Health problems associated with myopia in babies and toddlers

• Due to anatomical changes in the eye and body that are associated with myopia, certain diseases and conditions can be suspected when myopia develops in babies and very young children.
• These conditions can affect eye health and/or general body health. They may be present at birth, but may be diagnosed later when the child is older.
• If a baby or toddler has myopia, assessment and/or management by a pediatric ophthalmologist and/or pediatrician is often required.

Myopia, also known as short-sightedness or near-sightedness, typically onsets in the early school-aged years. It causes blurred far vision, and in children it typically progresses or worsens regularly until the late teens or early 20s.¹ Myopia brings with it blurred distance vision, frequent changes in vision, and increases the lifelong risk of eye diseases and vision problems in adulthood.²

Myopia occurs when the eye grows at an accelerated rate. Eyes are meant to grow slowly larger until the early teen years and then stop. In myopia, the eyes grow too quickly and too long.³ This stretches the retina, the light sensitive layer at the back of the eye, which makes it thinner and more vulnerable to eye diseases like retinal detachment and myopic macular degeneration.²

Myopia in children younger than school-age is less common, and can be associated with other general health syndromes, especially if it is high myopia. If the eye is already too large at birth or shortly after, this can be linked to other developmental issues in the body which are present at birth or develop afterwards.

In school-aged children, particularly aged 6 and older, myopia is typically managed with myopia control treatments. These treatments include special types of spectacles (glasses), contact lenses and atropine eye drops. Vision and eye health is monitored closely by an optometrist or eye doctor.

In children younger than this, or older children with high myopia, extra clinical care can be required. This often necessitates 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 associated with early childhood myopia.⁴

There are some eye diseases which can be associated with myopia in babies in toddlers. These conditions can also occur in older children and adults. Treatment of these conditions is typically provided by an ophthalmologist (eye surgeon).

• Retinal detachment: this occurs when the eye’s sensory layer at the back of the eye, called the retina, separates from the inner back wall of the eye. Eyes with myopia tend to be more vulnerable to this due to the stretched, thinner retina. Once the retina has detached it will no longer see normally in that area, even if repaired. This may not affect visual clarity if the retinal detachment occurs in the very peripheral parts of the eye, but if it occurs close to the central part of vision it can cause permanent vision impairment. Retinal detachment is an eye health emergency and requires immediate medical attention to preserve vision. Symptoms in older children and adults can include flashes of light and a sudden increase in floaters in the vision. There is no pain in the eyes with retinal detachment, so in young children it can be difficult to detect.⁵
• Retinopathy of prematurity (ROP): when a baby is born prematurely, blood vessels in the retina may grow abnormally, leading to a lack of retinal integrity or strength. This would typically be screened for in premature babies by neonatal specialists. ROP can be associated with development of high myopia in very young children, and increases the risk of retinal detachment and other retinal health problems.⁶

The following general health syndromes can be associated with myopia in babies and toddlers, and may be present at birth. In a survey of all children under age 10 with high myopia who presented to an ophthalmology clinic over 3 years, only 8% were found to have 'simple high myopia' without any other eye or general health concerns. In more than 50%, there was an underlying systemic health issue.⁴ Here are some of these potential conditions.

• Stickler syndrome: this refers to a group of genetic disorders that affect the connective tissue in the body. Babies with Stickler syndrome have higher risk of eye abnormalities like retinal detachment, and early onset cataracts. Predominant features include flatter facial appearance, hearing loss and joint problems.⁸
• Marfan syndrome: this is a genetic disorder affecting connective tissue throughout the body, and is associated with very high myopia. Marfan syndrome can often be difficult to detect at birth, as clinical features (such as disproportionately long limbs and fingers, flat feet, and heart murmurs) may only become apparent when the child is older. It often runs in families, and affects the eyes, heart, blood vessels and bones.⁹
• Homocystinuria: this is a genetic disorder that affects how certain proteins are metabolized in the body. A key feature is high myopia, but typically this syndrome is not diagnosed until later on in life – average age of diagnosis is around 11 years. It can cause other issues like abnormal blood clots, learning disabilities and developmental problems.¹⁰

Babies and toddlers with myopia often need general health and eye health investigations, as described above. It is important that they also receive the best possible vision care, too, to correct their blurred vision and ensure healthy visual development.

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. 

1. Hou W, Norton TT, Hyman L, Gwiazda J; COMET Group. Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens. 2018 Jul;44(4):248-259. (link)
2. 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)
3. Mutti DO, Hayes JR, Mitchell GL, Jones LA, Moeschberger ML, Cotter SA, Kleinstein RN, Manny RE, Twelker JD, Zadnik K; CLEERE Study Group. Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia. Invest Ophthalmol Vis Sci. 2007 Jun;48(6):2510-9. doi: 10.1167/iovs.06-0562. (link)
4. Marr JE, Halliwell-Ewen J, Fisher B, Soler L, Ainsworth JR. Associations of high myopia in childhood. Eye (Lond). 2001 Feb;15(Pt 1):70-4. (link)
5. Soliman MM, Macky TA. Pediatric rhegmatogenous retinal detachment. Int Ophthalmol Clin. 2011 Winter;51(1):147-71. (link)
6. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005 Jul;123(7):991-9. (link)
7. Nagpal M, Nagpal K, Rishi P, Nagpal PN. Juvenile rhegmatogenous retinal detachment. Indian J Ophthalmol. 2004 Dec;52(4):297-302. (link)
8. Coussa RG, Sears J, Traboulsi EI. Stickler syndrome: exploring prophylaxis for retinal detachment. Curr Opin Ophthalmol. 2019 Sep;30(5):306-313. (link)
9. Maumenee IH. The eye in the Marfan syndrome. Trans Am Ophthalmol Soc. 1981;79:684-733. (link)
10. Isherwood DM. Homocystinuria. BMJ. 1996 Oct 26;313(7064):1025-6. (link)