We have understood the basics of progressive myopia and myopia causes. Now, let’s understand the progressive myopia risks one needs to know about.

If a child has been diagnosed with myopia at a younger age, a myopic shift occurs around school age following a rapid increase in myopia, which continues until the late teenage years. Progressive myopia is associated with complications like retinal detachment and degeneration, glaucoma, and cataracts at a young age, leading to a lifetime risk of severe visual impairment including blindness.¹

To prevent the progression of myopia in children, it is important to look for the risk factors for myopia progression and find ways to reduce the incidence of myopia and its progression. Myopia risk factors in children include genetics (family history of myopia), excessive close-up activities like screen time and reading, limited outdoor time, and sedentary lifestyles, among others. These can be further segregated into modifiable and unmodifiable risk factors.^1,3

When it comes to unmodifiable risk factors such as age and parental myopia, age is the strongest independent risk factor for myopia progression.^1,3

School-age children between the ages of 6 and 14 are most at risk of developing myopia. When myopia develops at a young age, the rate of progression is faster. Therefore, it makes sense to stabilize myopia at a younger age with resources at our disposal. Talking about the genetic factors, the risk of myopia in children increases by two times when one parent is myopic and by three times when both parents are myopic. Parental myopia is not only the risk factor for the development of myopia but also the risk factor for the progression of myopia. It has been observed that children who have at least one myopic parent are at increased risk compared to children with no myopic parent.^1,2

High myopia or pathological myopia is a severe form of myopia that occurs when your child’s eyeballs grow longer than they should, or the cornea is too steep. It is characterized by a very strong prescription with a refractive error greater than -6 that can progressively worsen to higher powers. The exact cause of high myopia is not fully understood, but it is believed to result from a combination of genetic, environmental, and structural factors.^3,4

Lack of physical activity along with the excess of near-work activities are thought to contribute most to the progression of myopia in children, making them some of the potentially modifiable risk factors.3 Nowadays, the teaching trend of using tablets and computers is highly prevalent as early as in preschool education and these devices are being used after school too, leading to the progression of myopia.³ It is recommended that children should not spend more than 3 hours on close work such as reading, doing homework, using devices, etc. When they are using a tablet or computer, parents should ensure that they are properly placed to avoid eye strain and should be taught to take a break after 20 minutes by looking across the room for 20 seconds. ³A study has shown that eyeball length is different in children doing near-work activities for almost 3 hours and more in children who are involved in near-work activities for less than 3 hours a day.⁵

Coming to the amount of time spent outdoors, it has been observed that sporting activities have a significant positive effect on the eyeball length when performed for 3 hours or more. Outdoor sports and playing for at least 90 minutes a day can reduce the risk of developing myopia.^1,6,7

Due to the significant risks associated with progressive myopia, eye care professionals have been very interested in developing treatment and management strategies for the prevention of myopia progression.¹ If you are a parent who has a myopic child, you should be aware of the negative impacts of near work and computer work on the eyeball length and the possible progression of myopia and find ways to mitigate the effects.⁸

References:

1. Recko M, Stahl ED. Childhood myopia: epidemiology, risk factors, and prevention. Missouri medicine. 2015 Mar;112(2):116.
2. Foster PA, Jiang Y. Epidemiology of myopia. Eye. 2014 Feb;28(2):202-8.
3. Cleveland Clinic. Myopia & Nearsightedness | Cleveland Clinic [Internet]. Cleveland Clinic. 2012. Available from: https://my.clevelandclinic.org/health/diseases/8579-myopia-nearsightedness
4. Kumar A, Chawla R, Kumawat D, Pillay G. Insight into high myopia and the macula. Indian journal of ophthalmology. 2017 Feb;65(2):85.
5. Rusnak S, Salcman V, Hecova L, Kasl Z. Myopia Progression Risk: Seasonal and Lifestyle Variations in Axial Length Growth in Czech Children. J Ophthalmol. 2018 Mar 6;2018:5076454.
6. He X, Sankaridurg P, Wang J, Chen J, Naduvilath T, He M, Zhu Z, Li W, Morgan IG, Xiong S, Zhu J. Time outdoors in reducing myopia: a school-based cluster randomized trial with objective monitoring of outdoor time and light intensity. Ophthalmology. 2022 Nov 1;129(11):1245-54.
7. liz1625. Here’s why more time outside is important for your child’s eyesight [Internet]. MyMyopia. 2021 [cited 2023 Nov 8]. Available from: https://mymyopia.com/heres-why-more-time-outside-is-important-for-your-childs-eyesight/
8. Porter D. Myopia Control in Children [Internet]. American Academy of Ophthalmology. 2022. Available from: https://www.aao.org/eye-health/diseases/myopia-control-in-children

FAQs

Q1. Who is most at risk for myopia?
Ans. School-age children between the ages of 6 and 14 are most at risk of developing myopia.

Q2. What are the risk factors for myopia in children?
Ans. Myopia risk factors in children include genetics (family history of myopia), excessive close-up activities like screen time and reading, limited outdoor time, and sedentary lifestyles, among others. These can be further segregated into modifiable and unmodifiable risk factors.

Q3. What are modifiable risk factors for myopia?
Ans. Lack of physical activity along with the excess of near-work activities are thought to contribute most to the progression of myopia in children, making them some of the potentially modifiable risk factors.

Q4. What is the cause of high myopia?
Ans. High myopia or pathological myopia is a severe form of myopia that occurs when your child’s eyeballs grow longer than they should, or the cornea is too steep. It is characterized by a very strong prescription with a refractive error greater than -6 that can progressively worsen to higher powers. The exact cause of high myopia is not fully understood, but it is believed to result from a combination of genetic, environmental, and structural factors.

Q5. What age is at risk for myopia?
Ans. School-age children between the ages of 6 and 14 are most at risk of developing myopia. When myopia develops at a young age, the rate of progression is faster.