Myopia Control in Children: How We Can Slow the Progression of Nearsightedness
- David B. Sabin
- 5 minutes ago
- 8 min read
If your child's glasses prescription seems to become stronger every year, you are not alone.
Myopia—commonly called nearsightedness—often begins during childhood and can continue progressing throughout the school years as the eyes grow.
For many years, the traditional approach was simple: when the prescription changed, we prescribed stronger glasses.
Today, optometrists can take a different approach.
Instead of only correcting blurry vision, myopia control attempts to slow the underlying progression of myopia itself.
That distinction is important because the goal is no longer simply: "How clearly can my child see today?"
We also want to ask: "How can we reduce how nearsighted their eyes become over the next several years?"
Modern myopia-control strategies include specially designed eyeglass lenses, daily disposable contact lenses such as MiSight, multifocal contact lenses, orthokeratology, low-dose atropine eye drops, and environmental strategies such as increasing outdoor time.
What Is Myopia?
Myopia occurs when the optical system of the eye focuses distant light in front of the retina rather than directly on it.
One of the most important structural changes associated with childhood myopia is axial elongation—the eye becomes longer from front to back.
As the eye becomes longer, the child's prescription typically becomes increasingly negative.
For example, a prescription might progress from:
-0.75 D
to -1.50 D
to -2.50 D
and potentially continue increasing as the child grows.
Myopia is generally defined as a spherical equivalent refractive error of -0.50 diopters or greater, while high myopia is commonly defined as approximately -6.00 D or greater.
Why Does It Matter if Myopia Gets Worse?
Parents understandably tend to think of myopia as a problem that can simply be corrected with stronger glasses.
Glasses do correct the blurry vision.
But they do not necessarily stop the eye from continuing to elongate.
That matters because increasing levels of myopia—particularly high myopia—are associated later in life with a greater risk of conditions such as:
retinal detachment
myopic macular degeneration
glaucoma
cataracts
The FDA specifically identifies these complications as important long-term concerns associated with progressive and high myopia.
This is why myopia management has shifted from simply correcting myopia toward attempting to control its progression.
What Is Myopia Control?
Myopia control refers to treatments designed to reduce the rate at which a child's myopia increases.
It is important to understand that myopia control generally does not eliminate the prescription a child already has.
Instead, we are trying to change the trajectory.
Imagine two children who both start with a prescription of -1.00 D.
Without treatment, one child's prescription might eventually progress substantially during the school years.
With effective myopia management, the goal is for that progression to occur more slowly.
Even reducing the amount of progression can potentially leave the child with a lower lifetime level of myopia.
Research increasingly supports optical and pharmacologic approaches that reduce both refractive progression and axial elongation of the eye.
Myopia-Control Treatment Options
There is no single treatment that is best for every child.
Age, prescription, astigmatism, rate of progression, lifestyle, contact lens maturity, corneal shape, family history, and previous prescription changes can all influence the recommendation.
Here are the major approaches currently used.
1. Myopia-Control Eyeglass Lenses
One of the biggest recent developments in myopia management is the arrival of eyeglass lenses designed specifically to slow progression.
In September 2025, the FDA authorized Essilor Stellest eyeglass lenses for correcting myopia and slowing its progression in children who are 6 to 12 years old when treatment begins.
Unlike a traditional single-vision eyeglass lens, Stellest uses a clear central area surrounded by specialized peripheral lenslets.
The child sees clearly through the center while the peripheral optical design creates a controlled defocus signal intended to influence eye growth.
In the clinical data evaluated by the FDA, Stellest lenses produced a 71% reduction in refractive myopia progression and a 53% reduction in axial elongation at 24 months compared with conventional single-vision lenses.
Why parents may like this option
There are:
no contact lenses to insert or remove
no overnight lens wear
no eye drops
minimal changes to the child's daily routine
For younger children or children who are not ready for contact lenses, myopia-control glasses can be an especially attractive option.
2. MiSight 1 Day Contact Lenses
MiSight 1 day is a daily disposable soft contact lens specifically designed for myopia control.
The FDA indication includes children who are 8 to 12 years old when treatment begins, with myopia between -0.75 and -4.00 D spherical equivalent and no more than 0.75 D of astigmatism.
The lens contains different optical treatment zones that allow the child to see clearly while simultaneously creating a myopic defocus signal on the retina.
The goal is to reduce the stimulus for excessive axial eye growth.
In the pivotal three-year randomized clinical trial, children wearing MiSight lenses experienced approximately 59% less refractive progression and 52% less axial elongation than children wearing conventional single-vision daily contact lenses.
Because MiSight lenses are daily disposables, a fresh lens is inserted each morning and discarded at night.
For many active children, contact lenses also provide practical benefits during sports and other activities.
3. Multifocal Soft Contact Lenses
Other specially selected multifocal or extended-depth-of-focus soft contact lenses can also be used for myopia management.
Although these lenses may have originally been designed for other optical purposes, certain designs create peripheral or simultaneous myopic defocus that can reduce the stimulus for axial elongation.
Randomized clinical trials have demonstrated meaningful reductions in both prescription progression and axial eye growth with appropriately designed multifocal soft contact lenses.
These lenses can be particularly useful when a child's prescription or astigmatism does not fit the parameters of another treatment.
4. Orthokeratology
Orthokeratology, often called Ortho-K, uses specially designed rigid gas-permeable contact lenses that are worn while the child sleeps.
The lenses temporarily reshape the front surface of the cornea overnight.
When the lenses are removed in the morning, many children can see clearly throughout the day without glasses or daytime contact lenses.
But Ortho-K does something else that makes it particularly interesting for myopia management.
The reshaped cornea creates a peripheral optical profile that can help reduce axial eye growth.
In the randomized ROMIO study, children wearing orthokeratology lenses experienced approximately 43% less axial elongation than children wearing conventional single-vision correction.
Orthokeratology requires careful fitting and monitoring.
Unlike fitting a conventional soft contact lens, Ortho-K typically involves corneal topography so the optometrist can analyze the shape of the cornea and evaluate how the treatment zone changes over time.
Because the lenses are worn overnight, proper cleaning, hygiene, follow-up examinations, and parental involvement are especially important.
5. Low-Dose Atropine Eye Drops
Atropine is another important area of myopia research.
In myopia management, atropine is typically used at much lower concentrations than the traditional 1% atropine used for pupil dilation and cycloplegia.
Concentrations that have been studied include:
0.01%
0.025%
0.05%
The large LAMP clinical trials demonstrated a concentration-dependent effect, with 0.05% atropine producing greater myopia-control efficacy than 0.025% or 0.01% atropine in the children studied.
However, the atropine story is more complicated than simply saying that every low concentration works equally well.
A randomized U.S. clinical trial found that 0.01% atropine did not significantly slow either refractive progression or axial elongation compared with placebo in American children.
That is one reason atropine concentration should be selected thoughtfully rather than assuming that the lowest concentration will work for every child.
Possible side effects can include increased pupil size, light sensitivity, and reduced near focusing ability, although these effects are generally less pronounced at lower concentrations.
Atropine may sometimes be used alone or in combination with an optical myopia-control strategy.
Does Outdoor Time Help?
Yes—particularly when we are thinking about preventing or delaying the onset of myopia.
Outdoor exposure appears to have a protective effect that cannot be explained simply by exercising instead of looking at screens.
Light exposure itself seems to play an important role in signaling normal eye growth.
Randomized school-based studies have shown that increasing children's outdoor time can reduce myopic shifts and lower the likelihood of developing myopia.
For that reason, we frequently encourage children to:
spend more time outside
take regular breaks from prolonged near work
avoid holding tablets, phones, or books excessively close
balance schoolwork and screen time with distance viewing and outdoor activities
Outdoor time is beneficial, but once significant progressive myopia is present, lifestyle changes should generally be viewed as part of a broader management strategy rather than a replacement for evidence-based myopia-control treatment.
Which Children Should Be Evaluated for Myopia Control?
Myopia control may be worth discussing if a child:
has recently become nearsighted
requires stronger glasses every year
developed myopia at a young age
has one or both parents who are significantly nearsighted
has experienced rapid prescription changes
has increasing axial length measurements
already has moderate or high myopia
spends extensive amounts of time doing close work or using digital devices
Earlier onset deserves particular attention because a young child potentially has more years of eye growth ahead.
A child who becomes myopic at age seven or eight may therefore have considerably more opportunity for progression than someone who first becomes mildly myopic late in adolescence.
What Happens During a Myopia-Control Evaluation?
Myopia control should begin with more than simply reading the child's current glasses prescription.
A comprehensive evaluation may include:
Comprehensive eye examination
We evaluate visual acuity, refractive error, binocular vision, focusing ability, and overall ocular health.
Prescription history
One of the most useful pieces of information is how quickly the prescription has changed.
For example:
2024: -0.75 D2025: -1.50 D2026: -2.25 D
That pattern tells us considerably more than looking at the current -2.25 D prescription by itself.
Cycloplegic refraction when appropriate
Children have powerful focusing systems.
Cycloplegic drops temporarily relax accommodation and can allow a more accurate measurement of the child's refractive error.
Axial length
When available, axial length provides an objective measurement of the physical length of the eye.
This can be extremely useful because the primary structural process we are trying to influence is excessive axial elongation.
The International Myopia Institute identifies refractive error and axial length as the major objective outcomes used to evaluate myopia progression and myopia-control treatment.
Corneal topography when indicated
Corneal topography is particularly important when considering orthokeratology because the lenses are designed according to the shape of the cornea.
A routine soft myopia-control contact lens fitting does not automatically require corneal topography.
How Often Should Children Be Monitored?
Myopia management is an ongoing process rather than a one-time fitting.
Children are typically reevaluated periodically so we can determine:
whether the prescription is changing
whether axial length is increasing
whether the treatment is being worn as prescribed
whether vision remains clear
whether the eyes remain healthy
whether the current strategy is providing adequate control
Many myopia-control clinical studies evaluate cycloplegic refraction and axial length at approximately six-month intervals.
Some children may need more frequent visits depending on age, treatment modality, contact lens use, or rate of progression.
Does Myopia Control Stop Myopia Completely?
Usually not.
No currently available treatment can guarantee that a child's prescription will never increase.
The goal is slower progression, not necessarily zero progression.
Some children respond extremely well to one treatment while others continue progressing and may require a different strategy or combination treatment.
This is why monitoring is so important.
Myopia management is best thought of as an ongoing process:
Measure → Treat → Monitor → Adjust
rather than simply prescribing a lens and assuming the problem is solved.
When Should Myopia Control Start?
In general, the earlier progressive childhood myopia is identified, the earlier it makes sense to discuss management.
Waiting until a child reaches -5.00 or -6.00 D before considering treatment misses years during which the eye may have been rapidly elongating.
The ideal opportunity is often when myopia first appears or when we identify a clear pattern of progression.
Myopia Control at OPT-ISM Eye Care in Tampa
At OPT-ISM Eye Care, our goal is not simply to determine whether your child needs stronger glasses.
We want to understand how their eyes are growing and how quickly their myopia is progressing.
Depending on the child's age, prescription, eye health, lifestyle, and previous progression, we can discuss available options such as:
myopia-control eyeglass lenses
MiSight 1 day contact lenses
other myopia-control soft contact lenses
orthokeratology
low-dose atropine
lifestyle and outdoor-time recommendations
ongoing prescription and axial-growth monitoring
There is no single myopia-control strategy that is right for every child.
The best approach is individualized.
The Bigger Goal
A child's glasses prescription is not just a number.
It can also provide clues about how the eye itself is developing.
Traditional glasses can make a child see 20/20 today.
Myopia control asks a different question: What can we do today to help protect that child's vision for decades to come?
If your child's prescription has been increasing or they have recently become nearsighted, a myopia-control evaluation can help determine their risk of progression and whether treatment may be appropriate.
Comments