Progressive myopia in babies and toddlers and how to manage it

Key Points

Myopia in babies and toddlers is linked to more myopia progression and a higher overall prescription as the child grows. It can also be associated with general health conditions.
The most important first step is to give your baby or toddler clear vision with glasses, and for them to be managed to ensure normal visual development.
Managing the progression of myopia in young children has evidence from age 4.

What is progressive myopia in young children?

Progressive myopia is when a person’s short-sightedness continually worsens over a period of time. This can mean that they experience blurry vision whenever their prescription needs updating. Babies and toddlers are less aware of how clear the world should appear, making it more difficult for you to be aware if their myopia is progressing.

When children develop myopia at a very young age (below 6 years old), this is concerning because their myopia has more time to progress across their childhood. Myopia has been shown to progress faster at younger age, creating greater likelihood of progressing to higher levels of myopia by the time they reach adulthood.¹

Higher myopia increases risk of myopia related eye health problems in later life such as retinal detachment, glaucoma and myopic macular degeneration.² The good news is there is a lot of research showing that progressive myopia can be managed and steps taken to slow the rate of myopia progression,³although most of this research doesn't apply to children under age 4 to 6.

What should I do to help my baby or toddler with myopia?

Myopia in children younger than school-age can be associated with other eye health and general health syndromes, especially if it is high myopia. Often this requires the involvement of eye care practitioners such as an optometrist and/or ophthalmologist, and also paediatrician, to manage eye health as well as general health risks for your young child.⁴

Once your optometrist or eye doctor has established that your toddler has myopia, they will manage two important aspects:

Correcting blurred distance vision, and
Slowing the progression of myopia.

Read more about myopia control in our article What is myopia control and why is it important? The eye and general health concerns which can be associated with myopia in very young children can be found in our article on Health problems associated with myopia in babies and toddlers.

How can we correct blurred vision from myopia in babies and toddlers?

It’s important to correct your baby or toddler's blurred vision with either spectacles or contact lenses, to ensure that they have clear vision.

Spectacles are often the first solution for vision correction in toddlers and young children, because they’re simple and easy to use. Single vision spectacles can be prescribed for very young children.

Contact lenses are less commonly used for vision correction in babies and toddlers, but can be prescribed when they are believed to offer a benefit and/or if the young child is motivated enough to wear them.

Read more about these options in Eye glasses for babies and toddlers and our article on Why babies and toddlers might wear contact lenses.

What is the best myopia control treatment for young children?

Standard single vision spectacles and contact lenses correct blurred vision, but do not work to slow myopia progression. There are special types of spectacles and contact lenses which can do both.³

Babies and toddlers with myopia will typically have their blurred vision corrected with spectacles, and their visual development and eye health monitored. Myopia control treatments may be typically commenced from age 4 to 6, as this is where the evidence starts to exist for the safety, tolerance and effectiveness of the treatments.

Depending on your baby or toddler’s vision and any other vision issues also present, the optometrist or eye doctor may not immediately recommend these myopia controlling spectacles or contact lenses. It may be more important to ensure your child’s normal visual development first.

Atropine eye drops have been shown to be effective in slowing myopia progression in children as young as 4 years of age. These are drops that are put on the eyes once every day, at night before the child goes to sleep. Atropine eye drops are prescribed at low concentrations for myopia control, which reduces the side effects that can occur making them safe to use in children long-term.⁵

Other treatments for myopia control have evidence for older children. Ortho-k contact lenses have shown effectiveness for children from age 6, soft contact lenses from age 7 to 8 and myopia controlling spectacles from age 8. Read more in Which is the best option for myopia control?

Atropine eye drops have been shown to be effective in slowing myopia progression for children as young as 4 years of age.

Read more about the potential use of atropine for myopia control and safety considerations in our article Atropine eye drops for babies and toddlers.

Managing screen time for your baby or toddler

A very important aspect of managing your child’s eye health is to ensure they spend enough time outdoors, and to limit their time using digital devices. Both of these factors can influence visual development in young children.

Lots of time spent looking up close (screen time and reading) is associated with myopia.⁶On the positive side, research has shown that spending 2 hours per day outdoors can delay the onset of myopia.⁷

The Australian Department of Health and the American Academy of Paediatrics recommend that children under two years of age should have no screen time (except for video calls), and children aged 2-5 years should have a maximum of one hour a day of screen time which is co-viewed with a parent or carer.

Where limiting your baby or toddler’s screen time is not practical, ensure that the screen is not being held or positioned too close to their eyes and encourage regular breaks to reduce the impact on their eyes and visual development. Read more on this in Screen time for babies and toddlers: what is ok?

Learning more about myopia in babies and toddlers

Myopia in your baby or toddler will require ongoing eye care throughout their childhood. To learn more about vision and myopia in very young children, read the following.

References

Verkicharla PK, Kammari P, Das AV. Myopia progression varies with age and severity of myopia. PLoS One. 2020 Nov 20;15(11):e0241759.
Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363. (link)
Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. (link)
Marr JE, Halliwell-Ewen J, Fisher B, Soler L, Ainsworth JR. Associations of high myopia in childhood. Eye 2001;15:70-74.
Yam JC, Zhang XJ, Zhang Y, Wang YM, Tang SM, Li FF, Kam KW, Ko ST, Yip BHK, Young AL, Tham CC, Chen LJ, Pang CP. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout: Phase 3 Report. Ophthalmology. 2022 Mar;129(3):308-321.
Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, Lv M, He X, Xu X. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017 Sep;95(6):551-566. (link)
Huang HM, Chang DS, Wu PC. The Association between Near Work Activities and Myopia in Children-A Systematic Review and Meta-Analysis. PLoS One. 2015 Oct 20;10(10):e0140419. (link)

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