Progressive myopia in children and how to manage it

• Myopia in primary school aged children (6-12 years) is linked to myopia progression and continually worsening vision as the child grows.
• Management of childhood myopia is important for slowing progression and reducing eye health risks.
• Optometrists or eye doctors may recommend regular eye checks, and special types of glasses, contact lenses or eye drops to slow myopia progression.

Myopia, also known as “short-sightedness” or “near-sightedness”, causes vision to become blurred in the distance, needing glasses or contact lenses to bring vision back into focus. Progressive myopia describes when a person’s short-sightedness continually worsens over a period of time, due to abnormally fast eye growth. This can mean that they experience blurry vision and more difficulty with seeing distant objects when their prescription needs updating.

High myopia increases the lifetime risk of serious myopia-related eye health problems which can occur in adulthood. Many of these can lead to permanent vision loss, such as retinal detachment, glaucoma, and myopic macular degeneration.³ Progressive myopia can burden day-to-day life in a variety of ways. Worsening myopia causes vision impairment and social impacts, and stronger, thicker, more expensive lenses are needed to correct higher levels of myopia.⁴

A trip to an optometrist or eye doctor is the first step to detecting if your child may have myopia. They will check your child’s prescription, examine their eye health, and look for certain syndromes that may be associated with childhood myopia.⁵

Once your optometrist has established that your child has myopia, they will manage two important aspects:

1. Correcting blurred distance vision with glasses and/or contact lenses, and
2. Slowing the progression of myopia, also known as “myopia control”

The good news is there is a lot of research on understanding myopia progression and treatments focused on school-aged children. Progressive myopia can be managed in several ways, and steps can be taken to slow the rate of myopia progression.⁶

• Wearing the right prescription, full-time

It’s important to first correct your child’s blurred vision with glasses or contact lenses (or a combination of both), to ensure that they have clear vision. Wearing the right prescription is important for your child’s academic performance, social participation, and ability to complete daily activities. Short-sightedness has been shown to progress faster when it is not corrected, so ensuring that the glasses or contact lenses are worn full-time, during all waking hours, is the first step towards slowing down myopia progression.⁷

• Spectacles (glasses)

Spectacles are often the first solution for vision correction in children because they’re simple and easy to use. Glasses for children with myopia should be prescribed in the full correction power - wearing an older or weaker prescription can actually speed up myopia progression. Standard single vision spectacles and contact lenses correct blurred vision but are not effective at slowing progression of myopia.⁸ There are special types of spectacles which are designed to do both, and are now becoming increasingly available across the world.⁶

• Soft contact lenses

Soft contact lenses overcome the need for wearing glasses making them great for active kids. Compared to glasses, they can improve children’s confidence, participation in activities and personal satisfaction.⁹ Contact lenses are a safe option for vision correction in children provided that the lenses are worn properly, and the lenses are well taken care of. Soft contact lens designs designed to slow progression have been available for longer than spectacle lens options, which can make them more accessible for myopia control in many countries.

• Orthokeratology (ortho-k)

Orthokeratology, also known as ortho-k, involves wearing an individually designed rigid contact lens that gently and temporarily alters the shape of the front surface of the eye during sleep. The lenses are removed on waking to provide clear vision without glasses or soft contact lenses throughout waking hours. Ortho-k was one of the first vision correction options to be widely used for myopia control and its effectiveness for slowing progression of myopia is backed by many research papers.¹⁰

• Atropine eye drops

Atropine eye drops have been shown to be effective in slowing myopia progression in children as young as 4 years of age. These are eye drops that are applied once every day, at night-time before your child goes to sleep. Because atropine is prescribed at very low concentrations for myopia control, this makes them safe to use in children in the long-term.¹¹

Glasses or contact lenses still have to be worn during the day as atropine eye drops do not correct blurred vision on their own. This means that two levels of compliance are required: wearing the glasses or contact lenses full-time, as well as using the eye drops every night. 

A very important aspect of managing your child’s eye health and development is to ensure they spend enough time outdoors, and to manage 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.¹² On the positive side, research has shown that spending at least 2 hours per day outdoors can delay the onset of myopia.¹³ Where limiting screen time is not practical, ensure that the screen is not being held or positioned too close to the eyes and encourage regular rest breaks. Read more on this in All about screen time and close work.

Myopia is an ongoing condition requiring regular check-ups, and the collaborative care of optometrists and/or eye doctors. If your child has myopia, or is at high risk of developing myopia, their vision and eye health will need to be reviewed more often than usual. Frequent eye examinations allow the eye care professional to ensure the myopia treatment is working well for your child, is tolerated well, and being used correctly. 

According to the International Myopia Institute (IMI), a global group of myopia experts, the frequency of eye examinations will depend on the form of treatment.⁶ IMI recommendations are as follows.

• Spectacles: follow-up appointment 1 month after obtaining spectacles, then 6 monthly thereafter.
• Contact lenses: follow-up appointment 4-7 days after obtaining contacts, then 1 month, then 6 monthly thereafter.
• Orthokeratology: follow-up appointment 1 day after obtaining orthokeratology lenses, then 4-7 days, then 1 month, then 3 months, then 6 monthly thereafter.
• Atropine: follow-up appointment 1 day after obtaining atropine eyedrops, then 4-7 days, then 1 month, then 3 months, then 6 monthly thereafter.

It is important to adhere to your child’s prescribed follow-up schedule, as these appointments allow for any questions you might have regarding treatment to be addressed, and for your eye care practitioner to determine if the treatment is sufficiently effective.

1. Bullimore MA, Richdale K. Myopia Control 2020: Where are we and where are we heading?Ophthal Physiol Opt 2020;40:254–270.
2. Bullimore MA, Lee SS, Schmid KL, Rozema JJ, Leveziel N, Mallen EAH, Jacobsen N, Iribarren R, Verkicharla PK, Polling JR, Chamberlain P. IMI-Onset and Progression of Myopia in Young Adults. Invest Ophthalmol Vis Sci. 2023 May 1;64(6):2.
3. 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.
4. Sankaridurg P, Tahhan N, Kandel H, Naduvilath T, Zou H, Frick KD, Marmamula S, Friedman DS, Lamoureux E, Keeffe J, Walline JJ, Fricke TR, Kovai V, Resnikoff S. IMI Impact of Myopia. Invest Ophthalmol Vis Sci. 2021 Apr 28;62(5):2.
5. Marr JE, Halliwell-Ewen J, Fisher B, Soler L, Ainsworth JR. Associations of high myopia in childhood. Eye 2001;15:70-74.
6. 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. 
7. Chung K, Mohidin N, O'Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Res. 2002 Oct;42(22):2555-9. 
8. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith EL 3rd, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012 Jan;89(1):27-32.
9. Walline JJ, Gaume A, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Kim A, Quinn N. Benefits of contact lens wear for children and teens. Eye Contact Lens. 2007;33(6 Pt 1):317-321. 
10. Sun Y, Xu F, Zhang T, Liu M, Wang D, Chen Y, Liu Q. Orthokeratology to control myopia progression: a meta-analysis. PLoS One. 2015 Apr 9;10(4):e0124535.
11. 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.
12. 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.
13. 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.