Does nearsightedness get worse with age?

Nearsightedness is likely to get worse during childhood and adolescence. Medical interventions and lifestyle changes can effectively aid in slowing or even halting the progression. 

So, school is reopening for fall, and you found out that your child needs a new pair of glasses again. You can't help but wonder: Is it normal that nearsightedness gets worse every year?

Many parents find themselves asking the same questions as their children undergo their annual eye exams and receive new prescriptions.

This article aims to demystify the complexity of nearsightedness and its progression, especially in school-aged children. We'll delve into why it tends to get worse in children each year and the measures you can take to manage it effectively.

What is the cause of nearsightedness progression?

Nearsightedness, known medically as myopia, occurs because the way light enters the eye and converges onto the retina becomes misaligned. Picture the retina as a highly advanced sensor in a digital camera, responsible for capturing and transmitting visual information to our brain, the central processing unit. In a healthy eye, incoming light rays precisely focus on this sensor—the retina. However, in eyes with nearsightedness, light rays converge in front of the sensor, leading to blurry images.^1,2

An important point regarding the progression of nearsightedness is that, in general, people are born farsighted or hyperopic.³ Throughout the natural growth process, a child's eyes undergo emmetropization—a developmental phase during which the eye's refractive components and axial length reach a balanced state.³ To simplify, their body self-adjusts the growth of their eyes so that light rays can accurately focus on the retina, resulting in clear vision.

In most cases of nearsightedness in children, the emmetropization process overshoots, causing the eye to elongate excessively. This elongation causes light to focus in front of the retina rather than directly on it, leading to nearsightedness.³

Risk factors associated with worsening of nearsightedness

1.       Insufficient outdoor time: Studies have consistently demonstrated that children who spend less time outdoors face a heightened risk of myopia progression. While the exact mechanisms are not fully understood, exposure to natural light appears to play a protective role.⁴

2.       Excessive near work: Prolonged engagement in close-up activities, such as reading or using electronic devices, has been linked to nearsightedness getting worse.²

3.       Poor sleep: Recent studies showed insufficient sleep duration (< 7 hours), poor sleep quality, and staying up late (after 9:30 pm) are correlated with an increased risk of nearsightedness progression in children. Establishing healthy sleep habits is important not only for eye health but also for the overall healthy growth of a child.⁵

4.       Indoor lighting: Being in a well-lit indoor space can have a positive impact on your child's vision. Studies have shown that elevating light levels in school from around 100 to 500 lux reduces the risk of nearsightedness progression.⁶

Do glasses worsen nearsightedness?

Contrary to a common misconception, wearing glasses does not exacerbate nearsightedness. This misunderstanding often stems from a confusion between correlation and causation.

It is our nature to spot associations and then extrapolate causes and effects. For instance, if one observes an increase in the presence of police officers within a neighborhood, the tendency might be to assume that something has occurred – like a surge in break-ins – prompting the police force to respond by deploying additional personnel.

Similarly, the worsening nearsightedness results in an updated prescription, rather than glasses causing the deterioration.⁷ Drawing a comparison between glasses and the worsening of nearsightedness would be akin to linking the increase in police officers to the worsening of crime rates.

In fact, medical experts and research indicated that not wearing glasses to correct vision is not beneficial and can even be harmful to our little ones.⁷

Does nearsightedness get worse with age?

Nearsightedness in school-aged children typically gets worse during childhood and adolescence. A study has found that nearsightedness progresses most rapidly at its onset, about -0.5 D per year. This rate of progression decreases over time, typically stabilizing around the mid-twenties to early thirties.⁸ Interestingly, Asian children seem to progress at a faster rate, about -0.6D to -0.8D per year in the initial years.^9,10

Further, research also has shown that individuals who progressed to high myopia in adulthood generally exhibit faster progression throughout their youth. On the other hand, those who had minor refractive errors largely ceased to progress after the age of 15.⁸

How to manage nearsightedness in children?

The effective management of childhood nearsightedness involves a multifaceted approach that encompasses both medical interventions and lifestyle adjustments. Therapeutic options encompass the use of atropine eye drops, specialized soft contact lenses, overnight contact lenses, and myopia-control glasses.¹¹ Research has demonstrated the effectiveness of these treatments, with the potential to decrease the rate of nearsightedness progression by 45-65%.

Furthermore, adopting lifestyle changes such as increasing outdoor activity, taking regular eye breaks, improving sleep, and enhancing indoor lighting can act as complementary strategies. These adjustments help mitigate the impact of the risk factors and augment the effects of medical interventions.

Conclusion

In general, nearsightedness gets worse with age in children. And most markedly during the first few years. Parents should be vigilant in monitoring for signs of progression and consult with healthcare providers for individualized management plans.

As the old adage goes, "Seeing is believing," but with proactive management, you can also believe in better seeing!

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1. Jacobs, Deborah S et al. “Refractive Errors Preferred Practice Pattern®.” Ophthalmology vol. 130,3 (2023): P1-P60. doi:10.1016/j.ophtha.2022.10.031

2. Wolffsohn, James S et al. “IMI - Myopia Control Reports Overview and Introduction.” Investigative ophthalmology & visual science vol. 60,3 (2019): M1-M19. doi:10.1167/iovs.18-25980

3. Wolffsohn, James S et al. “IMI - Myopia Control Reports Overview and Introduction.” Investigative ophthalmology & visual science vol. 60,3 (2019): M1-M19. doi:10.1167/iovs.18-25980

4. Wu, Pei-Chang et al. “Outdoor activity during class recess reduces myopia onset and progression in school children.” Ophthalmology vol. 120,5 (2013): 1080-5. doi:10.1016/j.ophtha.2012.11.009 

5. Liu, Xiao Nicole et al. “Myopia and sleep in children - a systematic review.” Sleep, zsad162. 29 Jun. 2023, doi:10.1093/sleep/zsad162 

6. Hua, Wen-Juan et al. “Elevated light levels in schools have a protective effect on myopia.” Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) vol. 35,3 (2015): 252-62. doi:10.1111/opo.12207 

7. Jacobs, Deborah S et al. “Refractive Errors Preferred Practice Pattern®.” Ophthalmology vol. 130,3 (2023): P1-P60. doi:10.1016/j.ophtha.2022.10.031

8 Verkicharla, Pavan Kumar et al. “Myopia progression varies with age and severity of myopia.” PloS one vol. 15,11 e0241759. 20 Nov. 2020, doi:10.1371/journal.pone.0241759

9. Larkin, G Luke et al. “Atropine 0.01% Eye Drops for Myopia Control in American Children: A Multiethnic Sample Across Three US Sites.” Ophthalmology and therapy vol. 8,4 (2019): 589-598. doi:10.1007/s40123-019-00217-w 

10. Donovan, Leslie et al. “Myopia progression rates in urban children wearing single-vision spectacles.” Optometry and vision science : official publication of the American Academy of Optometry vol. 89,1 (2012): 27-32. doi:10.1097/OPX.0b013e3182357f79

11. Lanca, Carla et al. “Effectiveness of myopia control interventions: A systematic review of 12 randomized control trials published between 2019 and 2021.” Frontiers in public health vol. 11 1125000. 23 Mar. 2023, doi:10.3389/fpubh.2023.1125000