Myopia is surging around the world, with more younger patients at the head of the large wave now breaking against Australia’s ophthalmic sector. Insight assistant editor Rob Mitchell looks at what the nation’s eyecare professionals are doing to push back the tide.
In 2020, as Australia and the rest of the world faced the global crisis of COVID-19 and its many consequences, another equally devastating health condition was building quietly but rapidly from what some described as an “emerging health issue” into what is now considered an epidemic.
The numbers and predictions are confronting.
The Child Myopia Working Group, a collaboration of leading optometrists and ophthalmologists from Australia and New Zealand established in 2018, estimated a current prevalence of 36% for the region. By 2050, this is forecast to rise to 55%.
Further, Australia is expected to have 4.1 million high myopes and New Zealand over 600,000 high myopes by that time, unless myopia management is implemented by everyone. This pales in comparison to the 2020 numbers that sat at around 1.1 million and 200,000 high myopes, respectively.
Given those numbers, it is probably no surprise that myopia is tipped to become the leading cause of avoidable blindness around the world, and younger children are increasingly at the crest of that dark, rising swell.
A recent study in the British Journal of Ophthalmology (BJO) found that short-sightedness had tripled in children between 1990 and 2023, with the rise “particularly notable” after the COVID pandemic, as nervous families struggled to break free of the perceived safety of isolation and indoor activity.
That meant vulnerable young eyes were more focused on small screens, rather than the vital eye exercise obtained in outdoor play and interaction.
That BJO research is backed up Down Under, where the Australian College of Optometry (ACO) says myopia is affecting more Australian children than ever before, and they are presenting at increasingly younger ages.
“In less than 20 years, the typical onset age has fallen from 11 years of age to 8 years – a shift that has significant implications for long-term vision and overall eye health,” the ACO says.
Those issues with younger eyes are growing into significant problems for the economy.
Australia’s Brien Holden Vision Institute, quoting a study in the scientific journal Ophthalmology, said impairment caused by uncorrected myopia cost the global economy an estimated US$244 billion in lost productivity in 2015, a figure supported by the BJO’s own reporting.
That means when an eyecare professional has a young patient in front of them, they are not only considering how to remedy that child’s faltering vision, they are also weighing treatments that will impact on not only their academic performance but also that person’s contribution to the community and economy.
Hardly child’s play.
But just as the Australasian Child Myopia Working Group was set up to meet that building swell, other professionals and organisations are also reacting to help their colleagues and young patients swim rather than sink.
Plenty of tools in the tool belt
Myopia may have surged around the world but so have the tools and resources to combat that rise.
Myopia Profile began nine years ago as a single piece of paper put together by Brisbane optometrist Dr Kate Gifford, a collection of notes from her lectures about the eye disease.
Now it is one of the world’s premier sources of support and assistance for eyecare professionals, practices and parents. Its emailing list runs into the tens of thousands and last year there were 26 million interactions with its web-based platforms.
That’s jumped 700% in the past couple of years, matching the rise of myopia and the angst that follows in its wake, says Ms Jeanne Saw, manager of professional affairs and relationships.
She says eyecare professionals will find plenty of educational content on MyopiaProfile.com and in its Knowledge Centre section, including articles, and clinical and science summaries. Parents too can find valuable, evidence-based information.
“We have developed our ‘Made Simple’ courses to address the growing need for quick and simple breakdowns of key myopia topics for busy practitioners. So there’s myopia management, orthok made simple, atropine made simple courses for example,” says Saw.
“They are topics that you really need, to become confident in prescribing for myopia management.”
Like so many others, Myopia Profile has had to adapt to not only the tsunami of cases in Australia and around the world but also the increasingly younger patients carried along with it.
“A lot of the time when a really young child comes in and they’re myopic, optometrists can feel quite overwhelmed by that, because of the eye health concerns but also because it begs the question of co-management with ophthalmologists,” says Saw.
“Do we need to get an ophthalmologist involved? What are the things that we should look out for when a young child comes in with myopia, because there’s also things that you have to consider, like syndromic myopia as well.”
Professionals need to consider the parents too.
Which is why Myopia Profile has also developed mykidsvision.org, a public-facing website driven specifically by questions from nervous, worried parents.
“We found that a lot of parents were starting to become more cognisant of myopia and wanting to ensure the eye health of their children as they grow up,” she says.
Those questions tend to revolve around the symptoms of myopia, when parents should bring their child in for an eye test, and treatments.
Parents are also keen to know more about how much time children should spend outdoors to help halt the progression of the eye disease, and also about screen time.
Saw says this information “empowers” the parents and helps make potentially awkward conversations about behavioural change a little easier.
“The best way to approach it would probably be to start with questions like, How old are your children? How much time do they spend on their devices? Have they had an eye test yet? How much time do they spend outdoors?
“Those are all very important questions to ask, even if it’s just the adult in the consult room and not the child or their children – asking questions definitely starts the conversation.”
And encouraging children to spend more time outdoors and less on small screens are among the easiest of interventions, she says.
“Even if there is a low risk of myopia, it’s a good idea to provide that advice to both parents and patients, because not only does it give the best chance of a child not becoming myopic, but there are other benefits to it as well.”
Raising awareness is vital for professionals too.
“A lot of times, some optometrists think that atropine is the best intervention to use,” says Saw, “but of course, you also need an optical, single-vision lens to correct the vision.
“So for me, optical treatments provide correction of myopia, but also control of myopia, and I think that’s a really important point for practitioners.”
Like Myopia Profile, the Australian College of Optometry (ACO) has also had to adapt and put together new resources to help the ophthalmic sector come to grips with myopia and its increasingly younger cohort.
That includes its 2025 Advanced Certificate in Children’s Vision (ACCV) course, which equips optometrists with “the skills to confidently diagnose and manage many paediatric conditions”, including myopia.
Ms Catherine Tay, clinical education co-ordinator of the course, says it has been designed with working professionals in mind and combines evidence-based learning with practical experience.
“Keeping up with the latest research and techniques is becoming increasingly essential in modern practice, particularly when managing the diverse and complex needs of young patients,” she says.
The ACO is also offering a new short course – Myopia Management in Clinical Practice – five weeks of intensive online study, scheduled to launch in early October 2025.
It is designed with clinical optometrists in mind, with a practical evidence-based perspective, but it also delves into emerging research and technology. The course comprises four modules covering topics ranging from emmetropization, risk factors for myopia progression and pathological considerations, to effective communication, treatment strategies and treatment alteration.
Raising awareness of a rising problem
Dr Joe Paul, head of professional services at Specsavers, would love to see an eye test considered as routine for a child as a visit to the dentist.
“There’s still a lack of understanding among people in Australia, of the importance of having an eye check for young kids,” he says. “We’re not there yet as optometrists, but it should be part of just regular health checks.”
In the meantime, in part because of the rise of myopia but also to bridge that gap and build awareness of eye health, Specsavers often sends its optometrists out into the community.
“A number of our optometrists do school screenings to help diagnose myopia,” he says.
“They are talking to local communities and using those links to make sure that we’re spreading awareness outside of the test room, doing everything we can to encourage good visual habits and outdoor time.”
He says the numbers inside the test room are proof that the global concerns about myopia are justified and such initiatives are needed.
A Specsavers 2022 retrospective review of more than three million de-identified patient records aged 18 and under showed child myopia detection rates had increased to 28.8% in Australia and remained as high as 29.8% in New Zealand. This review also found that the age at which patients were being diagnosed with myopia was decreasing.
In the UK, he notes studies have found similar results and show that the typical onset of myopia occurs in children aged between six and nine, and its progression is most rapid under 10 years of age.
“Now, more than a third of our kids in some of our stores are myopic, and it’s getting bigger.
“In 2016 the average kid was -1.00 D when we first picked them up; it’s close to -2.00 D in their worst eye now.”
In the face of such challenging numbers, Specsavers is also building knowledge and awareness of myopia within its practices.
“A few years back we started developing some kits and guides for all our stores to borrow, and we work very closely with suppliers and other groups to develop educational content and meeting webinars.
“It’s been part of our grad program as well.”
The content covers myopia diagnosis and management, but also how to approach younger patients and their parents.
“It is around comfort and confidence,” says Dr Paul. “The optometrists learn the general skills they need in university to be confident, but they don’t get a lot of exposure to young kids in clinic in university.
“We have some tips and tricks, ways to quickly build confidence and help them feel comfortable doing the job they all know how to do.”
That’s important because he feels optometrists need to talk about therapies as well as lifestyle change.
“Perhaps years ago, optometrists wouldn’t have been comfortable suggesting behavioural changes, but I think times have changed.
“We’ve got good evidence now,” he says. “There are studies coming out that show that time outdoors can in fact help prevent progression.
“We’ve known about near-work for a long time, and we know screens are not what we should be spending a lot of time on. So it’s about having that conversation with the parents, informing them of the risks and, wherever possible, just working with parents or with the kids.”
Sydney independent optometrist Dr Susan Ang says a notable trend among her colleagues is the number of pre-myopes they’re now picking up.
A common example is a four-year old with 6/6 vision, who should ideally be around +1.50 D. To become emmetropic, they would need to maintain this “hyperopic reserve” until eight years old.
“If you’re a +0.50 and you’re six years old, you’re already considered a myope, a pre-myope.”
Her own eight-year-old son sits at +1.00 D, but after he shifted a diopter in six months despite “carefully engineering him”, she placed him in a pair of plano Stellest myopia control lenses as a preventative measure while reading and in the classroom.
“But it’s hard to get a parent to spend $900 to $1000 to try to prevent their kids from becoming myopic when they see perfectly clear. I have that benefit of being able to easily access these products and scan him every three months and seeing where it goes.”
Having more sensitive tools for axial length measurement has been a key factor in picking up kids earlier.
Eyecare professionals need to be mindful of that, even if a young patient appears to have good vision. The key is to test, to test early and to try to obtain some idea of the child’s axial length.
“We know that if they’re more than 23.07mm at six years old, then they’re at risk of myopia,” she says. “But even asking parents to have no handheld technology till four years old has been a challenge.”
Parents more aware of myopia
Dr Trent Sandercoe says the ophthalmic sector is working quickly to adapt to the rise of myopia, the earlier onset of the condition, and the new therapies to combat it. “In the past, we just went ‘you’re myopic’, gave you a pair of glasses and sent you on your way,” says the paediatric and general ophthalmologist working out of Western Sydney.
But that has changed considerably with a greater understanding of what’s going on with myopia and the greater number of young patients bursting through the doors of practices around the country.
Dr Sandercoe says that’s because parents are more aware of it and keen to get their children checked and then treated, and more children are being picked up in various screening programs, especially in New South Wales.
“Those predisposed are presenting earlier, and we’re getting kids that may not necessarily have been myopic in the past but are now presenting with it,” he says.
“So there’s definitely more than what I saw when I first started my ophthalmology training.”
He finds most of his young patients, and particularly those aged over nine, reasonably easy to deal with.
The key, says Dr Sandercoe, is to get a good subjective refraction for those aged over nine or cycloplegic refraction for those under nine in that first consultation.
That can be a challenge but is especially important if the child has ADHD, developmental delay or is on the autistic spectrum. But it is vital to get a good baseline.
“Number two is getting a good axial length, because it’s what’s driving what’s going on.”
On top that he likes to look at the keratometry to make sure he’s not missing something like keratoconus.
“And then I always make sure there’s no red flags.”
He believes very young children presenting with high myopia need to see an ophthalmologist or paediatrician to make sure they don’t have an underlying issue, like Sticklers syndrome or retinal dystrophy.
If there is a hint of myopia, parents can be “very motivated” to go down the pathway of treatment.
“My approach is, I’ll see them every six months,” says Dr Sandercoe. “And I want to demonstrate that there’s axial length growth. And if there is then you start treating it, and that needs to be in my threshold, somewhere between 0.2 and 0.3 millimetres in a year.”
Six months is also a good amount of time to see if any treatment is working.
Often, with children so early in their potential myopia journey, that treatment involves a healthy dose of common sense.
“The strategies tend to involve simple things like walking to and from school,” he says.
“That gets you 20-30 minutes of daylight exposure.
“There’s getting a weekend outdoor sport, which is doing many things at once – you are increasing their socialisation, they’re getting exercise and they’re getting outdoor daylight exposure.
“I tell the parents, you don’t see very many surfers who are short-sighted; you don’t see kids doing outdoor sports who are short-sighted.”
Other treatments can include atropine drops, but not all children are happy to take them, even at a low dose.
“I’m a big fan of the peripheral defocusing lenses, because they’re doing something when the child is doing nothing else is, and they don’t require much compliance to get you wearing glasses.”
Dr Sandercoe is not such a big fan of the orthok that others advocate, “because I’ve seen what happens when people get nasty infections with them”.
But all of the eyecare professionals readily agree on one thing: In the face of this epidemic, doing nothing is not an option.
As Dr Paul puts it: “The outcome if we don’t do anything to change this is a huge expense to the medical system and a lot more potentially avoidable blindness of people in Australia.”
More reading
Considerations for low-dose atropine for myopia control in a non-Asian population
What is the ideal concentration of atropine for myopia control?
Don’t forget about myopia progression in adults
