Myopia in children is a growing concern. Effective myopia management can help slow progression of nearsightedness and protect your child's vision for the future.
Myopia or nearsightedness is a refractive error where light entering the eye is focused in front of the retina, which results in blurred distance vision while near vision remains clear. In an eye with myopia, the image is not properly focused on the retina because the eyeball is too long or has a corneal curvature that is too steep. This reason is why we note myopic prescriptions with a negative diopter value, typically progressing between –.5 and -1.00 every year.
The elongation of the eyeball, referred to as axial length elongation, is a principal contributing factor to myopia progression. As children grow, their eyes may also grow longer from front to back, which can lead to a greater degree of myopia. This process is significant because the longer the eyeball becomes, the higher the likelihood of future eye health issues. Understanding this growth pattern helps our eye doctors design precise management strategies that slow down the progression and protect your child’s vision.
Typically, myopia starts developing during childhood, often between the ages of 5 and 14, and can continue to progress into early adulthood. The early years are marked by rapid growth in the eye, which can lead to quick changes in the strength of your child’s prescription. Younger children may experience faster progression, which gradually slows as they approach their teenage years. Annual progression gets worse on average by -0.50 diopters to -1.00 diopters, although various factors can impact the actual progression of your child.
Both genetic predisposition and environmental factors contribute to the development and progression of myopia. If one or both parents are nearsighted, their child is at an increased risk.
Extended periods of focus on screens or near tasks are linked with increased accommodative strain—that is, the effort required to focus on close objects. The close proximity often demanded by mobile devices and computers forces the eyes to work harder, is thought to be a contributing factor to myopia progression. This theory has support from specific populations with extremely high rates of myopia, such as ultra-orthodox Jews, where young children spend most of the day reading small texts,
A decrease in the time spent outdoors has been associated with a higher risk of developing and worsening myopia. Natural sunlight prompts a natural narrowing of the pupil, which can minimize peripheral blur—a phenomenon believed to mediate the growth of the eye. Encouraging more outdoor play can be a simple yet effective step in managing nearsightedness in young eyes. Studies indicate that 2 hours a day of outdoor time can have a major impact on the progression of a child's myopia.
Another factor that should not be overlooked is the amount and quality of sleep a child receives. Research indicates that a regular sleep schedule, with adequate rest and an early bedtime, can have a positive impact on visual development. These lifestyle habits, though sometimes seen as minor contributors, play an important role in the overall approach to managing myopia progression.
The early years of myopia are the years with the fastest progression, which underscores the importance of detecting and starting treatment early. Early intervention with myopia management is one of the best defenses against the increasing severity of myopia. It is suggested that a child has their first comprehensive eye examination as early as 6 to 12 months old, a program sometimes referred to as InfantSEE. Following this, additional evaluations around age 3 prior to entering kindergarten, and then regular yearly check-ups, ensure that any progression is closely monitored and managed. The earlier a child's myopia is detected and a myopia management strategy begins, the greater the impact and risk reduction.
Schedule an appointment with a top optometrist near you to discuss myopia management strategies for your child.
Beyond traditional corrective lenses, there are several advanced strategies, known as either myopia management or myopia control, that have become the standard of care for children with myopia.
Ortho-K, also known as Orthokeratology, Corneal Reshaping Treatment (CRT), or Vision Shaping Treatment (VST), is a unique approach to managing myopia in children. These specially designed rigid, oxygen-permeable contact lenses are worn overnight, gently reshaping the cornea while your child sleeps. The lens uses a reverse-geometry design to flatten the central cornea and steepen the periphery, which not only improves central vision but also helps reduce peripheral hyperopic blur—a key factor in slowing myopia progression. Research has shown that Ortho-K is highly effective at reducing the progression of myopia and reducing axial length gain, making it a top option for myopia management.
Multifocal contact lenses offer an effective method for managing myopia in children by altering the visual stimuli on young eyes. These lenses provide clear distance vision while also supporting good near vision, which can help slow the progression of nearsightedness. MiSight 1 day lenses from CooperVision are the first FDA-approved contact lenses specifically for myopia control in children aged 8 to 12, but other multifocal lenses with broader parameters are also available for kids with higher levels of myopia. These daily disposable lenses are comfortable, require no cleaning, and offer a convenient alternative to Ortho-K lenses.
Atropine eye drops have become a well-regarded option for managing myopia progression in children. Low-dose atropine is used to relax the eye's focusing mechanism, which can help slow the elongation of the eyeball—a key factor in worsening myopia. Unlike other treatments, atropine does not require the use of contact lenses or glasses, making it a good option for younger children or those who struggle with other myopia control methods. Studies have shown that atropine is highly effective at reducing myopia progression, and it is often used in combination with other treatments, such as multifocal contact lenses, to enhance effectiveness.
Standard corrective methods such as prescription eyeglasses or contact lenses are commonly used to improve blurry vision caused by myopia. While these lenses help bring distant objects into clear focus, they do not address the underlying progression of myopia. Instead, they serve to provide immediate clarity during daily activities, ranging from reading the classroom board to watching TV at home. This form of correction will still leave your child at risk, as their myopia will continue to get worse, requiring new prescriptions as they age as well as significantly increasing the risk of eye disease later in life.
Each child’s eye health is unique, and there is no one-size-fits-all solution in myopia management. Our eye doctors carefully evaluate the individual factors at play by considering age, current prescription, rate of myopic progression, and lifestyle. This personalized approach ensures that any intervention—whether it be advanced contact lenses, overnight corneal reshaping, or pharmacological measures—is well suited to your child’s specific needs.
Recent research in myopia management is opening new doors for protecting your vision. The COMET study is exploring long-term treatment strategies for myopia control (learn more: https://www.sciencedirect.com/science/article/abs/pii/S0197245601001568?via%3Dihub ), while the COOKI trial investigates how overnight orthokeratology can safely reshape the eye to slow myopia in children (learn more: https://iovs.arvojournals.org/article.aspx?articleid=2415090 ). Similarly, the CLAMP study examines the role of specially designed contact lenses in reducing myopia progression (learn more: https://journals.lww.com/optvissci/abstract/2001/04000/the_contact_lens_and_myopia_progression__clamp_.11.aspx ), and the CRAYON study focuses on the benefits of corneal reshaping techniques in young patients (learn more: https://bjo.bmj.com/content/93/9/1181 ). SMART trial, a three year study on the impact of ortho-k lenses on reducing myopia progression in children 8-14 (learn more: https://pdfs.semanticscholar.org/4631/42d4328464b832806d1c229b83b7da10e9da.pdf ).
Schedule an appointment with a top optometrist near you to discuss myopia management strategies for your child.
Understanding myopia management is crucial for your child's eye health. Explore effective strategies to prevent worsening nearsightedness.
