Myopia management guidance: FAQs

1.1. What is myopia?

Myopia is also known as being short-sighted or near-sighted. If you are short-sighted you have problems seeing things in the distance clearly, but can see things that are close. There are different degrees of short-sightedness. 

1.2. What causes myopia?

Myopia is usually due to the eye being slightly too long. This means that light focusses in front of the retina at the back of the eye, rather than focussing on it.

1.3. How can you detect myopia?

Symptoms of myopia include having difficulty seeing things in the distance. This means you or your child might have to move closer or narrow your eyelids (called “squinting”) to see things clearly. Your optometrist can detect if you have myopia during a sight test.

1.4. Why did my child develop myopia?

The exact causes of myopia are not fully understood, so it is difficult to predict how myopic a person may become in the future. We know that the following things may make it more likely that a child will become myopic:

• having one or both parents with myopia.
• being of east-Asian ethnic origin.
• spending limited time outdoors.
• prolonged near vision activities.

Becoming myopic before you are nine years old may increase your risk of developing a high level of myopia.

1.5. Is myopia harmful? 

Myopia makes your distance vision blurry, so you need to wear glasses or contact lenses to help you see clearly. 

If you have a high level of myopia, you will be at a slightly greater risk of developing conditions such as retinal detachments, glaucoma and myopic retinal degeneration later in life. These conditions can lead to sight loss. 

If you have myopia it is important to have regular sight tests with your optometrist. This is so they can pick up as early as possible any conditions that could affect your sight. 

1.6. How do you treat myopia?

Myopia is usually easy to correct with glasses and contact lenses. Some adults with myopia have laser surgery to correct it. There are some treatments that may slow down myopia during childhood. This is called myopia management or myopia control.

1.7. What can I do to prevent my (child’s) vision from getting worse?

Spending more time outdoors can help prevent or delay myopia developing. This is particularly important for children at higher risk of developing myopia. We think doing this can also help slow down how quickly myopia increases, but we need more research on this to be sure. Reducing prolonged near work, such as screen use may also help prevent myopia development but the evidence for this is not strong.

1.8. Isn’t reading or screen use important for school work?

Long periods of reading and screen use (phones, tablets, laptops and computers) may have an impact on myopia development, but the evidence is not strong. This does not mean these activities should be completely stopped, but should be balanced with spending more time outdoors. When reading or using screens for a long time, you should take regular breaks to rest your eye muscles and blink to keep them comfortable. We recommend the 20-20-20 rule. Every 20 minutes, take a break for approximately 20 seconds and look at an object at least 20 feet away.  You also need to ensure that your screen is rightly positioned and display settings are set-up properly, please see here for more information on screen use.

1.9. Does watching TV, or using phones or tablets cause myopia?

Long periods of reading and screen use (phones, tablets, laptops and computers) may have an impact on myopia development, but the evidence is not strong and we do not yet know why this happens. Spending time on these activities might mean your child will spend less time outdoors, which we know can help prevent or delay myopia developing.

We know that the following things may also make it more likely that a child will become myopic:

• Having a parent with myopia.
• East Asian ethnic origin.
• Spending limited time outside.

1.10. Can too much screen time impact my child’s health and vision?

Some people find that looking at screen for a long time is tiring, but there is no evidence to suggest that using a screen damages the eyes. You should take regular breaks when using a screen to rest your eye muscles and blink to keep them comfortable. We recommend following the 20-20-20 rule. Every 20 minutes, take a break for approximately 20 seconds in which you look at an object at least 20 feet away.  You also need to ensure that any screen used is rightly positioned and display settings are set-up properly, please see here for more information on screen use.

1.11. Can my child wear glasses or contact lenses to correct their vision?

Your child will be prescribed traditional glasses or contact lenses if they are diagnosed with myopia. These will improve how well they can see, but it will not change how quickly their myopia develops. 

1.12. What are the different treatments available for myopia?

There are some treatments that may slow down myopia during childhood. This is called myopia management, or myopia control.

Different myopia management treatments are available in the UK. These are: 

• Myopia management contact lenses.
• Myopia management spectacles.
• Orthokeratology lenses. These are a type of rigid gas-permeable contact lens that are worn at night.

1.13. Is one treatment more effective than another?

We know that myopia management glasses, myopia management contact lenses and orthokeratology lenses have similar results. 

1.14. Will myopia management reduce my child’s risk of sight loss later in life?

If you have a high level of myopia, you will be at a slightly greater risk of developing conditions such as retinal detachments, glaucoma and myopic retinal degeneration later in life. These conditions can lead to sight loss. 

We do not yet know the long-term impact of myopia management on conditions that could lead to sight loss later in life. Reducing a child’s level of myopia may slightly reduce their risk of these conditions. However, it is not possible to remove the risk completely. 

There isn't enough evidence yet to know if the long-term benefits of myopia management outweigh the costs.  Because of this, you might choose to continue to use traditional glasses or contact lenses instead of myopia management.

1.15. Is it expensive? I can’t afford myopia management treatment - are there cheaper options to treat my child?

Myopia management is not currently funded by the NHS in any part of the UK. That means you have to pay for myopia management, and it is more expensive than traditional glasses or contact lenses. You may be able to use an NHS voucher toward help meeting the cost of these treatments. Your optometrist can give you more information about the costs and if you can use an NHS voucher. 

1.16. Is myopia management safe?

We know that wearing myopia management glasses does not have any more risks than wearing traditional glasses.

The risks of wearing myopia management contact lenses are similar to the risks of wearing traditional contact lenses. Some people have mild discomfort and blurred vision. There is a risk of serious complications, such as corneal infections that may result in sight loss, but this risk is low. There is a higher risk of complications if you wear contact lenses overnight.

If your child wears contact lenses, it is important that they follow your optometrist’s advice about hygiene and caring for the lenses. They should also have regular contact lens check-ups to prevent complications. It is important for you to make sure your child is following your optometrists’ advice correctly.

1.17. What age can my child start myopia management treatment?

There is no minimum age when myopia management treatment can be started. However, for contact lens and orthokeratology treatments your child needs to be old enough to be able to carefully use and look after their lenses. Your optometrist will show them how.

1.18: How long will the treatment last? When will my child be able to using myopia management?

We need more research before we can be sure of the best age to end myopia management treatment. Experts currently believe that children should stop using myopia management in their late teens. Your child may need to restart their treatment if their myopia starts to get worse again after their treatment has stopped.

1.19. Why is my child’s myopia management treatment not working? What can you do?

Your child’s optometrist may use a calculator to predict the impact of myopia management treatment. However, it is not possible to know for certain how successful their treatment will be. Your optometrist will examine your child’s eyes regularly and should explain how they will measure the results. 

Your child may not respond to myopia management treatment as expected. They may need to change to a different treatment, or to try a combination of treatments if the first choice does not slow down myopia development.

2.1. Why did the College review the guidance?

We aim to review all of our guidance on a regular basis.  Myopia management is an evolving area of research and practice, so it is important to regularly review all new and relevant evidence published. We particularly focussed on studies that addressed the key gaps identified in the 2019 literature review.

2.2. Who is this guidance for?

This guidance is for all optometrists providing eye care for children at risk of myopia or with progressing myopia.

2.3. How did you review the evidence?

This review involved searches for systematic reviews, meta-analyses and individual randomised controlled trials on the clinical effectiveness of myopia management interventions in children with myopia. This was achieved using a standardised literature search methodology using peer-reviewed scientific journal databases. A panel of subject matter experts was asked to review the results of these searches and provide information about missing evidence and studies that were due to be published, up to March 2022. Papers were assessed for relevance and the subject matter experts invited to review our decisions on whether to include or exclude papers.

2.4. What does the guidance say?

This guidance is for all optometrists providing eye care for children at risk of myopia or with progressing myopia. Provided that myopia management is within your scope of practice, you can offer this treatment. This means you must have the relevant knowledge and skills to do so, through appropriate training and experience.

You need to remain well informed and familiar with the current evidence so that you are able to offer clear and balanced information to patients. You should be able to explain the benefits and risks of the treatments available, as well as the option of no intervention, even if you do not provide these treatments. You should be able to inform patients and parents about the current evidence and explain why you do, or do not, offer myopia management. 

2.5. Should I offer myopia treatment to all patients?

The evidence shows that myopia management is effective at reducing myopic progression in children. Provided that myopia management is within your scope of practice, you can offer this treatment. This means you must have the relevant knowledge and skills to do so, through appropriate training and experience.

All children at risk of developing myopia should be encouraged to spend more time outdoors and limits prolonged near vision activities to help prevent the onset of myopia. 

For children with newly diagnosed myopia or progressing myopia, you should be able to explain to parents what myopia is and what lifestyle factors may impact myopia, the increased risks to long-term ocular health that myopia brings, and the approaches that can be used to manage myopia. You should be able to explain the benefits and risks of the treatments available, as well as the option of no intervention, even if you do not provide these treatments.

2.6. How can myopia progression be prevented?

Myopia management interventions have been shown to slow down myopic progression, but there is no evidence that they can completely prevent myopia progressing or that they can prevent myopia developing in the first place. 

There is evidence that shows that spending time outdoors and reduced frequency of near visual activities are effective at preventing or delaying the development of myopia, although the exact mechanism by which the protective factors are exerted remains unclear. This lifestyle advice may also benefit children with existing myopia by slowing progression, but the evidence for this is not strong.

2.7. Is myopia genetic?

Research has shown that the risk of a child developing myopia increases when one parent has myopia, compared to child without any myopic parents. The risk is even higher when both parents have myopia, so the genetic association is well established.

2.8. Should myopia be treated in children?

Myopia is associated with other eye conditions that may cause sight loss later in life, such as retinal detachment, cataract, glaucoma and myopic maculopathy. The risk of developing these conditions increases as the degree of myopia increases.  However, it is difficult to determine whether myopia alone is the cause, as other well established risk factors are also associated with these conditions. Among the general population, the incidence of these conditions is low. 

2.9. What myopia management treatments are currently available in the UK?

There are a range of licensed treatments (medical devices) with marketing authorisation for myopia management in the UK. These include specially designed contact lenses and spectacle lenses. 

A number of standard multifocal contact lenses and orthokeratology lenses have been used for myopia management, but these do not have specific marketing authorisation for this purpose. These can be offered, provided that their use is supported by a suitable evidence, clinical rationale and where an alternative licensed product would not meet the patient’s clinical needs.

2.10. What is the most effective myopia management method?

Optical intervention strategies for myopia management have similar levels of efficacy, ranging from 40% to 60% reduction in the level of myopia progression over 1 – 3 years. This equates to a reduction of around 1D less myopia compared to controls. The majority of this effect occurs during the early phase of treatment. 

However, there is no evidence that these optical interventions prevent or delay myopia from developing in the first place. While the link between myopia and future sight-threatening pathology is well established, there is no direct evidence that these treatments reduce the risk of developing myopia-related eye disease later in life.

2.11. How can I choose the right treatment for my patient?

The optical interventions used to slow down myopia progression have similar levels of efficacy. You should work in partnership with patients and parents to discuss the risks and benefits of each option, including the costs involved, to reach a shared decision. 

2.12. Can I combine several treatments for my patient?

We cannot yet accurately predict which (and to what extent) patients will benefit from a given intervention, or explain why variations in response to interventions occur.  Patients may not respond to an intervention as expected. This may take time to become apparent, and it may be necessary to change to a different intervention, or to try a combination of interventions if the first choice does not have the desired effect. 

2.13. Can I change a treatment that is not working for my patient?

Patients may not respond to an intervention as expected. This may take time to become apparent, and it may be necessary to change to a different intervention, or to try a combination of interventions if the first choice does not have the desired effect.

2.14. When should I start treatment?

There is no minimum age at which myopia management can be offered, but you should consider the age of the patient when deciding which optical method would be most appropriate. In very young children it would be more appropriate to offer spectacle-based interventions rather than contact lens-based interventions.

2.15. What College resources are available to support me delivering myopia treatments and keep me up to date with the latest research?

• Childhood-onset myopia management: Guidance for optometrists
• Childhood-onset myopia management: Evidence review
• Myopia management: Member briefing
• More articles on myopia