What is pre-myopia? Causes, risks, and treatments

• Pre-myopia describes a stage where a child's vision is still normal, but their eyes have a combination of risk factors that suggest that they will develop myopia (near-sightedness).
• Regular eye checks during childhood are essential to identify signs of pre-myopia. Early detection gives parents a chance to delay or prevent their child’s need to wear glasses full-time.
• There are now multiple treatment options for pre-myopia, but the easiest way to protect the eyes from developing myopia is to spend more time outside, at least 2 hours per day.

Myopia (near-sightedness) causes blurry vision when viewing distant objects. It is quickly becoming one of the most common eye conditions in children, and currently affects over a third (36%) of all children globally.1

Pre-myopia is a relatively new term that is used to describe children who do not yet have myopia but are at high risk of developing it. Their vision is still normal, but their eyes are showing early warning signs of growing towards myopia. 

Typically, myopia starts in early childhood and tends to worsen as the child progresses into teenage years and early adulthood. During these years, the eye grows too quickly and too long, causing far vision to appear more and more blurred. Pre-myopia refers to the window just before this happens. 

There’s a lot more to myopia than just wearing glasses. It’s an eye condition that affects a person’s ability to see things unassisted, and it carries real risks to eye health across their lifetime. The more severe the myopia, the worse the vision, and the greater the risk of related eye diseases later in life, such as retinal detachment and macular degeneration.

Pre-myopia sits at a critical crossroads. There is no way to cure or reverse myopia once it has already developed. Acting at this stage gives families a real chance to delay or even prevent myopia from developing in the first place.

Pre-myopia by itself causes no symptoms. Children who have pre-myopia see clearly, perform normally at school, and will not notice any changes or issues with their eyes. This is precisely what makes it easy to overlook, and why routine eye examinations during childhood are so important even in the absence of symptoms. Once myopia develops though, complications begin to arise, for example:

• Vision difficulties from myopia itself, e.g. blurry vision while watching TV, or viewing signs
• Needing to wear glasses or contact lenses full-time
• Frequent changes in glasses or contact lens prescription
• Increased risk of eye diseases and vision problems over the remainder of life3

Because pre-myopia causes no symptoms, it can only be identified through a comprehensive eye examination with an optometrist or eye doctor. 

There are 4 key risk factors they will consider:

1. Current prescription: if a child has less far-sightedness (hyperopia) than they should for their age4
2. Family history: risk of myopia is higher if one or both parents have myopia5
3. Visual environment: spending less than 2 hours outside per day increases risk, especially when combined with more than 3 hours of close-up activities per day6 
4. Binocular vision: children with certain focusing or eye coordination disorders may have an increased risk of developing myopia7-9

The easiest way to lower the risk of developing myopia is to address the risk factors that can be changed (modifiable). Family history is impossible to change, but a child’s visual environment (how much time they spend outdoors, and what visual activities they undertake indoors) can certainly be improved.

Spending more time outdoors is the first recommendation for all children with pre-myopia. Outdoor time is a simple, low-risk intervention with benefits that extend well beyond eye health. There is strong evidence that spending at least 13 hours per week (about 2 hours per day) outdoors reduces a child’s risk of developing myopia.10 Sun protection, including sunglasses, a hat, and shade, should be encouraged outdoors to prevent the risks of direct sun exposure.

Time spent on screens and close-up work should be considered too. Digital devices have transformed the way we use our eyes and are becoming more common in schools and daily life. But excessive use can leave unwanted effects like digital eyestrain, which causes eye fatigue, dryness, and headaches.11 Recent studies also link screen time with myopia, finding that every additional hour of screen time increases the risk of myopia by 21%.12 Screen time recommendations are zero hours (except for video calls) for kids under 2; 1 hour per day co-watched with parents for 2 to 4-year-olds; and 2 hours per day of leisure screen time in 5 to 17-year-olds.

A number of medical treatments are also beginning to emerge for pre-myopia. These include:

• Atropine eye drops13
• Essilor Stellest glasses lenses14
• Hoya MiYOSMART glasses lenses15 
• Repeated low-level red light (RLRL) therapy16

If your child has pre-myopia, attending regular eye exams with your optometrist or eye doctor is essential. During schooling years, children’s eyes grow and change quickly, even more so for those who have been identified as high-risk for myopia. Ideally, children at risk of developing myopia should be seen at least every 6 months.17

In the meantime, aim to achieve at least 2 hours per day of outdoor time with your child, and minimize the amount of screen time and close-up activities for leisure.