Overview
Multiple studies show that myopia (nearsightedness) typically begins between ages 6 and 9, progressing quickly at first and then slowing with age. Most progression stabilizes between ages 16 and 21. Many researchers link this trend to reduced outdoor time and increased use of digital devices. In the United States, the prevalence of myopia has risen from 25% to 42% over the past 50 years. Rates are even higher in many Asian populations, reaching up to 96% in certain regions. The rapid increase within a single generation strongly suggests that environmental factors play a major role in myopia development, even when genetics are involved. By 2050, an estimated half of the world’s population will be myopic.
Myopia significantly increases the risk of serious eye diseases—including glaucoma, myopic maculopathy, cataracts, and retinal detachment—in a dose-dependent manner. A person with –6.50D of myopia has a 21-times higher risk of retinal detachment and a 40-times higher risk of myopic maculopathy, exceeding the relative risk of many major cardiovascular factors. The risks of cataract and glaucoma are comparable to the risk of stroke from untreated hypertension. Reducing myopia by 50% can lower the likelihood of these ocular diseases by more than tenfold.
Standard glasses correct distance blur but do not slow the progression of myopia. It is essential, however, that children always wear glasses with their most accurate prescription. Myopia control treatments do not reverse existing myopia, but early intervention is crucial for maximizing long-term benefits. Because younger children experience faster progression, starting treatment as early as possible yields the greatest cumulative impact. Parents and practitioners should no longer view myopia progression as normal or merely inconvenient. Myopia poses a significant threat to long-term eye health in addition to affecting daily activities. We now have effective tools to treat myopia as the progressive condition it is—just as we do with many other health disorders.
Treatment Options
1. Atropine with Regular Glasses
Research shows that low-dose atropine (0.025%, 0.05% > 0.01%) used once daily can slow myopia progression by about 50% with minimal light sensitivity or pupil dilation (LAMP study). These drops reduce eye growth by acting on receptors in the retina and sclera. Some children may respond better to higher concentrations or may require bifocals/progressives or sunglasses for comfort. Possible side effects include pupil dilation, reduced focusing ability (sometimes requiring bifocals), allergies, rapid heartbeat, dry eyes or mouth, constipation, and flushing. This option works well for younger children, those not ready for contact lenses, or those experiencing rapid early progression. It is simple and requires little parental involvement.
2. MiSight Daily Soft Contact Lenses
MiSight is the first and only FDA-approved myopia control contact lens (approved in 2020). When initiated between ages 8 and 12, it slows myopia progression by 59%. Its dual-focus design uses a central distance-correcting zone surrounded by treatment zones that create peripheral myopic defocus, reducing the stimulus for eye growth. As a comparison, off-label soft multifocal contacts with distance-centered concentric designs, such the monthly Biofinity D lenses, can slow progression by roughly 30–45%.
3. Nighttime Orthokeratology (Corneal Reshaping Therapy)
Orthokeratology (CRT) lenses are worn overnight to temporarily reshape the cornea, allowing clear daytime vision without glasses or contacts. These lenses also create peripheral retinal defocus, slowing eye growth similarly to soft multifocal lenses. On average, orthokeratology slows axial elongation by a little over 40%, similar to multifocal soft lenses and slightly less than atropine. Our practice uses Paragon CRT lenses exclusively.
4. Stellest (Essilor) Glasses
Stellest lenses—the first and only FDA-authorized spectacle option in the U.S. (authorized September 2025)—use a highly aspheric lenslet design arranged in concentric rings around a central clear-vision zone. The peripheral lenslets create myopic defocus and modulate retinal image contrast. With full-time wear, Stellest lenses can reduce myopia progression by up to 71% over two years. They are especially suitable for younger children or when first-line treatments are not preferred or feasible.
Lifestyle Modifications Needed
Reducing screen time during the day and eliminating screen use at least one hour before bedtime are important steps. Children should also maintain proper working distance and posture when using digital devices, following the 20/20/20 guideline: every 20 minutes, take a 20-second break and ensure screens or books are kept at least 20 inches away while sitting upright at a desk or table. In addition, 90–120 minutes of outdoor play each day is recommended to help lower the risk of developing myopia.
Time to Act
Myopia typically begins around ages 6–9 and progresses rapidly at first, slowing with age and stabilizing in late adolescence. Early treatment is essential for achieving lifetime reduction in risk. Since younger children’s myopia advances more quickly, starting myopia control immediately offers the greatest long-term benefit. Parents and practitioners must move away from viewing myopia as merely inconvenient. It is a significant risk factor for serious eye disease and can impair quality of life. With the treatments now available, it is time to manage myopia proactively, as we do with other progressive health conditions
Additional Resources
MyKidsVision.org, MyopiaProfile.com, ManageMyopia.org, Brilliant Futures App, ParagonVsion.com
Myopia Education Video:
Lens Insertion Video:
Lens Removal Video:
