Myopia

Progressive myopia in primary school children

26 August 2024

Starting primary school is a new and exciting journey for every child. It’s also a significant time in their overall development, and good vision forms a crucial part of this. Depending on the country, most children must undergo some form of school entry examination. This “test” usually includes an assessment of the child's visual ability. If any abnormalities are detected during this examination, it is recommended to consult an eyecare practitioner. The specialist will conduct a more thorough examination of the child's eyes and visual ability and may, for example, diagnose nearsightedness (myopia) and decide, together with the parents, whether the child needs visual aids such as glasses.

  • Girl with glasses writing with pen

When it comes to nearsightedness, early detection is key, so it’s most beneficial for the child if this is diagnosed as early as possible. Therefore, an optician, ophthalmologist or other local specialist should always be consulted if the child shows abnormalities, even at a preschool age. The earlier measures are taken against nearsightedness, the better.

Progressive myopia is a special form of nearsightedness that gets worse over time. Above all, it is important to slow down or stop the progression of myopia through appropriate measures to prevent high myopia. This is important because it helps to improve the child's quality of life, but it also reduces the risk of further eye health issues.

What is Myopia

Boy with glasses using a magnifier
Boy with glasses using a magnifier

Basically, myopia (nearsightedness) is a form of visual impairment in which light rays entering the eye are focused in front of the retina. The image produced on the retina is blurred when the uncorrected eye looks into the distance and accommodation is relaxed. This optical defect of the eyes is usually caused by the eyeballs being too long. Usually, myopia first occurs in school-age children and does not necessarily lead to high myopia.

  • High myopia starts at -5 diopters – depending on the definition.
  • Progressive myopia (a special form of nearsightedness) is characterized by the fact that it gets worse over the years. The length of the eye can continue growing for years. This could, for example, lead to values of -12 diopters. In addition to the health problems that this can cause, it also has a very negative effect on daily life. The furthest point that a person in this case can still see in sharp focus is only eight centimeters from the eye. Normal everyday life without visual aids is then no longer possible.
  • Pathologic myopia is characterized by pathological manifestations such as complication in the fundus (for example retinal detachment – see below). Pathologic near sightedness occurs more likely - but not inevitably - in eyes with high myopia.11

Certain steps can be taken to limit the progression of myopia. When eye care specialists implement myopia management treatment/s, the goal is to protect children from high levels of nearsightedness and potential long-term health consequences for their eyes. A healthy lifestyle can also help. Studies have shown that spending at least two hours outdoors and reducing near work have a positive impact on the eye development of children.1

The development of the juvenile eye

Newborn babies are generally farsighted.2 As they age, their eyes elongate and the lens's refractive power develops so that a state of normal vision (emmetropia) is achieved by around the age of 10 (under normal circumstances).3,4 This natural process is known as emmetropization.

In addition, visual acuity develops over time. Newborn babies don’t have sharp vision yet, but visual acuity improves quickly and increases until around the age of six to ten years.5 That means when a child starts school and their vision develops normally, they will have visual acuity similar to that of an adult with normal vision. When children are emmetropic (they have normal vision), they can then see objects clearly and in focus at near and far distances. This development is crucial as it supports reading, writing, and interaction with the world. Additionally, spatial perception continues to develop during elementary school years, and children learn to estimate the depth and distance between objects. This plays a significant role in sports, riding a bike, or playing in the park. Good depth perception helps children to move confidently in their environment and promotes motor skills at the same time.

Preventing and recognizing myopia

During a child’s early developmental phase, it is crucial to pay attention to any signs of vision problems. Frequent squinting, headaches, or difficulty with reading and writing can be indicators. If there are any concerns, parents should let their child be examined by a specialist to assess vision.

If vision correction is necessary, it can make a big difference in the child's academic and social life. Although children are often masters at hiding minor or major vision problems, research shows that academic success and overall quality of life depend on good vision.6

Prevention: Get children outside, away from smartphones

To prevent myopia in children, experts recommend reducing the amount of time children spend on smartphones, tablets, or other activities that require constant near vision.

Children should take regular breaks to go outside. Studies have shown that spending more time outdoors reduces the risk of myopia and slows down the progression of this vision impairment in children who are already affected.7

Experts therefore recommend that children spend at least two hours outdoors in daylight every day, regardless of their age.

However, it is important to know that the risk of developing (high) myopia is higher when the first signs of myopia appear before the age of seven.8 Based on various studies, the ZEISS Myopia Management Guide states the following: If a child still has a far refraction greater than +0.75 diopters at the age of six, or a far refraction greater than +0.5 diopters between the ages of seven and ten, the development of their eye length growth can be considered normal. If the value is below this or even in the minus range, the child is at risk of myopia.9

  • Boy with glasses riding a bike outdoors smiling
  • Group of children with glasses and magnifiers playing and laughing outside
  • Boy having an eye examination with ZEISS IOLMaster 500

In brief

Prevention is key when it comes to myopia

✔ Spend more than two hours outdoors daily in natural light.10

✔ Reduce near work such as reading and screen time, which should always be interspersed with generous recreational breaks, ideally spent outdoors and preferably paired with physical activity.

✔ Schedule at least one annual eye examination for children at significant risk of myopia.

Myopia management in elementary school children

If an elementary school child shows any signs of myopia, it’s important to pick up on this as early as possible. The school entrance examination is crucial, and both teachers and parents should carefully observe if any difficulty is experienced during class or when doing homework. At this stage it’s important to determine through regular examinations and tests whether the myopia is progressing within normal limits or if the increase is occurring rapidly, indicating progressive myopia.

If progressive myopia is diagnosed, the child should be treated. To slow down the progression of myopia in children and adolescents, various options are available, including medical eye drops, specialized contact lenses (which may not be suitable for children of that age), or specialized eyeglass lenses that can slow down the elongation of the child's eye.

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Specialized ZEISS eyeglasses lenses for myopia management

The ZEISS MyoCare Portfolio consists of two lens designs specifically designed for myopia management. These lenses can slow down the eye's length growth. This is achieved by special microstructures in the functional area of the lens that create a so-called simultaneous myopic defocus. As a result, next to the sharp image on the retina, additional images are generated in front of the retina. This is meant to slow down the growth in eye length.

In the center of the lens, there is an area that corrects the child's refractive error and ensures clear distance vision. Surrounding the central clear zone, nearly invisible ring-shaped surfaces – the so-called microstructures with an additional optical power – alternate with zones that only have a corrective effect.

For children in elementary school, these eyeglass lenses offer two significant advantages that can impact their long-term quality of life and health. Firstly, it corrects the refractive error like any other lens, allowing the child to see clearly at all distances and fully participate in classroom activities. Secondly, it slows the progression of myopia, reducing the risk of limitations from high myopia and potential long-term eye health consequences.

The bottom line is that it’s important to treat and manage progressive myopia professionally, starting as early as elementary school. The impact of this treatment can improve a child’s overall quality of life.


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  • 1

    Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, Lv M, He X, Xu X. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017 Sep;95(6):551-566.

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    Sankaridurg P, Tahhan N, Kandel H, et al. IMI Impact of myopia. Invest Ophthalmol Vis Sci. 2021;62(5):2. https://doi.org/10.1167/iovs.62.5.2

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    Mutti, D. O., Mitchell, G. L., Jones, L. A., Friedman, N. E., Frane, S. L., Lin, W. K., ... & Zadnik, K. (2005). Axial growth and changes in lenticular and corneal power during emmetropization in infants. Investigative ophthalmology & visual science, 46(9), 3074-3080.

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    Flitcroft, D. I. (2014). Emmetropisation and the aetiology of refractive errors. Eye, 28(2), 169-179.

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    Zadnik, K., Manny, R. E., Yu, J. A., Mitchell, G. L., Cotter, S. A., Quiralte, J. C., & Mutti, D. O. (2003). Ocular component data in schoolchildren as a function of age and gender. Optometry and Vision Science, 80(3), 226-236.

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    Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, Lv M, He X, Xu X. Zeit in Outdoor-Aktivitäten im Zusammenhang mit der Prävention und Kontrolle von Myopie: eine Metaanalyse und systematische Überprüfung. Acta Ophthalmol. 2017;95(6):551-566. doi: 10.1111/aos.13403.

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    Rudnicka AR, Kapetanakis VV, Wathern AK, et al. Globale Variationen und zeitliche Trends in der Verbreitung von Myopie bei Kindern: Eine systematische Überprüfung und quantitative Metaanalyse: Implikationen für die Ätiologie und frühe Prävention. Br J Ophthalmol. 2016; 100: 882–890.

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    MI-Clinical-Myopia-Management-Guidelines_FINAL_German_MJ.pdf (myopiainstitute.org)

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    Jong M. Should We Be Identifying and Managing Pre-Myopia? Review of Myopia Management. February 1, 2021. Accessed October 18, 2022. Reviewofmm.com/should-we-be-identifying-and-managing-pre-myopia.

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    Kyoko Ohno-Matsui, Pei-Chang Wu, Kenji Yamashiro, Kritchai Vutipongsatorn, Yuxin Fang, Chui Ming Gemmy Cheung, Timothy Y. Y. Lai, Yasushi Ikuno, Salomon Yves Cohen, Alain Gaudric, Jost B. Jonas; IMI Pathologic Myopia. Invest. Ophthalmol. Vis. Sci. 2021;62(5):5. doi: https://doi.org/10.1167/iovs.62.5.5.