Progressive myopia in young adults and how to manage it

• Typically, myopia appears during childhood and worsens until the late teens to early twenties. It is recommended to start myopia control early and continue until it has become stable.
• In young adults, myopia can develop and progress but is less rapid and frequent than in kids and younger teens. 
• Many treatments have been established to slow myopia progression in children but have not yet been investigated for young adults.

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 abnormal eye growth. This results in blurry vision and more difficulty with seeing distant objects when the prescription needs updating. 

In most cases, myopia starts in childhood, and then progressively increases until early adulthood when it stabilises. Myopia among young adults can be linked to certain behaviours and lifestyles, such as studying at university, more time spent on close work, and less time spent outdoors.¹

High myopia increases the lifetime risk of serious myopia-related eye disease. Many of these can lead to permanent vision loss, such as retinal detachment, glaucoma, and myopic macular degeneration.³ Worsening myopia can burden day-to-day life in a variety of ways, causing difficulties with work, study, driving, and participating in social events.

A trip to an optometrist or eye doctor is the first step to detecting whether there is any myopia. A typical eye exam involves checking the eyes’ vision and prescription, followed by an assessment of eye health. Some eye care professionals have the ability to measure the length of the eye from front-to-back (called axial length), which is used to monitor how the eyes are changing as well as the risk of eye disease from myopia.

If your optometrist or eye doctor has established there is myopia, then the blurred vision should be corrected. Most young adults with myopia will wear spectacles or contact lenses, or a combination of the two for vision correction. 

• Spectacles (glasses)

Glasses for young adults with myopia should generally be prescribed in the full correction power. Wearing the right prescription is important to enjoy clear vision and to participate in daily activities comfortably. 

Standard single vision spectacles correct the blurred vision of myopia but are not effective at slowing progression of myopia^.5 Two of the leading spectacle lenses for slowing myopia progression currently available are the Hoya MiYOSMART⁶ and the Essilor Stellest⁷ lenses. These feature ‘lenslets': multiple, strong powered, extremely small lenses dotted across the larger spectacle lens, and have published data for kids up to 19 and 16 years of age respectively. For older teens and young adults, research hasn’t shown the effect to slow myopia progression but has shown good vision outcomes in these special lens designs.⁸

• Soft contact lenses

Soft contact lenses offer numerous benefits for a young adult such as improved appearance (especially for social occasions), ability to participate in activities like sport and the convenience of not wearing glasses. They are a safe option for vision correction provided that the lenses are worn properly, and the lenses are taken care of properly. 

Like single vision spectacle lenses, single vision contact lenses are beneficial for correcting blurred vision but do not offer any benefit to slowing down the worsening of myopia. Many soft contact lenses with more than one focus (such as dual focus or multifocal contact lenses) have been specially designed for slowing myopia progression in kids. Although most of these have been effective, it is important to note that the limit of the evidence for these types of myopia controlling contact lenses is in wearers up to 16-18 years. The MiSight 1 day contact lens includes data showing safety and effective myopia slowing up to age 18.⁹

• 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. After waking up, the lenses are removed to provide clear vision throughout waking hours without glasses or soft contact lenses. This makes it a fantastic option for vision correction in young adults, with lots of evidence on its safety and ability to provide clear vision.¹⁰

Ortho-k is the only treatment with evidence for stabilizing eye growth in young adults with myopia (up to age 29), compared to spectacles and soft contact lenses, although it is a very small amount of evidence without the same strength or volume as for children.^11,12 There is strong evidence that ortho-k significantly slows progression of myopia in teenagers with most evidence for children up to 15-16 years of age.¹³

• Atropine eye drops

Atropine eye drops in low concentrations from 0.01 to 0.05% for myopia control have solid research evidence for children between the ages of 4-16.¹⁴ There is no evidence for using atropine eye drops to slow myopia progression in young adults – and there can be noticeable side effects from using atropine, including blurred vision for reading and sensitivity to light due to larger pupils. There isn’t any evidence to indicate tolerance of these eye drops and frequency of side effects in young adults.

Screen time and near work such as reading is an inevitable part of life for young adults, whether it is used for leisure, study, or work commitments. Research has pointed to two behaviours as potentially driving the myopia problem: not spending enough time spent outdoors, and more time engaged in near vision work activities.¹⁵

As near work is normally performed indoors, reducing the intensity and time spent on near viewing such as study or gaming may also encourage more activity outdoors. A recent large-scale study suggested a link between smart device screen time, alone and in combination with computer screen time, with increased risk of myopia.¹⁶

However, myopia is not the only concern when it comes to screen time. 

• Digital eye strain: Headaches, blurry vision, sore or itchy eyes could suggest digital eye strain from prolonged screen use, which affects at least 50% of digital screen users. Holding the digital device closer to your eyes and using it for longer durations increases the likelihood of suffering digital eye strain.¹⁷ 
• Dry eye: Our eyes blink less when concentrating on a task up close such as screen work, which can cause the eye surface to become dry. Dry eye covers a broad set of symptoms including dryness, watering, redness, irritation, soreness, and sometimes blurred vision.¹⁸

Progressive myopia in young adults may require more frequent eye examinations than usual, for example every six to twelve months. As there is little research on myopia control for young adults, it’s uncertain whether using a treatment option will produce the desired effects, so it’s important to balance the risks and benefits. Oftentimes, since spectacles or contact lenses will be needed anyway to see clearly, using a myopia control design poses little risk and offers potential benefit to slow myopia progression. Your optometrist or eye doctor may also recommend focusing more on outdoor activity and less screen time to keep your vision and eyes healthy.

The International Myopia Institute (IMI), a global group of myopia experts, recommend the follow-up schedule below for monitoring the progress of myopia:¹⁵

• 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 eye drops, then 4-7 days, then 1 month, then 3 months, then 6 monthly thereafter.