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Nearsightedness is on the rise and may run in families. But is it a given? An America’s Best optometrist sets the record straight on this common vision problem.
When most adults today were coming of age, common wisdom held that vision problems were diagnosed, not prevented. You likely got your first vision checks at school or in the pediatrician’s office. And if there seemed to be a problem, only then would you see an optometrist.
The problem with that: It doesn’t do much for prevention. Childhood eye checkups give parents a chance to learn how to protect their child’s eyes and help get issues addressed early on, when they’re most treatable.
If you did end up with vision correction later in life, it’s not your parents’ fault: Headlines haven’t focused much on preventive eye care for kids until recently, when studies started examining the effects of screen time and reduced outdoor play on young eyes.
Recently, parents have been seeing more and more reports of a shocking rise in nearsightedness — where close-up objects are clearer than those far away — in kids. Rates of nearsightedness (called myopia) are doubling among elementary school-aged children in China, according to a 2021 report in the journal JAMA Ophthalmology. (Researchers have noted similar trends in the U.S.)
The problem with headlines: They often leave parents wondering, “So is there anything I can actually do about it?” The short answer (and the good news) is yes, says Rebecca Passa, O.D. She’s an optometrist for the Doctor’s Exchange of Arizona, located within America’s Best Contacts & Eyeglasses at the Pavilions at Talking Stick in Scottsdale.
“There are things that an optometrist can do to help delay the onset of nearsightedness in kids and to help slow the rate of vision change from year to year,” she says. “And there are things that parents can do at home that can help too.”
Here’s her down-to-earth explanation of the science behind the headlines — and what parents can do to delay and slow vision changes in their kids.
Is myopia really increasing in kids — or are we just paying more attention?
Nearsightedness has been on the rise for decades, says Dr. Passa. According to the American Optometric Association, one-quarter of Americans ages 12 to 54 in the early ’70s had myopia. By 2004, the statistic had risen to more than 41%, and by 2050, it’s expected to hit 50% worldwide.
Some of this is because we’re detecting problems earlier, thanks to more accurate diagnostic technology and a push toward earlier eye exams with optometrists. But that’s not all of it, she adds.
In recent decades, children have spent less time outdoors and more time with screens. Research has linked both habits to a rise in myopia risk for kids.
The pandemic has made matters even worse: Kids were suddenly spending the school day on a computer, outdoor activities such as recess and sports were canceled, and the vision checks that would typically happen in school or at the pediatrician were being canceled or delayed.
When should kids begin visits to the optometrist?
“I tell all my pregnant patients that we want to see their baby for its first comprehensive eye exam at 6 months old, then two more times before they start kindergarten. It’s easy to remember this as the three-before-school rule,” says Dr. Passa.
If your child hasn’t hit those vision-check goals or if they’ve missed their scheduled eye exam because of COVID, make an appointment to get them back on track as soon as possible.
Of course, kids should see the optometrist sooner if something seems wrong. Headaches, an eye that’s starting to turn, or even clumsiness can be signs of a vision problem. If your gut (or a health professional) tells you something is going on, get it checked out.
How much of a difference do early appointments make?
“The earlier we can correct problems in kids, the better the outcomes we see,” Dr. Passa says. “Since a child’s prescription for distance lenses tends to stop changing as rapidly around age 10 or 12, we need to see them well before that if we want to slow the onset or progression of myopia. There’s no way to prevent myopia [or reverse it], but we can often delay the onset or slow the rate of progression.”
The benefits of an eye exam at an early age go beyond distance vision: For kids with colorblindness, for example, getting diagnosed in preschool can help with confidence. “Imagine what it’s like if a teacher is asking you to point to the blue kite, but they all look gray to you,” she says. Those early vision checks mean parents can give teachers a heads-up so that kids won’t feel they’re doing something wrong.
How much do genetics have to do with nearsightedness?
A lot. A child who has two parents with myopia will have a 50/50 chance of developing it. If only one parent is nearsighted, the child will have a 1 in 3 chance. And if neither parent does, the chance falls to 1 in 4. The degree of nearsightedness in parents matters too. Parents with a high prescription are more likely to have kids with a high prescription.
Why does prescription strength matter?
What specifically causes myopia is not yet understood. Some factors that may influence it are genetics, time spent indoors vs. outdoors, and the amount of close work done. Myopia typically occurs if the eyeball is too long.
The elongated eyeball forces the retina to stretch to cover the now-longer eyeball. Picture stretching a piece of plastic wrap over something: The farther you stretch it, the thinner it gets. The same happens to the retina: As the eyeball lengthens, the retina does too, which can make the tissue more likely to tear or detach.
Besides causing nearsightedness, a stretched retina can also increase the risk of serious future vision problems, including glaucoma, cataracts, and retinal detachment.
“Those conditions are more frequent in adult patients with a prescription of more than a -6.00, and the risk drops off dramatically if we can keep the prescription under a -3.00,” says Dr. Passa. “So if we can slow down your child’s vision changes and keep their prescription under a -3.00, you’ll be delivering serious lifelong benefits.”
What can optometrists do to slow the progress of myopia?
Treatments center on helping the eye keep its rounded shape to prevent changes such as elongation of the retina. Research has proved that three approaches work well for kids:
Orthokeratology (Ortho-K) rigid contact lenses. When worn during sleep, these rigid lenses serve as a sort of mold that helps reshape the eye. Often, this means the child can see well enough during the day that they don’t need glasses or contacts.
Multifocal daytime soft contact lenses. Myopia in kids can be slowed with the use of multifocal lenses that have a center zone for distance vision and an outer ring for close-up work. Daily disposable lenses are safest for children because they reduce the risk of eye infections.
Low-dose atropine eyedrops. These prescription drops help slow the growth and lengthening of the eyeball. Eyedrops can be a good solution for kids who aren’t ready for contact lenses. They may also offer extra benefits when used along with Ortho-K lenses, though the research on this is still new.
Is there anything parents can do at home that may help?
In addition to making sure kids get eye checks early and often, parents can try these three approaches at home:
Teach kids the 20/20/20 rule. Any type of close work — whether it’s reading a book, doing artwork, or working on a digital device — plays a role in myopia risk. When we’re looking at a computer screen, there’s even more to process, and our visual systems aren’t made to handle that load.
To help prevent headaches and fatigue when doing close-up work, kids should take a 20-second break every 20 minutes and gaze at something 20 feet away. (This is good for all ages, not just kids!) Set a timer on their digital device (phone, watch, computer, etc.) as a reminder.
Send them outside to play. Spending time outdoors helps the eyes in several ways. First, when we’re outside, we’re usually looking at things that are farther away, which can help keep the eyes in good shape. Second, outdoor activities offer exposure to bright, natural light (even when wearing UV-protective sunglasses), which appears to reduce nearsightedness risk.
Research has shown that two hours or more a day of outdoor time is optimal for preserving distance vision in kids. That can be as simple as an hour of outdoor recess plus an hour of outdoor sports after school.
Get your child’s input. “If a child needs corrective lenses, I always ask them what they want to do,” says Dr. Passa. “Some kids may prefer contacts over glasses. I’ve fitted kids as young as 7 years old with contact lenses. But especially for younger children, what they will tolerate can also affect the parent/optometrist decision-making. So if contacts are going to be an everyday struggle to get into the child’s eye, we might use atropine therapy for a year and then try the lenses again.
(For help determining if your child is ready for contacts, read this.)
“Thankfully, optometrists now have these different options available,” she adds. “So it’s easier than ever to find a plan that works for everyone.”