Progressive myopia in teenagers and how to manage it

• Teenagers that develop myopia can still progress and should be managed to ensure their myopia progression is tracked and slowed
• No amount of myopia is considered a safe amount
• Optometrists may recommend regular eye checks, eyedrops, glasses or contact lenses to slow myopia progression

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.

Although myopia typically presents during childhood, teenagers can also develop myopia. Their risk of myopic progression is lower, however it can still occur and should be managed appropriately.¹

While myopia is not often associated with other eye health and general health syndromes in teenagers, it is still important to be assessed by an optometrist.

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

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

There are three main ways to correct blurred vision in teenagers. These are:

1. Spectacles: Spectacles are easy to use and are very effective in correcting blurred vision from short-sightedness. Your optometrist may choose to prescribe special myopia-controlling spectacles, which not only correct blurred vision but also assist in slowing prescription changes in your teenager. You can read more about the lens options in our article Eye glasses for myopia control in teenagers.
2. Soft contact lenses: Soft contact lenses are worn during the day and are also an excellent choice to correct blurred vision, and – like glasses – there are also special myopia-controlling contact lenses for teenagers that your optometrist may prescribe. You can read more about it in our article Soft contact lenses for myopia control in teenagers. Although they can initially take more time to handle than spectacles,, contact lenses are great for active teenagers with busy lifestyles. Studies have also shown people who wear contact lenses benefit from higher satisfaction  and confidence in their abilities for sport and other activities.³
3. Orthokeratology: Orthokeratology, also known as ortho-k for short, involves wearing an individually designed, rigid contact lens to precisely reshape the front surface of the eye (the cornea) to correct vision during sleep. The lens is removed on waking, and clear vision is enjoyed without glasses or contact lenses throughout waking hours. This is also a method of controlling myopia, as it can slow progression as well as correct blurred vision. Ortho-k has strong evidence for slowing myopia progression in teenagers up to age 16, and limited evidence for older teenagers. Read more about it in our article Ortho-k for myopia control in teenagers.

Atropine is an eyedrop that is put in the eyes once every day, at night time before sleep. Atropine eye drops are prescribed at low concentrations for myopia control. They are typically used in conjunction with optical correction as they do not assist in correcting blurred vision. While this option can be effective in children, there is no evidence base for teenagers - it may actually impact their vision for studying and driving. Read more in our article Atropine eye drops for myopia control in teenagers.

Teenagers' education and social interactions heavily rely on screen time. A study found that teenagers spend an average of 8 hours and 39 minutes daily on screens, surpassing pre-teens' 5.5 hours. Screen usage notably rose during the two-year COVID-19 pandemic, more than in the previous four years, and appears to have remained higher since.⁴

Ways to manage the impact of screen time on your teenager’s eye health include ensuring that the screen is not being held or positioned too close to their eyes (further than 20-30cm), encouraging regular breaks and use the 20-20-20 rule: look 20 feet (six meters) away every 20 minutes for 20 seconds.⁵

The World Health Organization recommends teenagers up to age 17 are recommended to do 1 hour of energetic activity a day and break up sitting.⁶

Myopia is an ongoing condition requiring regular check-ups with your teenager’s optometrist or eye doctor tomonitor vision and eye health, and ensure myopia control treatments are working. 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.⁷ IMI follow-up 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.