Condition Library
Myopia (Nearsightedness)
Myopia is usually described as a nuisance you correct with glasses. That is true and incomplete. A myopic eye is physically longer than it should be, and the retina lining the back of it has stretched to cover the increased area.
Stretched retinal tissue is thinner and more fragile, and that is the mechanism behind essentially every long-term risk associated with high myopia. It is why slowing childhood progression is now treated as a clinical goal rather than a cosmetic one.
Symptoms
- Distant objects appearing blurry while near vision stays clear
- Squinting to see at distance
- Difficulty seeing a whiteboard, road signs or a television
- Headaches from squinting
- In children, sitting very close to screens or holding books close
- Difficulty driving at night
Causes and risk factors
- Genetics, with risk rising substantially if one or both parents are nearsighted
- Extended near work, which is associated with faster progression
- Reduced time outdoors, one of the more consistent findings in myopia research
- Onset in early childhood, which predicts a higher final prescription
Treatment
- Glasses or contact lenses to correct the blur
- Orthokeratology, which corrects overnight and slows progression
- Low-dose atropine drops to slow progression
- Myopia-control soft contact lenses using peripheral defocus designs
- Myopia-control spectacle lenses with treated peripheral zones
- More time outdoors, which has reasonable evidence for slowing onset and progression
- Refractive surgery in adults once the prescription is stable
Slowing progression in children
- Aim for around two hours a day outdoors. The evidence is most consistent for delaying onset, which makes it particularly valuable for a younger sibling who is not yet myopic.
- Encourage holding books and devices further away, and build in regular breaks that involve looking at something distant.
- Have annual exams, or more frequent reviews if a management programme is running, so progression is measured rather than assumed.
- Start treatment as soon as progression is documented, because the treatment window is age-dependent and does not reopen.
- Have younger siblings examined early if one child is already myopic, since family patterns are strong.
- Do not deliberately under-correct the prescription. It was once thought to help and is now considered likely to make progression slightly worse.
Common misunderstandings about myopia
- That glasses make it worse. They do not. This is the most persistent worry parents raise and there is no mechanism for it. Glasses correct the light entering the eye and have no effect on how it grows.
- That a weaker prescription slows progression. Deliberate under-correction was once thought to help. The research went the other way, and under-correction is now considered likely to make progression slightly worse.
- That children grow out of it. They do not. Myopia does not reverse. It stabilises when eye growth stops in the late teens, at whatever level it has reached.
- That it is only about needing glasses. The final adult prescription determines lifetime risk of retinal detachment, glaucoma and myopic macular degeneration. That is the reason slowing progression is now treated as a clinical goal rather than a convenience.
Measuring myopia properly in children
In children, the prescription measured without dilating drops is frequently wrong, and wrong in a specific direction. Children have very strong focusing ability, and that focusing effort masks part of their true refractive state. Measuring without relaxing it can under-detect farsightedness and misjudge the myopic prescription.
This is why paediatric exams often involve drops. It is not about viewing the retina in that instance, it is about measuring accurately.
For monitoring progression, what matters is the trajectory rather than any single number. We document the prescription at each visit alongside corneal measurements, so the rate of change is visible. A child progressing at half a dioptre a year and a child progressing at a quarter are in different situations and warrant different conversations.
What parents can do between appointments
Time outdoors has the most consistent evidence of any behavioural factor, and roughly two hours a day is the figure most often cited. The effect appears strongest for delaying onset, which makes it most valuable for the younger sibling who is not yet myopic. It is free, harmless, and worth doing regardless.
For near work, the useful guidance is about breaks and distance rather than quantity. Encourage holding material further away than a child naturally would, and build in regular breaks that involve looking at something far away. The twenty-twenty-twenty rule works for children as well as adults.
And keep the annual exams, or more frequent ones if a management programme is running. Progression is measured, not guessed, and treatment is adjusted based on what the measurements show rather than on assumption.
When to see an optometrist
Book a children's exam if your child squints, sits close to screens, or has a prescription that has increased at each of the last two exams. Progression is most treatable between roughly six and twelve. For a child, bring every previous prescription you can find. The rate of change over the last two or three years is the single most useful piece of information for deciding whether a management programme is warranted and which treatment suits. If you cannot find them, we can request records from a previous practice, and it is worth doing rather than starting the trajectory from zero.
Related conditions
- AstigmatismAstigmatism means the cornea is shaped more like a football than a basketball. Common, easily corrected, and no longer a barrier to contact lenses.
- KeratoconusKeratoconus thins and bulges the cornea, distorting vision glasses cannot fix. Why early detection and cross-linking matter so much.
This page is general educational information, not medical advice or a diagnosis. It is not a substitute for an examination. If you are experiencing sudden vision loss, eye pain or an eye injury, contact us immediately or go to an emergency room.
Myopia (Nearsightedness) questions
Is my child's increasing prescription normal?
It is common and expected. It is not harmless, and both things are true. Normal progression still produces an adult eye with elevated lifetime risk, and progression is now treatable.
Can myopia be reversed?
No. No available treatment reverses myopia that has developed. Treatment slows further progression, which is why starting earlier produces a better final result.
Does wearing glasses make myopia worse?
No. This is a persistent and unfounded worry. Glasses correct the light entering the eye and do not affect how it grows. Progression happens whether or not glasses are worn.
Does more time outdoors really help?
The evidence is reasonably good, particularly for delaying onset. Roughly two hours a day outdoors is the figure most often cited. The mechanism is not fully settled, and the intervention is free and harmless.
Book an appointment with a doctor who has time for you
We schedule 2 patients an hour, so your exam is unhurried and your questions get answered. Most patients are seen within a few days.