What Is Myopia and How Is It Managed in Children?

What is myopia?

Myopia, also called nearsightedness, is a vision condition where distant objects appear blurry while near objects are clear. It often begins in childhood and can worsen as a child grows.

Why does myopia get worse in children?

In most children, myopia progresses because the eye itself grows longer over time. This physical change affects how light focuses inside the eye.

Is myopia caused by screens?

Screens do not directly cause myopia. However, long periods of near work combined with limited outdoor time are linked to faster progression in children.

What is axial length?

Axial length is the front to back length of the eye, measured in millimetres. In myopia, increases in axial length reflect physical eye growth rather than changes in vision clarity alone.

Why does axial length matter in myopia management?

Axial length helps show how the eye itself is changing. Eye growth can occur before a prescription change is obvious, so measuring axial length can provide earlier insight into progression.

How is axial length measured?

Axial length is measured using a non contact device that is quick and comfortable for children. The measurement takes only seconds and does not involve drops or air puffs.

Does every child need axial length measurement?

Not every child needs axial length measurement. It is most useful for children who already have myopia or who are being monitored for progression.

Can axial length predict how bad myopia will get?

Axial length helps estimate progression trends and risk but cannot predict exact outcomes. This is why repeat measurements over time are important.

Can myopia be slowed?

Yes. While myopia cannot be reversed, research shows that certain strategies can help slow progression in many children, particularly when started early.

At what age should myopia management start?

Myopia management is often most effective when started early, especially in children whose prescriptions are changing over time.

What are the evidence-based myopia control options for children?

Several treatments have been shown to slow myopia progression in children. The main categories are:

• Specialty spectacle lenses -- designs such as MiYOSMART and Stellest use peripheral defocus to slow eye elongation while correcting distance vision
• Soft contact lenses -- daily wear lenses such as MiSight and Abiliti are designed specifically for myopia control in children
• Orthokeratology -- custom overnight lenses that reshape the cornea, providing clear daytime vision without glasses or contacts
• Low-dose atropine eye drops -- prescription drops used alongside other interventions to help slow progression

Research published in JAMA Ophthalmology and BMC Ophthalmology shows these treatments can slow myopia progression and eye elongation by approximately 60% on average. Your optometrist will recommend a combination based on your child’s age, prescription, lifestyle, and risk factors. For a full overview of options and pricing, see our myopia control service page.

Who provides myopia control at Spadina Optometry?

Myopia control at our downtown Toronto clinic is provided by:

• Dr. David Wilkinson -- Fellow of the American Academy of Optometry (FAAO), certified clinical investigator, and clinical instructor at the University of Waterloo. His clinical and research interests include contact lenses and myopia management.
• Dr. Ema Hazra -- University of Waterloo graduate whose clinical interests include myopia control, specialty contact lenses, and pediatric eye care.

Both optometrists work with families to assess risk, monitor eye growth over time, and tailor treatment plans.

How do I get started with myopia control in Toronto?

The first step is a comprehensive children’s eye exam at Spadina Optometry. The exam includes assessment of myopia risk factors and axial length measurement. From there, your optometrist will walk you through your child’s results and discuss which treatment options make sense.

If you are concerned about your child’s vision, early assessment can help clarify risk and next steps.