Myopia, also called nearsightedness or shortsightedness, is a condition in which a child sees things up close but finds problems seeing distant objects. Myopia is the most common refractive error, affecting more than 20% of children (1).
In this condition, the light does not fall on the retina (light-sensitive tissue) in the back of the eyes and instead focuses in front of the retina, creating blurred images of distant objects.
Read this post to learn about the causes, risks, symptoms, complications, diagnosis, treatment, and prevention of myopia in children.
Risks And Causes Of Myopia In Children
Myopia progression in children is often a result of an increase in the axial length of the eye.
The following factors can contribute to this and cause myopia in children (2).
- Eye growth: Naturally, the eyes grow and change shape up to 20 years. Myopia in children may worsen or progress before this age due to natural eye growth.
- Genetic factors: If both parents have myopia, the child has an increased chance of having it too.
- Continuous use of eyeglasses: Myopia may worsen in children who wear eyeglasses throughout the day. Children with moderate and high myopia may have a higher risk since they need glasses for near and distant vision. Low myopia may not interfere with distant vision, and children may require glasses only for near vision tasks.
- Using eyeglasses with full correction: If the glasses have lenses with the full correction, the disease may progress over time. Fully corrected lenses give clear vision initially, but may worsen myopia in children.
- Less outdoor plays: Children who spend less time outdoors, less than one to two hours per day, may have a higher risk of myopia progression. Outdoor activities help the eye muscles relax and give them a break from focusing activities.
- Prolonged screen time: Spending long hours on various screens such as smartphones, televisions, and computers can cause eye strain and contribute to myopia progression in children.
- Prolonged near-vision activities: Besides screen time, prolonged near-vision activities such as continuous reading and writing can also strain the eyes and contribute to myopia.
Signs And Symptoms Of Myopia In Children
Myopia is commonly seen in children around the ages of nine and ten years. This may often go unnoticed in some children who can write and read without trouble. Myopia is often discovered when a child cannot read the blackboard from the back of the classroom.
The common signs and symptoms of myopia may include (1)
- Squinting when looking at distant objects
- Nausea while reading
- Sitting close to the television
- Keeping the head on the table while writing or reading
- Holding books or objects close to the face
Some children with myopia may have additional symptoms such as short attention span and poor academic grades. You may consult a pediatrician or an ophthalmologist to check your child’s vision if you suspect any symptoms or signs of myopia.
Complications Of Myopia
Myopia may cause attention problems and impact a child’s academic performance. Most cases can be controlled with eyeglasses, refractive surgery, or contact lenses. However, the following complications may occur in some cases (3).
- Myopic macular degeneration (MMD): This condition causes tears and cracks in the macula, leading to bleeding beneath the retina when the retina stretches to adjust the vision.
- Cataract: This is the opaque formation or clouding of the lens that prevents light from entering the retina. Cataracts may develop slowly and cause blurry vision in children.
- Retinal detachment (RD): This may occur in high myopia due to axial elongation of the eye and thinning of the retina. Girls with high myopia may have the risk of retinal detachment during vaginal delivery in the future.
- Open-angle glaucoma (OAG): OAG may occur in children with high myopia. This may prevent normal draining of the intraocular fluid and increased intraocular pressure (IOP), resulting in optic nerve damage.
- Vision impairment: This may occur in high myopia cases if the complications listed above are not managed.
Diagnosis Of Myopia
The symptoms are often enough to identify the condition. The pediatrician may do a vision screening of the child and refer them to an ophthalmologist or optometrist if they have concerns. Eye specialists perform detailed vision evaluations and prescribe eyeglasses, lenses, or other treatments based on the condition (4).
Treatment For Myopia In Children
Eyeglasses or contact lenses are usually prescribed for children with myopia (5). Lenses with negative numbers, such as -2.5, are recommended for myopia. The lens will be stronger if the number is high. These lenses help correct the eye focus and make the light fall on the retina for clearer vision.
In addition, vision therapy, such as certain eye exercises to strengthen eye muscles, is often recommended to improve focus.
In some rare cases, the following procedures may be done to correct myopia (6).
- Ortho-k or CRT (temporary corneal refractive contact lenses)
- LASIK (Laser-assisted in situ keratomileusis)—a refractive surgery that uses a laser to precisely change the shape of tissue in front of the cornea
- PRK (photorefractive keratectomy)—a refractive surgery that removes the top layer of the cornea to improve vision
- LASEK (laser epithelial keratomileusis)—a combined eye procedure including both PRK and LASIK.
- Phakic intraocular lenses—artificial lenses placed in front of the natural lens
- Intraocular lens implant—insertion of a new lens to replace the natural lens.
Usually, these procedures can help adults avoid eyeglasses or contact lenses and are not recommended to treat childhood myopia since the refractive error may keep changing as the eyes grow.
How To Prevent Myopia In Children?
- Increase outdoor times: It is recommended for children to spend at least two hours outdoors during the day. Studies have shown that children who spend a minimum of 90 minutes outdoors in sunlight are shown to have a slower rate of myopia progression (8). However, do not forget to apply sunscreens and wear hats and sunglasses during outdoor activities.
- Use good lighting: Ensure good lighting for children when they are reading or doing homework. This may reduce eye strain and lower the risk of myopia progression.
- Take a break during focused activities: Ask children to take breaks when reading, drawing, looking at their screens, or doing any other focused activity to let the eyes relax. Also, ask them to get up to drink water or look out the window.
- Keep a working distance: Teach your child to keep their book or smartphone at an appropriate distance rather than keeping it near the face. You may also teach them the right place to sit and watch television. Do not encourage them to sit close to screens.
- Use eye drops: Administering 0.01% atropine eye drops is known to slow down the progression of myopia in some cases. You may do this as recommended by the ophthalmologists, and the effects should be evaluated every six months.
- Consider PMMA lenses: Prefer PMMA contact lenses, as these are hard lenses and have a lower risk of infections than soft lenses.
Myopia cannot be reversed. So, the treatment options and preventive measures focus on reducing the progression and worsening of the condition.
Myopia progression can be prevented with proper treatment and eye care measures. Parents may encourage children to do more outdoor activities and set screen-time rules. Consider eyeglasses or contact lenses as prescribed and evaluate if they need to be changed periodically. You may also talk to your child’s ophthalmologists about future procedures and more personalized eye care tips.
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