Myopia in children — how to slow it down

More and more children squint at the board, hold books right up to their nose and complain that “everything far away is blurry”. This is most often a sign of myopia (short-sightedness) — a condition that is becoming more common, and appearing earlier, around the world. The good news: its progression can be slowed — and the methods that genuinely work are now well studied.

What is myopia?

In myopia, the image of distant objects focuses in front of the retina rather than on it — so distance is blurry while near vision stays sharp. It usually results from an eyeball that is too long axially: the eye grows “too much”. In children the condition typically appears during the school years and progresses year on year until the visual system stabilises.

What matters is not only the spectacle correction but the rate at which the error grows — the slower it progresses, the lower the risk of high myopia in adulthood and the complications that come with it (including retinal changes).

How to spot myopia in a child

• squinting when looking into the distance (TV, whiteboard),
• holding a book, tablet or their face very close,
• sitting right in front of the screen,
• losing their place when copying from the board, reluctance towards the board,
• headaches and fatigue after a school day.

What actually slows myopia down?

Below are methods with documented effectiveness. Note: some of them (drops, specialist lenses) are selected and supervised by a specialist after an examination — they should not be used on your own.

More time outdoors

This is the simplest and completely safe preventive measure. In a randomised trial, adding about 40 minutes of daily outdoor activity at school reduced the three-year incidence of myopia (30.4% vs 39.5% in the group without the extra outdoor time). Natural daylight is today one of the best-confirmed ways to delay the onset of myopia.

Low-dose atropine drops

Low-concentration atropine slows the growth of the error. In the LAMP study all three concentrations (0.05%, 0.025% and 0.01%) worked, and 0.05% was the most effective and well tolerated. A Cochrane systematic review agrees that antimuscarinic drops (especially atropine) most strongly curb progression. However, this is a prescription medicine — used only on a doctor’s order and under supervision.

Specialist contact lenses and orthokeratology

• MiSight soft lenses (daily disposable): in a three-year trial they reduced progression of the error by about 59%, and eyeball elongation by about 52%, compared with standard lenses.
• Orthokeratology (ortho-k) — lenses worn overnight: in the ROMIO study they slowed axial eye elongation by about 43% over 2 years.

Fitting lenses for myopia control is always preceded by a thorough examination — you can read about the scope of diagnostics in the services.

Everyday eye care

Habits do not replace treatment, but they genuinely support a child’s eyes:

• The 20-20-20 rule — every 20 minutes of near work, 20 seconds looking into the distance (at least 6 metres),
• a distance of about 30–40 cm from books and screens,
• daily time outdoors — ideally in daylight,
• limiting screen time, especially for the youngest.

A child’s myopia is not “weaker eyesight that just needs correcting” — it is a process that can be slowed if we respond early enough.

When to see a specialist?

If you notice signs of myopia in your child, or the error grows quickly between examinations, don’t delay. During an optometric-orthoptic examination I assess the refractive error, axial eye length (where possible), binocular vision and put together a safe plan of action. It’s also worth knowing when to schedule a child’s first eye examination.

Have questions about your child’s eyesight? Write or call.

Sources

1. Yam JC, et al. (2019). Low-Concentration Atropine for Myopia Progression (LAMP) Study. Ophthalmology. PubMed
2. Chamberlain P, et al. (2019). A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optometry and Vision Science. PubMed
3. He M, et al. (2015). Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China. JAMA. PubMed
4. Cho P, Cheung SW. (2012). Retardation of Myopia in Orthokeratology (ROMIO) Study. Investigative Ophthalmology & Visual Science. PubMed
5. Walline JJ, et al. (2020). Interventions to slow progression of myopia in children. Cochrane Database of Systematic Reviews. PubMed