Refractive Disease in Children: Understanding and Managing Myopia

Created by Doctor Jax in Eye Health, 5 months ago

Refractive errors, particularly myopia, have been extensively studied in both domestic and international research due to their prevalence among school-age children. The modern lifestyle characterized by increased use of electronic devices and intense studying has contributed to a rise in the incidence of refractive errors in this population. 

Uncorrected refractive error has been identified by the World Health Organization (WHO) and the International Organization for the Prevention of Blindness (IAPB) as a significant cause of impaired vision and blindness. 

This article aims to provide an overview of myopia in children, including its types, signs for recognition, examination procedures, and treatment options.

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Understanding Nearsightedness:

Nearsightedness, or myopia, is a refractive error where the image of an object is focused in front of the retina instead of directly on it, resulting in blurred vision. It can be classified into two types: refractive myopia and axial myopia.

1.1 Refractive Myopia:

Refractive myopia occurs when the refractive power of the eye is excessively strong, typically due to the cornea or crystalline lens. The axial length of the eyeball remains normal in this type. Prolonged and intense near work causes the lens to bulge, increasing the eye's focal point. 

Clear vision requires objects to be brought closer to the eye. School myopia, which typically appears during school age, is a common form of refractive myopia. It tends to progress faster when onset is earlier, but rarely exceeds 6 diopters and is usually not associated with retinal thinning or other fundus risks.

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1.2 Axial Myopia:

Axial myopia occurs when the eyeball's axial length is longer than normal, while the refractive power of the eye remains unaffected. This type often has a genetic predisposition and may manifest in early childhood, even before starting school. 

Axial myopia progresses rapidly, leading to significant vision loss, difficulty with corrective lenses, and potential complications such as retinal thinning, choroidal degeneration, retinal tears, and detachment. Glaucoma can also occur in myopic eyes, often challenging to detect due to normal intraocular pressure.

Signs of Myopia in Children:

Recognizing the signs and symptoms of myopia in children is crucial for early detection and appropriate intervention. Some common signs include:
  • The need to bring objects close to the eyes for clear vision, such as holding books close or sitting near the television.
  • Squinting or making unusual eye movements, especially in low-light conditions.
  • Complaints of blurred vision or eye pain.
  • Academic difficulties and preference for near-sighted activities like reading or playing games rather than participating in sports.
  • Severe myopia may be accompanied by strabismus (crossed or misaligned eyes).
Parents should be vigilant and promptly consult an ophthalmologist if they observe these signs in their children.

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Diagnosis and Management:

When a child is suspected of having myopia, it is important to seek professional evaluation and guidance from an ophthalmologist. The examination procedure may include the following steps:
  • Assessment of the duration and severity of myopia symptoms.
  • Vision testing without and with glasses to determine the presence and degree of refractive error.
  • Pupillary examination (skiascopy) and subjective refraction with test glasses.
  • Administering corrective medication and re-measuring objective refraction (skiascopy) to determine the appropriate prescription.
  • Assessing the correlation between the objective refraction after medication and the pre-examination visual acuity test for astigmatism. If needed, a prescription will be issued, or a follow-up appointment scheduled to fine-tune the prescription once the effects of the medication wear off. This streamlined procedure ensures accurate results and minimizes examination time.

3.1 Treatment Options:

The primary treatment for myopia in children involves the use of corrective glasses. Properly prescribed and fitted glasses enable children to achieve optimal vision, develop binocular vision, and actively engage with their dynamic environment. 

Wearing glasses helps children see distant objects clearly and reduces the habit of straining their eyes while reading, thereby slowing down the progression of myopia. Consistent use of glasses, especially during studying and screen time, is recommended.

It is essential to ensure glasses are properly installed, taking into account the child's facial size, and teach children how to care for them to prevent scratches and damage. Additionally, maintaining visual hygiene is crucial. Balancing study time, reading, and outdoor activities is necessary. 

Encouraging regular breaks during study sessions, approximately every 40-45 minutes, and engaging in activities that promote looking into the distance for 15-30 minutes per day can help reduce eye strain. Massaging the area around the eyes can also provide relaxation and aid in eye regulation.

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3.2 Nutritional Considerations:

A well-balanced diet plays a role in supporting eye health. Including dark green or red vegetables, as well as adequate portions of meat, fish, eggs, and milk, provides essential nutrients. Eye tonics or functional foods specifically formulated to enhance eye function and prevent degeneration can be considered as supplementary measures.


Refractive errors, especially myopia, have become increasingly prevalent among school-age children in recent years. Early recognition of signs and symptoms, prompt evaluation by an ophthalmologist, and appropriate management are crucial for minimizing the impact of myopia on children's visual health and overall well-being. 

Corrective glasses, combined with visual hygiene practices and a balanced diet, form the foundation of managing myopia in children. By addressing myopia in its early stages, we can help ensure that children have the best possible vision and a brighter future.

Remember, if you suspect your child may have myopia, consult with an eye care professional for a comprehensive evaluation and personalized treatment plan.

Disclaimer: This article is for informational purposes only and should not replace professional medical advice.

Answered by Doctor Jax, 5 months ago