorded anywhere in the world. About 65% of children are short-sighted by the time they finish primary school. In studies of young adult male military conscripts, more than 8 in 10 are myopic. This article explains what the research tells us about why myopia is so common here, who is most affected, and what Singapore is doing about it.

The Numbers: How Bad Is It?

65%

of children are myopic by Primary 6

83%

of young male military conscripts in Singapore are myopic (Saw et al. 2001)

13%

of young adults have high myopia (≥−6D)

80–90%

adult prevalence projected by 2050 in some estimates — though exact figures vary by study and methodology

These figures come from named peer-reviewed sources. The roughly 65% Primary 6 figure is a widely cited public health estimate from Singapore myopia epidemiology; exact rates vary by cohort, year, and definition. The 83% figure refers specifically to young male military conscripts in a population-based survey of 15,095 males — not all Singapore young adults — from Saw et al. (2001, Br J Ophthalmol, PMID 11349931). The 13.1% high myopia rate comes from the same study. Projections of future adult prevalence reaching 80–90% by 2050 appear in Singapore public health communications and some research programme statements, but a specific Singapore-only peer-reviewed modelling study supporting a precise figure is not available in the published literature; treat these as indicative estimates rather than established research conclusions.

    What does this actually mean in daily life? In a typical Singapore primary school classroom of 30 students, roughly 20 will be wearing glasses by the time they sit their PSLE. In some heavily studied young adult Singapore cohorts, myopia prevalence exceeds 80% — among the highest rates recorded anywhere.

How Singapore Got Here: A 60-Year Story

Myopia did not always affect most Singaporeans. Research tracing myopia rates over six decades shows a dramatic rise that rose in parallel with Singapore's educational expansion.

A study published in PLOS ONE by Sensaki, Sabanayagam, Saw and colleagues (PMID 28733687, Singapore Eye Research Institute) reconstructed myopia prevalence among Chinese Singaporeans born from the 1920s to the 1980s. Here is what they found:

1928–1948 (pre-independence era)

Among adults who started primary school in this period, myopia prevalence was roughly 26–40%. Formal education was limited in reach and duration.

1965 — Singapore's independence

The education system began rapid expansion. Compulsory schooling was introduced and enrolment rates rose quickly.

1978 — New Education System introduced

A major restructuring of Singapore's school system introduced more rigorous academic streaming and examination preparation from early primary school.

1980s onwards

Myopia prevalence among adults who started school in 1982 had reached 82.2%. Those who started school in 1995 showed 85.9% prevalence. The jump was sharpest for those who entered the education system after 1978.

The timeline is notable. The Sensaki et al. study found a temporal alignment between the expansion and intensification of Singapore's education system and the rise in myopia rates — though ecologic correlation of this kind does not by itself establish causation. What the data does establish is that the change happened too fast to be explained by genetics alone.

Why genetics alone cannot explain this: A comparison study of the same ethnic groups living in different countries (Saw et al. 2006, Br J Ophthalmol, PMID 16809384) found that Singapore Malays had significantly higher myopia rates (22.1%) than Malaysian Malays with the same genetic background (9.2%). Singapore Chinese (40.1%) were substantially more myopic than Malaysian Chinese (30.9%). Because the genetics are similar but the environments differ, the researchers concluded that environmental factors are driving the difference.

Who Is Most Affected: Ethnicity and Myopia in Singapore

Myopia affects all ethnic groups in Singapore, but rates differ significantly between communities. Two large studies measured this carefully.

Children (7–9 years): SCORM Data

The Singapore Cohort Study of the Risk Factors for Myopia (SCORM), led by Professor Seang-Mei Saw at the National University of Singapore, studied children aged 7–9 years from three Singapore schools. It found that myopia prevalence in this age group varied substantially by ethnicity, with Chinese children consistently showing the highest rates.

Young Adults: Military Conscript Data

A population-based survey of 15,095 Singaporean male military conscripts (Saw et al. 2001, Br J Ophthalmol, PMID 11349931) found:

Ethnic Group	Myopia Prevalence (any myopia, ≤−0.5D)	High Myopia Prevalence (≤−6.0D)
Chinese	82.2%	Highest
Indian	68.7%	Intermediate
Malay	65.0%	Lowest of the three groups
All groups combined	79.3%	13.1% overall high myopia

The same study found that education was strongly associated with myopia prevalence and severity — but importantly, significant differences between ethnic groups persisted even after adjusting for education level. This suggests that education alone does not fully explain the ethnic differences.

An older study of 110,236 Singaporean males (Saw et al. 1996, Br J Ophthalmol, PMID 8266124) found the same ranking: Chinese highest, then Eurasian, then Indian, then Malay — across all educational levels. Whether this reflects genetic differences in susceptibility, differences in reading habits, lighting environments, or other factors remains an active area of research.

What Actually Causes Myopia to Be So Common Here?

Myopia happens when the eye grows slightly too long from front to back. Instead of light focusing exactly on the retina, it focuses just in front of it — making distant objects blurry. The key question is: what makes eyes grow too long?

The research points to two main environmental drivers, with genetics playing a background role.

Driver 1: Intense Near Work and Education Pressure

Singaporean children spend many hours each day reading, doing homework, and studying. Several studies from the SCORM cohort found meaningful associations between near work and myopia:

In cross-sectional SCORM data, children aged 7–9 who read more than two books per week were significantly more likely to have higher myopia (odds ratio 3.05, 95% CI 1.80–5.18, for SER ≤−3.0D) than those who read fewer books (cited in Saw et al. 2002, SCORM cross-sectional analysis; confirmed in systematic review PMC4041336). Important caveat: the longitudinal SCORM cohort study by Saw et al. 2006 (Invest Ophthalmol Vis Sci) subsequently found that reading in books per week did NOT predict the development of incident myopia in the following years in this same population, highlighting that cross-sectional associations between near work and myopia are not always replicated prospectively.
A large study of 110,236 Singapore males (Au Eong KG, Tay TH, Lim MK. "Education and myopia in 110,236 young Singaporean males." Singapore Med J. 1993 Dec;34(6):489–92. PMID 8153707) found a consistent positive association between years of formal education and both the prevalence and severity of myopia — more school, more myopia. (Note: a separate paper from the same dataset examined race and culture: PMID 8266124)
The jump in myopia rates was temporally aligned with the post-1978 education system reform, suggesting increased academic intensity coincided with increased myopia incidence — though ecologic association of this kind does not establish direct causation (Sensaki et al., PMID 28733687)

The biological mechanism proposed — though not definitively proven in humans — is that prolonged near work may alter the biochemical signals in the retina that normally regulate eye growth, causing the eye to elongate further than it should.

Driver 2: Not Enough Time Outside

This is the finding that has driven the most public health action globally, and much of the foundational evidence comes from Singapore.

Multiple studies — including data from SCORM — found that children who spent more time outdoors were less likely to be myopic, independent of how much near work they did. In SCORM teenage participants, Dirani et al. (2009, Br J Ophthalmol, PMID 19211608) found that each additional hour per day of outdoor activity was associated with lower odds of myopia (OR 0.90, 95% CI 0.84–0.96, p=0.004), after adjusting for near work, parental myopia, and other factors. Muralidharan and Lança et al. (2021, Therapeutic Advances in Ophthalmology), from Singapore's Eye Research Institute and Duke-NUS, synthesised the broader evidence: outdoor time has a protective effect against myopia even in children performing higher amounts of near work.

The proposed mechanism: bright outdoor light triggers the release of dopamine in the retina. Dopamine is thought to act as a natural brake on eye growth. Indoor artificial light — even in well-lit Singapore classrooms — is typically orders of magnitude dimmer than outdoor daylight, providing a much weaker dopamine signal.

    The Singapore paradox: Singaporean children already spend much of their day in brightly-lit, air-conditioned schools. But "brightly-lit indoors" is not the same as outdoor exposure. Typical classroom lighting is around 300–500 lux. Outdoor daylight is 10,000–100,000+ lux depending on conditions. This difference in light intensity is thought to be one major explanation for why indoor environments — however well-lit — may not provide the same retinal stimulus as outdoor time, though the precise biological mechanism is still being investigated.

The Role of Genetics

Family history does matter. SCORM data (Saw et al., PMC1772924) found that children with one or two myopic parents had greater increases in axial length compared to children without any myopic parents. The risk rises further with two myopic parents.

Researchers at the Singapore Eye Research Institute developed a polygenic risk score for high myopia in Singapore Chinese children using SCORM data (PMC8322707). They found that parental myopia, time outdoors, and genetic risk each had independent effects — meaning even children with high genetic risk can be partially protected by environmental factors, and even children with low genetic risk can develop myopia in high-risk environments.

But as the Malaysia-Singapore comparison makes clear, genetics alone cannot explain Singapore's rates. The environment shapes whether genetic risk is expressed.

Singapore's National Response: What Has Been Done

The National Myopia Prevention Programme (NMPP)

Singapore is one of very few countries in the world to have implemented government-level policies specifically targeting childhood myopia. The National Myopia Prevention Programme (NMPP) was established in 2001, making Singapore an early mover on this issue globally (Yap and Mishu, Children 2024, PMC11726763).

The programme includes:

School vision screenings — systematic checks to identify children with myopia early, enabling earlier intervention
Public education campaigns — targeted at families and children, promoting outdoor activities and good eye care habits
Recommended outdoor time — public health guidance of 8 to 15 hours of outdoor time per week for children
Good near work habits messaging — encouraging breaks, proper lighting, and appropriate reading distances

Has it worked? The NMPP has increased awareness and led to earlier detection. However, myopia prevalence in Singapore has continued to rise. Screening alone does not slow eye growth — it detects what is already happening. The programme's outdoor promotion advice is evidence-based, but translating population-level guidance into consistent behaviour change across a highly competitive academic culture has proven difficult. Singapore's myopia rates have not reversed under the NMPP, highlighting the challenge of structural versus behavioural interventions.

Singapore as a Global Research Leader

Perhaps Singapore's most significant contribution to the global myopia problem is not any single policy, but its role as one of the world's major centres for myopia research.

The Singapore National Eye Centre (SNEC) and Singapore Eye Research Institute (SERI), in partnership with Duke-NUS Medical School and the National University of Singapore, have produced highly influential myopia research — directly informing how children are treated in clinical practice globally.

The most important of these are the ATOM studies.

The ATOM Studies: Singapore's Most Influential Clinical Trials

The Atropine for the Treatment of Myopia (ATOM) programme, led by Professor Donald Tan and colleagues at SNEC, ran two major clinical trials that changed how childhood myopia is managed worldwide.

ATOM 1 (Chua et al. 2006, Ophthalmology, PMID 16996612): 400 Singapore children aged 6–12 with myopia of −1.00 to −6.00D were randomised to either 1% atropine eyedrops or placebo, applied nightly, for two years.

Control group (placebo): myopia progressed by −1.20 ± 0.69D; axial length grew 0.38mm
Atropine 1% group: myopia progressed only −0.28 ± 0.92D; axial length barely changed (−0.02mm)

The result was striking — atropine at 1% markedly reduced axial elongation. But there was a serious problem: the 1% dose caused significant side effects — pupils dilated so widely that children were sensitive to bright light and had blurred near vision. And when treatment stopped, myopia rebounded faster in those who had been on higher doses.

ATOM 2 (Chia et al. 2012, Ophthalmology, PMID 21963266): This follow-up trial tested three lower concentrations — 0.5%, 0.1%, and 0.01% — in 400 children aged 6–12 over two years, with a washout period and then retreatment phase. The 5-year results were published by Chia et al. in 2016 (Ophthalmology, PMID 26271839).

The counterintuitive finding: 0.01% atropine — the lowest dose tested — produced the best long-term outcome at 5 years.

Concentration	5-Year Total Myopia Progression	Rebound on stopping	Side effects
0.5% atropine	−1.98 ± 1.10 D	Largest rebound	Significant — light sensitivity, blurred near vision
0.1% atropine	−1.83 ± 1.16 D	Moderate rebound	Moderate side effects
0.01% atropine	−1.38 ± 0.98 D (lowest)	Smallest rebound	Minimal — negligible effect on pupil or near vision

At two years, higher doses showed stronger suppression of myopia progression — but greater rebound on stopping contributed importantly to their worse 5-year cumulative outcome. The 0.01% dose produced less rebound during the washout phase, and this difference in rebound dynamics contributed to its better long-term total result. The relationship between dose, treatment effect, and rebound is not fully explained by any single simple mechanism.

The global impact of ATOM: The ATOM studies directly influenced the widespread adoption of low-dose atropine as a myopia control option for children across Singapore, Hong Kong, Taiwan, and internationally. Singapore's research helped establish that pharmacological myopia control was viable — a significant contribution to the global field. However, the picture has evolved since ATOM2. Subsequent trials — particularly the LAMP study from Hong Kong (Yam et al. 2019, Ophthalmology) — tested even lower concentrations (0.01%, 0.025%, 0.05%) in a placebo-controlled design and found a clear dose-response relationship: higher concentrations produced greater axial length control. The IMI 2025 Interventions White Paper reflects this updated evidence: 0.05% atropine is now considered to have the strongest evidence for axial length control among the low concentrations, not 0.01%. The ATOM2 finding that 0.01% had minimal rebound was important, but the framing of 0.01% as the universally "preferred" dose is no longer current clinical consensus. Clinicians now typically weigh efficacy against side-effect tolerance when selecting a concentration, and 0.025% or 0.05% are increasingly used when stronger axial control is the goal.

A third study, ATOM3, is currently active (NCT03140358) at SNEC — investigating whether 0.01% atropine can prevent myopia from starting at all in high-risk children (those with one myopic parent who have low hyperopia or borderline myopia). This represents the next frontier: prevention rather than treatment.

The Cost of Myopia in Singapore

Myopia is not just a health issue — it is an economic one. The costs are real and significant, and they land primarily on families.

A study by Zheng, Saw and colleagues (2013, Invest Ophthalmol Vis Sci, PMID 24159089) surveyed 113 Singaporean adults aged 40 and older with myopia:

Mean annual cost per adult: approximately SGD $900 (USD $709) per year
Lifetime per capita cost ranged from SGD $295 for newly diagnosed individuals to SGD $21,616 over 80 years
Spectacles, contact lenses, and optometry visits accounted for approximately 65% of total costs
The estimated total annual direct cost for Singapore as a whole was approximately SGD $755 million
For children aged 7–9 in Singapore, annual costs were estimated at SGD $222 per child; for adults, SGD $587 — rising with age as complications, LASIK, and complex correction become more common

These figures are from 2013 and will have increased with inflation and with the growing proportion of the population requiring correction. They also capture only direct costs — they do not include the productivity losses from uncorrected vision, quality-of-life impacts, or the costs of treating serious complications in high myopes.

The high myopia complication burden: 13% of young Singaporean male military conscripts already have high myopia (≥−6D), per Saw et al. 2001. Singapore public health communications and research programme statements suggest this proportion may grow substantially by 2050 — though a specific peer-reviewed modelling study providing an exact projected range for Singapore is not available in the published literature, and such projections should be treated as estimates. High myopia substantially increases lifetime risk of retinal detachment, myopic maculopathy, glaucoma, and early cataract — complications that require specialist care and carry significant costs and quality-of-life impact beyond headline correction costs.

What Parents in Singapore Can Do Right Now

The research is clear enough to support practical action, even while the science continues to develop.

The Most Evidence-Backed Preventive Step: Get Outside

The protective effect of outdoor time is the most consistent finding across Singapore myopia research. Singapore's NMPP recommends 8–15 hours of outdoor time per week. This translates to roughly 1–2 hours per day on school days. The light intensity matters more than the activity — a walk, sitting at an outdoor food court, or playing on a playground all count.

If Your Child Already Has Myopia: Consider an Axial Length Measurement

A standard vision test at an optical shop tells you the prescription. It does not tell you whether the eye is still structurally growing. Axial length measurement — available at optometrists and ophthalmologists with biometry equipment — is an important complementary metric: it shows whether the eye is elongating and at what rate. Refraction alone remains clinically useful, but axial length adds structural context that refraction alone cannot provide.

Active Treatment Options Available in Singapore

Singapore has good access to the full range of evidence-based myopia control options:

Low-dose atropine (0.01%) — supported by ATOM2 data from SNEC; prescribed by ophthalmologists and some optometrists; a nightly eyedrop
Myopia control spectacle lenses (MiYOSMART, Stellest, and similar) — available from optometrists; require full-day wear
Orthokeratology — overnight contact lenses worn during sleep; available in Singapore from qualified practitioners; appropriate for approximately −1D to −6D
MiSight and similar myopia control daily contact lenses — available for older children

When to Seek a Specialist

The following are reasonable clinical considerations that may prompt a referral to a paediatric ophthalmologist or myopia specialist — they are not formally validated guideline thresholds, but are widely used as clinical judgment triggers:

Your child's prescription has increased by approximately 1.00D or more in a year
Your child developed myopia before age 6
Your child already has moderate-to-high myopia (around −3.00D or more) under age 10
Axial length is already at or significantly above age-appropriate norms

Key Takeaways

Singapore has among the highest documented myopia rates in the world — About 65% of children are myopic by Primary 6; in studies of young male military conscripts, more than 83% are myopic — rates that are among the highest recorded in any studied population
This was not always the case. Rates rose sharply from the 1970s onwards, directly tracking Singapore's educational expansion — too fast to be explained by genetics alone
Both intense near work and reduced outdoor time are consistently associated with higher myopia rates in Singapore research, with outdoor exposure appearing to have a protective biological effect via retinal dopamine signalling
All ethnic groups in Singapore are affected, but Chinese Singaporeans have consistently higher rates than Indian and Malay Singaporeans — a difference that persists even after accounting for education, and which is smaller in Malaysia where the same ethnicities live in a different environment
Singapore's ATOM clinical trials at SNEC established that low-dose atropine (0.01%) was safe and effective for childhood myopia — a landmark finding. Subsequent evidence from the LAMP trial has since suggested that higher concentrations (0.025%, 0.05%) may provide stronger axial length control; the optimal dose is now individualised based on efficacy and side-effect tolerance, not a single universal "preferred" concentration
The National Myopia Prevention Programme has improved detection and awareness, but has not reversed the trend; myopia rates have continued to rise
The annual direct cost of myopia per person in Singapore is approximately SGD $900 for adults; the total annual direct cost to the country is approximately SGD $755 million (2013 data; higher today)
Outdoor time (8–15 hours per week), early monitoring via axial length measurement, and evidence-based treatment when progression is documented are the most actionable steps for Singapore families today

Key References

Sensaki S, Sabanayagam C, Verkicharla PK, et al. An Ecologic Study of Trends in the Prevalence of Myopia in Chinese Adults in Singapore Born from the 1920s to 1980s. PLOS ONE. 2017. PMID 28733687
Saw S-M, Goh PP, Cheng A, Shankar A, Tan DTH, Ellwein LB. Ethnicity-specific prevalences of refractive errors vary in Asian children in neighbouring Malaysia and Singapore. Br J Ophthalmol. 2006;90(10):1230–5. PMID 16809384
Saw S-M, Shankar A, Tan S-B, et al. A cohort study of incident myopia in Singaporean children. Invest Ophthalmol Vis Sci. 2006;47(5):1839–44.
Saw S-M, Chua W-H, Gazzard G, et al. Eye growth changes in myopic children in Singapore. Br J Ophthalmol. 2005. PMC1772924
Dirani M, Tong L, Gazzard G, et al. Outdoor activity and myopia in Singapore teenage children. Br J Ophthalmol. 2009;93(8):997–1000. PMID 19211608 [SCORM: OR 0.90 per hour/day outdoor activity]
Saw S-M, et al. A cohort study of incident myopia in Singaporean children. Invest Ophthalmol Vis Sci. 2006;47(5):1839–44. [Longitudinal SCORM — near work books/week did not predict incident myopia prospectively]
Saw S-M, Carkeet A, Chia K-S, et al. Incidence and progression of myopia in Singaporean school children. Invest Ophthalmol Vis Sci. 2005. PMID 15623754
Saw S-M, Shankar A, Tan S-B, et al. Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore. Br J Ophthalmol. 2001;85(7):798–802. PMID 11349931
Au Eong KG, Tay TH, Lim MK. Race, culture and myopia in 110,236 young Singaporean males. Singapore Med J. 1993 Feb;34(1):29–32. PMID 8266124 [Ethnic differences in myopia rates]
Au Eong KG, Tay TH, Lim MK. Education and myopia in 110,236 young Singaporean males. Singapore Med J. 1993 Dec;34(6):489–92. PMID 8153707 [Education-myopia association, same dataset]
Chua W-H, Balakrishnan V, Chan Y-H, et al. (ATOM1). Atropine for the treatment of childhood myopia. Ophthalmology. 2006;113(12):2285–91. PMID 16996612
Chia A, Chua W-H, Cheung Y-B, et al. (ATOM2). Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses. Ophthalmology. 2012;119(2):347–54. PMID 21963266
Chia A, Lu Q-S, Tan D. (ATOM2 5-year). Five-year clinical trial on atropine for the treatment of myopia 2: myopia control with atropine 0.01% eyedrops. Ophthalmology. 2016;123(2):391–9. PMID 26271839
Zheng Y-F, Pan C-W, Chay J, Wong TY, Finkelstein E, Saw S-M. The economic cost of myopia in adults aged over 40 years in Singapore. Invest Ophthalmol Vis Sci. 2013;54(12):7532–7. PMID 24159089
Muralidharan AR, Lança C, Biswas S, et al. Light and myopia: from epidemiological studies to neurobiological mechanisms. Ther Adv Ophthalmol. 2021. [Singapore ERI / Duke-NUS, review of outdoor light evidence]
Yap TP, Mishu MP. Pharmaceutical Prescribing Privileges for Optometrists to Combat Childhood Myopia in Singapore: Public Health Policy Review. Children. 2024. PMC11726763 [NMPP review]
New Polygenic Risk Score to Predict High Myopia in Singapore Chinese Children. SCORM cohort genetics. PMC8322707. 2021.