Childhood Myopia: What Parents Should Know

Myopia, or nearsightedness, is the reason a child squints at the whiteboard, drifts closer to the television, or holds a book almost against their nose. It is easy to correct with glasses, which is exactly why it is easy to shrug off.

Two things have changed. Far more children are becoming nearsighted than a generation ago, and we now know that the final strength of that prescription matters for eye health decades later. Here is what the research shows, in plain English, and what we tell families at our Coconut Creek, Boynton Beach and West Palm Beach offices.

Key takeaways

• Myopia is rising worldwide, from 22.9% of the global population in 2000 to a projected 49.8% by 2050 (Holden et al., 2016).
• Near work carries a small, dose-related association with myopia (Huang et al., 2015). The evidence for screens specifically is weaker and inconsistent (Lanca & Saw, 2020; Foreman et al., 2021).
• Time outdoors is the best-supported prevention. Adding 40 minutes of outdoor time to the school day cut three-year myopia incidence from 39.5% to 30.4% in a randomized trial (He et al., 2015).
• Myopia control slows progression but does not reverse it, and the certainty of the evidence ranges from moderate down to very low (Lawrenson et al., 2025).
• Myopia is not just a prescription. Higher myopia means higher lifetime risk of retinal, macular and glaucoma problems (Haarman et al., 2020).

Myopia is becoming more common

A pooled analysis of 145 studies covering 2.1 million people estimated that 22.9% of the world was myopic in 2000, and projected 49.8% by 2050. High myopia, the severe end of the range, is projected to rise from 2.7% to 9.8% of the world’s population (Holden et al., 2016). Those are projections, not measurements, and they assume current trends continue.

In the United States the change has already been measured. Comparing two national health surveys using matched methods, myopia in Americans aged 12 to 54 rose from 25.0% in 1971-1972 to 41.6% in 1999-2004 (Vitale et al., 2009). The most severe category rose from 0.2% to 1.6%. Genes do not change that fast in 30 years, which is why researchers look hard at how children spend their days.

Myopia usually starts in the school years and keeps progressing while the eye is still growing, typically until around age 20 (American Optometric Association). The younger it starts, the more years it has to progress, and that is the number worth watching.

What actually raises a child’s risk

Near work

Reading, homework, handheld games and drawing all count. A meta-analysis of 27 studies covering 25,025 children aged 6 to 18 found that more near work was associated with higher odds of myopia (odds ratio 1.14), and that the odds rose by about 2% for each additional diopter-hour of near work per week (Huang et al., 2015). That is a real but modest effect, and it is an association rather than proof of cause.

Screens

Screens are near work, so parents reasonably assume they are the culprit. The evidence is thinner than the headlines. A 2020 systematic review reviewed 15 studies covering 49,789 children: seven of them reported a link between screen time and myopia, but the five that could be combined statistically gave a pooled odds ratio of 1.02 (95% CI 0.96-1.08), which is not a statistically significant association. The authors’ own summary is that the results are mixed (Lanca & Saw, 2020).

A later meta-analysis in Lancet Digital Health found a modest association for smart devices (OR 1.26, lower confidence bound touching 1.00) that rose to 1.77 when computer use was included, with high variability between studies (Foreman et al., 2021). The AOA’s patient page puts those same numbers in plain language: heavy smart-device use is “associated with around a 30% higher risk of myopia and, when combined with excessive computer use, that risk rose to around 80%” (AOA). Those percentages track the odds ratios above, so read them as the same evidence in different words, not as a second study confirming it.

Our reading of it: screens matter mostly because of what they add to a child’s total near-work load and what they replace outdoors. If you want the fuller picture, see our complete guide to screen time for parents and our practical tips for protecting kids’ eyes in the digital age.

Less time outdoors, and what the pandemic showed

During COVID-19 home confinement, school-based photoscreening of 123,535 Chinese children aged 6 to 13 found a myopic shift of about -0.3 D in 2020 compared with prior years — but only in the youngest children, at ages 6 (-0.32 D), 7 (-0.28 D) and 8 (-0.29 D). Myopia prevalence at age 6 rose almost fourfold, from 5.7% to 21.5%, and rose at ages 7 and 8 as well, while the changes at ages 9 to 13 were minimal (Wang et al., 2021). This was screening rather than full cycloplegic refraction, in one country, and the authors themselves urge caution. Read as a natural experiment in indoor living, it points the same way the rest of the evidence does, and it suggests the youngest eyes are the most sensitive.

Time outdoors is the strongest prevention we have

The best single piece of evidence is a cluster-randomized trial in Guangzhou. Twelve primary schools and 1,903 first-graders were randomized; six schools added one extra 40-minute outdoor class each school day for three years, and parents at those schools were encouraged to get their children outside after school and at weekends. Cumulative myopia incidence was 30.4% in the intervention group versus 39.5% in the control group (difference -9.1%, 95% CI -14.1 to -4.1). Refraction changed slightly less in the intervention group (-1.42 D versus -1.59 D), while axial eye growth was not significantly different (He et al., 2015).

A meta-analysis of 25 studies reached the same conclusion and drew an important line: outdoor time roughly halved the risk of myopia starting (risk ratio about 0.54), but did not slow progression in eyes that were already myopic (Xiong et al., 2017).

So outdoor time is prevention, not treatment. The trial that showed a benefit added outdoor time in a block a school day can absorb — one extra 40-minute class, every day, for three years — rather than hitting a daily total. For a child who is already nearsighted, more time outside is still good for them; it is simply not the tool that will slow the prescription.

Myopia control: what can slow progression

Once a child is myopic, the goal shifts. Nothing available today reverses nearsightedness — myopia is a refractive error caused by an eye that is slightly too long, and the eye does not grow shorter. Myopia control aims to slow how fast the prescription and the eye’s axial length change during the growing years, so the adult ends up less myopic than they otherwise would have been.

The February 2025 update of Cochrane’s living network meta-analysis is the best overview: 104 randomized trials in 17,509 children aged 4 to 18. At one year, compared with an inactive control, high-dose atropine (0.5% or stronger) slowed refractive change by 0.90 D, moderate-dose (0.1% to under 0.5%) by 0.55 D and low-dose (under 0.1%) by 0.25 D; myopia-control soft contact lenses slowed it by 0.27 D, and orthokeratology reduced axial eye growth by 0.18 mm. Repeated low-intensity red-light therapy ranked highest of all for refraction, but on very low-certainty evidence. Read the whole picture, not just the best number: certainty across the review runs from moderate down to very low, there is much less data beyond two years, and 66.3% of the trials were conducted in China or other Asian countries, so how well the numbers transfer to a South Florida child is a fair question (Lawrenson et al., 2025). An earlier Cochrane review reached the same headline: atropine is effective, and multifocal spectacles or contact lenses may add a small benefit (Walline et al., 2020).

Low-dose atropine drops

The LAMP study in 438 Hong Kong children aged 4 to 12 found a clear concentration-dependent effect over one year: spherical equivalent changed -0.27 D with 0.05% atropine, -0.46 D with 0.025% and -0.59 D with 0.01%, against -0.81 D on placebo. All three concentrations were well tolerated (Yam et al., 2019).

The picture in North America is less tidy, and parents deserve both halves. A PEDIG randomized trial of 187 US children found nightly atropine 0.01% did not slow myopia at all over 24 months compared with placebo (-0.82 D versus -0.80 D) (Repka et al., 2023). The three-year CHAMP trial across North America and Europe found the opposite for the same concentration: in its main efficacy group of 489 children aged 6 to 10, 0.01% significantly slowed both refractive progression and axial elongation, while 0.02% slowed only axial elongation (Zadnik et al., 2023). Two good trials, two different answers. Low-dose atropine is a reasonable option to discuss, not a guarantee.

Myopia-control soft contact lenses

In a three-year randomized trial that enrolled 144 children aged 8 to 12, of whom 109 finished, daily disposable myopia-control lenses reduced refractive progression by 0.73 D (59%) and axial elongation by 0.32 mm (52%) compared with a standard daily lens, with no serious ocular adverse events (Chamberlain et al., 2019).

Orthokeratology

Ortho-k uses rigid lenses worn overnight to reshape the cornea, so the child sees without correction during the day. A meta-analysis of seven studies in 435 children found axial elongation reduced by 0.26 mm over two years (Si et al., 2015). Only two of those studies were randomized. Overnight lens wear also carries a hygiene and infection responsibility that has to be discussed honestly with the family.

The AOA’s position is that children at high risk of progressive myopia — family history, early onset, extended near work — may benefit from bifocal spectacles or contact lenses, orthokeratology, eye drops, or a combination (AOA).

What myopia control is not

It is not vision therapy. Vision therapy at our offices treats eye teaming, focusing and eye movement problems, and we do not offer it as a myopia treatment. Cochrane’s living review of myopia control reports on drops, myopia-control spectacles and contact lenses, orthokeratology and red-light therapy; no eye-exercise treatment appears among the interventions it covers (Lawrenson et al., 2025). Blue-light-filtering lenses are not a myopia treatment either, and a Cochrane review of 17 trials found they may not even help eye strain (Singh et al., 2023) — more on that in our post on blue light glasses, hype and reality.

Why myopia matters beyond a stronger prescription

This is the part that changes how families think about it. A large review and meta-analysis found that the odds of myopic macular degeneration climbed steeply with severity — 13.6 times at low myopia, 72.7 at moderate and 845 at high myopia compared with non-myopic eyes. Retinal detachment odds rose 3.2-, 8.7- and 12.6-fold, with smaller but real increases for cataract and open-angle glaucoma. The authors specifically noted that low and moderate myopia carry considerable risk too (Haarman et al., 2020).

Read those numbers carefully. An odds ratio compares groups; it is a measure of relative risk, not the chance that any one child will develop the condition. What it does explain is why slowing progression by a diopter or two during childhood is worth the effort: a smaller final prescription means a shorter, structurally safer eye for the next 70 years.

What we do, and when to come in

At Vision & Learning Center we measure refraction carefully, track the prescription over time, and talk with families about whether myopia control is worth starting. Our clinical focus is developmental and binocular vision — how the eyes team, focus and move together — so when a child is a candidate for atropine, myopia-control contact lenses or orthokeratology, we coordinate with the colleague best placed to fit and monitor it rather than pretending one office does everything.

Two practical habits we recommend to every family, on the evidence above: get children outdoors daily, and break up long stretches of near work whether the near work is a book or a tablet. If your child is already in glasses, our guides on choosing children’s glasses and common eye problems at ages 6 to 12 cover the day-to-day questions.

On timing: the USPSTF recommends vision screening at least once between ages 3 and 5 to catch amblyopia and its risk factors (USPSTF, 2017), while the AOA recommends a comprehensive eye examination at 6 to 12 months, at least once between 3 and 5 years, and before first grade and annually thereafter (AOA, 2017). A screening checks whether a child can read a chart; an examination measures how the eyes are growing and how they work together. You can read more about what we check in a comprehensive vision evaluation.

If your child is squinting, moving closer to the board or the screen, or already has a prescription that keeps climbing, schedule an evaluation so we can measure what is actually changing and talk through the options together.