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If your child is squinting to see faraway objects or complaining of blurry vision, it may mean they’re experiencing nearsightedness.

Also known as myopia, nearsightedness is a common vision problem in which people struggle to see distant objects. Myopia is a major pediatric eye health concern.

It typically presents during childhood. It’s a growing problem in the United States and globally.

“We know that there’s an epidemic of myopia,” says Ken Nischal, MD, chief, Division of Pediatric Ophthalmology, Strabismus, and Adult Motility, UPMC Children’s Hospital of Pittsburgh, and director, pediatric program development, UPMC Eye Center. “It’s always been the case in the East, in places like Taiwan, China, and Singapore. But now, it’s beginning to affect people all over the world.”

Blurry vision can affect school performance and other everyday activities. Learn more about nearsightedness in children. This will include common causes, potential treatment methods, and more.

What Is Myopia?

Myopia is a type of refractive error. It makes seeing objects that are far away difficult.

In refractive errors, the shape of your eyes prevents light from settling normally on the retina — the layer in the back of the eye. With myopia, light settles in front of the retina instead of on it. It typically occurs because the eyeball grows too long, Dr. Nischal explains.

“The problem with myopia is that the longer the eyeball, the greater the risk when somebody gets into their 30s, 40s, and 50s of glaucoma, cataract, retinal detachment, and, if the eyeball is really long, what we call myopic maculopathies — when you lose your central vision because of a thinning of the retina,” he says.

“Everybody’s got the same amount of mass of tissue that they’re allowed in their eye. If you have a really long eyeball, then that tissue gets stretched, and it can stretch to the point of breaking.”

Cases of myopia are growing nationally and worldwide. The National Eye Institute estimates that nearsighted Americans will number 44.5 million by 2050. Worldwide, estimates are that by 2050, half of the population will have myopia.

How to Tell if Your Child Is Nearsighted

Myopia typically presents after the age of 5. The most common warning signs include:

• Eye strain.
• Squinting.
• Struggling to see distant objects.

You may see your child sitting closer to the television or holding something closer to their face to see better. Or you may hear from their teacher that they’re struggling to see the board in school.

However, not every child will show obvious symptoms. That makes vision screenings and eye exams for infants and kids critical.

Vision screenings use a variety of tests to screen for potential eye issues, including refractive errors. Children should receive their first vision screening as a newborn and at pediatric well visits throughout their childhood.

If a vision screening detects a potential vision problem, your child will get a referral for a pediatric ophthalmologist or optometrist. They can do further testing to diagnose vision problems and prescribe treatment.

What Are the Risk Factors for Nearsightedness?

A combination of genetic and behavioral factors can cause nearsightedness to develop and worsen. Children with nearsighted parents have a significantly higher risk of becoming nearsighted themselves. Vision screenings and eye examinations may prove especially important for these children.

However, genetics isn’t the only risk factor for nearsightedness.

Several behavioral factors are also risk factors for myopia onset and progression, including:

Near tasks

A common cause of nearsightedness is children spending a lot of time looking at objects too close to them, including:

• Books.
• Computers.
• Smartphones or tablets.
• Television screens.

A 2023 review and meta-analysis in the International Journal of Environmental Research and Public Health reported that the odds of myopia increased by 31% in children exposed to near work. It compared them to children who hadn’t had any exposure to near work.

The rise in use of digital devices draws a lot of blame for the rise in nearsightedness. But Dr. Nischal says the devices aren’t the problem; it’s the time spent looking at something close.

“If a child replaces a screen with a book and looks at the book for 10 hours a day, they’re going to become myopic,” he says. “It doesn’t matter whether it’s a screen or a book. It’s not anything coming from the screen; it’s the actual focal distance — the near task — that is the problem.”

There’s no particularly “safe distance” for tasks, Dr. Nischal says. But spending too much time looking at objects less than 20 centimeters away is a major concern.

Not enough time outdoors

Another factor in myopia development and progression is spending too much time indoors.

Higher levels of lux — a measurement of illumination in an area — can protect against myopia. Lux levels are far higher outdoors than indoors, even if you’re under a tree or wearing sunglasses and a hat.

“The more you are in the dark indoors without natural lux, the greater the chance of you becoming myopic,” Dr. Nischal says.

Two hours of daylight exposure can protect against myopia onset and progression. That’s according to the World Society of Paediatric Ophthalmology and Strabismus (WSPOS).

Near work in dim light

A combination of the first two factors — doing near work in dim lighting — can also cause myopia or myopia progression.

“Working in dim light inhibits the eyes’ ability to try to control their growth,” Dr. Nischal says. “It’s like you’ve got a trigger, which is the near task, and now you’ve got no control of the growth of the eye, and so the eye grows even longer.”

Prescription eyewear

A “shocking” cause of myopia progression, Dr. Nischal says, is traditional prescription eyewear.

“The glasses that we prescribe encourage myopic progression because while the center of the vision is in focus, your peripheral retina, which actually controls eye growth, is in something that’s called peripheral hyperopic defocus,” Dr. Nischal says.

“What that means is that the light in the periphery of the retina is falling behind the retina. When it does that, the retina thinks, ‘Oh, I’d better grow faster to catch the light.’ So you get more and more nearsighted.”

In recent years, designers and engineers have developed multiple types of lenses to slow myopia’s progression. Two that are promising, according to WSPOS, are defocus incorporated multiple segment (DIMS) lenses and highly aspherical lenslets (HAL). However, they’re not currently available in the United States.

How Do Eye Doctors Diagnose Nearsightedness?

If your child is showing signs of myopia or a vision screening detects a potential issue, schedule a visit with a pediatric ophthalmologist or optometrist. They’ll perform a test called a cycloplegic refraction.

During this test, eye drops temporarily paralyze the eye muscles and allow the specialist to get an accurate reading. They then test the strength of the eyeball.

How Do You Treat Nearsightedness?

Prescription eyeglasses or contact lenses are a typical first-line treatment for nearsightedness. Prescriptions typically change throughout childhood but stabilize by your late teens or early 20s.

Dr. Nischal says he also recommends behavioral interventions to help prevent myopia progression.

Those include:

• Avoiding near tasks — Limiting the amount of time a child spends focusing on an object near them can help prevent myopia progression. Dr. Nischal recommends taking a five-minute break for every 30 minutes spent on a near task. Always avoid working in dim lighting when performing a near task.
• Spend time outdoors — Two hours of daylight can help protect against myopia progression.

Dr. Nischal says a child should see their pediatric ophthalmologist or optometrist after six months with glasses and behavioral interventions. If the myopia has progressed, atropine eye drops are another potential treatment.

Your child should continue to get regular vision screenings and eye examinations to track their eye health.

The Myopia Treatment Center at UPMC Children’s Hospital of Pittsburgh provides expert care for children with nearsightedness. From diagnosis to treatment, we’re here for you and your child. To learn more, visit our website.