Why is myopia rising in children, and what can parents do about it?

More than one in three children and teenagers worldwide are shortsighted , according to the largest study of its kind, and there are set to be more than 740m myopia cases worldwide by 2050.

The study has prompted calls for screen time to be discouraged and physical activity increased, but what is shortsightedness, why has it become such a concern, and can anything be done about it?

What is myopia?

Also known as shortsightedness, myopia is an eye condition where someone cannot see objects far away clearly.

What are the first signs of myopia?

“Signs of myopia are usually spotted when a parent or teacher first notices that a child is holding things close to the face to see them better, or sitting close to the TV, or can only read the whiteboard in the classroom when sitting at the front of the room but not at the back,” according to Dr Annegret Dahlmann-Noor, a consultant paediatric ophthalmologist at Moorfields eye hospital.

How is myopia diagnosed?

“Myopia is usually diagnosed by an optician doing vision checks and measuring their eyes for glasses,” according to Prof Chris Hammond, a consultant paediatric ophthalmologist at Guy’s and St Thomas’ NHS foundation trust. “For children under six years, they may need to have dilating eyedrops to get an exact measure of whether a child is shortsighted (myopic) or longsighted. Older children often do not need the drops.”

How is myopia treated?

Although the straightforward treatment for myopia is wearing glasses or contact lenses to correct vision, it often gets worse with age and, according to Hammond, “as the glasses get stronger, the risk of long-term sight-threatening problems in late adult life grows”.

Hammond adds that this is especially true when the onset of myopia happens in children before the age of 10. “[This is because] eye growth (which causes myopia) slows during adolescence but only stops around 20 to 25 years of age. There are now treatments that try to control the myopia progression and these include special spectacle lenses, or dual-focus soft contact lenses or hard contact lenses worn at night (orthokeratology).”

According to Bhavin Shah, a myopia specialist at Central Vision Opticians, treatment options such as orthokeratology and special dual-focus contact lenses and spectacle lenses “have made a huge impact in slowing the rate of change of myopia”.

What is the link between myopia and screen time?

“Increased close work means that a child has to focus their eyes at close range,” according to Shah. “Prolonged focusing on near things has been shown to increase the rate of progression of myopia in children, and holding a device close to your eyes for a long period of time can drive myopia to get worse.”

According to Hammond, apart from having a family history of myopia, the major risk factors are too much close work and not enough time outdoors.

Close work is not limited to screen time, and can include reading. “Reading too much and holding books too close can also drive children to become more myopic,” Shah says.

There have also been several studies that indicated that “pandemic lockdown and the corresponding massive increase in screen time and lack of time outdoors caused a significant rise in the number of children with myopia”.

Hammond adds: “Myopia was already a major problem in urban east Asia (affecting up to 90% of teenagers) before children used screens, likely a result of the intense early education system there, so the situation is probably more complex. While further studies gather evidence, given screens keep children indoors and encourage children to look at things closeup, it seems sensible to limit screen use, particularly in young children.”

What are the challenges faced by medical professionals in treating myopia?

For Shah, the main challenges are raising awareness of the condition among parents and changing the lifestyles of children. There is also a need to raise awareness of the various options for managing myopia, rather than just treating it. “The other challenge is that having myopia increases the risk of diseases of the eye in adults,” Shah says. “Myopes are more likely to have a variety of eye conditions, including retinal detachments, glaucoma, cataracts. There should be more information sent to GPs and other health professionals, especially those who are in contact with children.”

Our increasingly urban lifestyle is also a challenge in treating myopia, according to Dahlmann-Noor. “[This means] that even young children have less and less opportunity to spend time outdoors, and we know that exposure to outdoor sunlight delays onset and slows progression of myopia,” Dahlmann-Noor says.

What can be done to better understand myopia?

More research is needed into how many children are affected by myopia and how current treatments work, Hammond says. “Continuing research is needed into risk factors and newer treatments which are more effective, as the current treatments only slow the myopia progression by around 50%-60% on average,” Hammond adds. “Finally, we still have no effective treatments for the long-term sight loss experienced by people who are highly myopic as they get older.”

With myopia on the rise among children, what can be done by parents to help prevent their children from developing this condition?

“The recommendation is 14 hours a week outside, either for sport or leisure. Many experts recommend screen use should be avoided for children under two years, limited to one hour a day up to age five, and then two hours a day until age 12,” says Hammond.

“When using screens and reading, children should be encouraged to take breaks every 20 minutes. Teach your children healthy habits – get off your screens and do some shared family outdoor activity. Not only will it be good for your children’s eyes, it reduces chances of the worrying rise in obesity levels and improves fitness. If there is a family history of myopia, make sure your children’s eyes are checked regularly, every year or so.”