The Troubling Rise of Myopia in Children and Adolescents

14 May 2024

Experts are concerned about the rapid increase of short-sightedness among children and young people, mainly due to external factors.1 The positive side to this is that there are ways to slow down its development through "myopia management".

  • The Troubling Rise of Myopia in Children and Adolescents

Increasing myopization is currently particularly evident in Asia, where an above-average number of children and young people are now short-sighted. It’s almost the norm for children to wear glasses. Fortunately, the situation in Europe is better, with only three percent of pre-school children, eleven percent of 7 to 10-year-olds and 20 to 30 percent of 11 to 17-year-olds presenting with short-sightedness. 2-8

However, these numbers are still concerning. Experts predict that by 2050, there will be around 4.8 billion short-sighted people worldwide. High myopia9, i.e. vision impairment exceeding minus five diopters, could affect around 940 million people. According to the World Report published by the WHO, there were around 2.6 billion short-sighted people worldwide in 2020, 312 million of whom were under 19 years old.10

What is alarming is that myopia can cause serious damage to the eyes, including the retina. This damage can even lead to retinal detachment or blindness or affect the optic nerve (known as glaucoma).

Signs of progressive myopia in children and adolescents

At above ten percent, the prevalence of myopia in children and adolescents is already high in many Southeast Asian countries. The prevalence of myopia among young students is as high as approximately 90 percent in some regions of China.11 And this trend could soon appear in other regions too. Therefore, parents should pay close attention to the first signs of short-sightedness.

Indications of possible myopia in a child

  • Problems reading boards or screens in class
  • Holding digital screens or books right in front of the face to see clearly
  • Frequent squinting
  • Regular headaches
  • Rubbing the eyes frequently

Remember that children themselves are not always aware of these signs. Limited vision seems normal to them, as they know no other way. The human brain even allows them to cope well with visual impairment. Nevertheless, myopia has been proven to affect a child's quality of life and educational opportunities negatively.12

Therefore, it is essential to visit the ophthalmologist or optician regularly. Only an expert can determine whether short-sightedness is present or imminent. If so, they can suggest a course of action or treatment.

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Causes of myopia in children

The development of a child's vision is a complex interplay of various adaptation processes in the eye, which primarily takes place during the first months and years of life. Based on current knowledge, the retina controls these adaptation processes and ensures that the eye's refractive power and eye length are ideally matched.

As the child grows, so does the eye. If everything proceeds as nature intended, the child grows up to have normal vision (emmetropia). If this process becomes unbalanced, vision impairment occurs, the most common form of which is short-sightedness, or myopia. It occurs when the eye grows too long compared to the refractive power of its refractive media (cornea, lens, aqueous humor and vitreous body).13

An initial comprehensive ophthalmic and orthoptic test for children is recommended before the child turns two, as vision develops particularly rapidly in the first two years of life. This way, visual impairments can be detected early and mitigated through the right treatment.14

Why myopia is increasing in children and adolescents

But why has short-sightedness increased so drastically among children and young people over the last few decades? Our changing lifestyle certainly plays a decisive role. There is a genetic component to myopia and it is very likely to be passed on from parents (one parent with myopia doubles the risk of the child developing myopia, if both parents have myopia the risk increases fivefold). However, external influences have recently had a significant impact on the numbers.

One of the main factors behind this is probably an urban lifestyle, particularly in large Asian cities. In these metropolitan areas, many children spend most of their day indoors without exposure to natural daylight. At a very young age, they use smartphones and tablets for hours on end. Even playgrounds are located in covered areas of large shopping centres.

Nowadays, tablets and smartphones are indispensable – but parents should make sure that children sit at least 30 centimetres away from screens, take regular breaks and keep time spent on digital devices to a minimum.

The same precautions also apply to reading books: holding the book too close to the eyes can lead to short-sightedness in the long term or worsen existing myopia.

Short-sighted children: myopia prevention strategies

To reduce the risk of myopia, children should not spend too much time in front of smartphones, TVs or do activities that involve focusing on something close-by for an extended period of time.

When children are using tablets or books indoors, their screen time should always be interspersed with generous recreational breaks, ideally spent outdoors and preferably paired with physical activity. Research has shown that children who frequently spend time outdoors are less prone to myopia or those who are affected show slower progression.15 It is therefore recommended that children spend at least two hours per day outside in daylight. This applies to all age groups.

It is also important to know that the risk of (severe) myopia is higher if the first signs appear before age seven.16 A rule of thumb based on various studies states that if a child still has a distance refraction of above +0.75 diopters at age six or above +0.5 diopters from seven to ten, the development of their eye length growth can be described as normal. If the value is below this or even in the minus range, the child is at risk of myopia.17

Prevention: children and young people should have their eyes checked on a regular basis

Anyone who wears glasses knows that vision problems can vary over time, especially in growing children. However, if myopia worsens by over 0.5 diopters within six to twelve months, progressive myopia could be the cause.

Children over five should have an eye test at least once a year to detect any problems with their eyesight or rapid progressive myopia at an early stage. This can be done by an ophthalmologist, optometrist or optician, depending on country specifics and regulations. A valid eye test for children requires using eye drops which, for example in Germany, can only be done by ophthalmologists.

In addition to the familiar, traditional eye tests, eye care professionals can now use state-of-the-art optometric devices such as a biometer to measure the child or adolescent's axial eye length and carry out an objective refraction.

Myopia management: Treatment options for progressive myopia

Slowing the progression of myopia in children and adolescents can be achieved through a range of options. If a child is already wearing glasses or has progressive myopia, an individualized treatment plan should be drawn up by an ophthalmologist and/or optometrist. This so-called myopia management plan may include pharmaceutical eye drops, special eyeglass lenses or special contact lenses for day or night.

In addition to treatment plans, it is still important for parents to ensure that their child consistently spends more than two hours per day outdoors. At the same time, they should limit the time children and adolescents spend in front of tablets, computers, smartphones and reading books and comics.

Collaboration between the ophthalmologist and an optician is crucial in determining the optimal treatment – be it through visual aids or pharmacologically or a combination of the two. The overall aim is to slow the progression of myopia through targeted myopia management and ideally to reduce eye growth to the level of non-myopic eyes, or as close as possible to it. This can, for example, prevent very high prescription values and the associated risks to eye health.

You need more background information? Visit the Myopia Insights Hub for expert knowledge.

A myopia management program includes a comprehensive patient history covering risk factors, suitable tests and risk assessment, as well as treatment measures and behavioral recommendations. All of this must be jointly determined by the child and his/her parents, ideally in close collaboration with an ophthalmologist and optometrist or optician. It is also essential that regular checkups are suited to the child's individual refraction status and, where applicable, to the respective treatment method.

ZEISS MyoCare: Special eyeglass lenses for successful management

One particular treatment method for progressive myopia is the use of specially developed eyeglass lenses. This is because the excessive growth in length in myopic eyes at a young age cannot be slowed down using standard single-vision lenses.

ZEISS has been offering eyeglass lens solutions tailored towards myopia management for more than ten years, but until now it has focused primarily on the Asian market. Combining its many years of extensive experience in progressive and high myopia in Asia with scientifically sound findings, ZEISS now also offers effective, specific myopia management services in Europe.

As part of ZEISS myopia management, ZEISS MyoCare and ZEISS MyoCare S eyeglass lenses are available in several countries.

How do ZEISS MyoCare eyeglass lenses work?

These special eyeglass lenses slow the elongation of the eye. This is achieved through special microstructures in the peripheral area of the eyeglass lens, which bring about what is known as simultaneous myopic defocus. As a result, next to the sharp image on the retina, other images are in front of the retina. This is meant to slow down the growth in eye length.

The centre of the eyeglass lens contains a zone that corrects the child's myopic vision and ensures sharp vision in the distance. Around this central clear zone, the almost invisible, ring-shaped surfaces – the microstructures, with an additional optical power – alternate with zones that only have a corrective effect.

If diagnosed and treated in time, myopia doesn't have to be a one-way street to severe short-sightedness.

A lens design for the simultaneous myopic defocus

Functional zone

with altenating, ring-shaped surfaces in the peripheral area of the eyeglass lens

C.A.R.E® technology

Cylindrical Annular Refractive Elements (C.A.R.E®) are microstructures, which bring about what is known as simultaneous myopic defocus

Central zone

for clear, sharp vision in the centre of the eyeglass lens

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