Should we start myopia control for an asymptomatic low myope?
In this article:
How should a young asymptomatic low myope be managed? Should you monitor with no correction due to lack of symptoms, or start myopia control from the first indication of myopia? The case discussion is as follows.
What other clinical information is needed?
Binocular vision can play an important role in myopia onset and progression. Read more in our blog Four reasons why binocular vision matters in myopia management. Managing any potential binocular vision issues is in the patient’s best interest to ensure a comfortable, robust visual system.
Should we correct the myopia?
There has been a school of thought suggesting that under-correcting myopia in children may reduce myopic progression, and indeed even in the current day around 20% of eye care practitioners still believe this. This has been disproven: under-correction of 0.75D (blurring the child’s vision to 6/12 or 20/40) has been shown to speed up myopic progression and axial elongation.1
Should we start myopia management?
Risk factors for myopia progression
The first consideration would be to assess the child’s risk factors for myopia progression, and she has three that indicate significant risk for progression, indicating the imperative for early intervention with a myopia control strategy.
Myopia treatment options
The commenters mostly suggest prescribing myopia controlling spectacle or contact lenses. As the patient may have some accommodative issues, she could potentially benefit from spectacle lenses with a near addition while doing near work. Atropine was also initially suggested, with consideration given to possible side effects - any impact on accommodation or pupil size can be managed with progressive addition or bifocal spectacle lenses, with or without photochromatic treatment.8
What else can be done for low myopes?
As for all myopes, It is also important to emphasize the importance of managing near work and outdoor time in for both delaying myopia onset and reducing risk of progression. The key ‘rules’ to provide to parents are:
Take home messages:
- Myopia management can be implemented from the early stages when a child is pre-myopic or in the early stages of myopia. It is important to evaluate the child's visual function in cases of low myopia, and risk factors for myopia progression in determining the strategy to discuss with parents.
- Whether optical correction and/or myopia control is prescribed or not, asking questions and providing advice on near work and outdoor time habits is important.
Meet the Authors:
About Connie Gan
Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.
About Kimberley Ngu
Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.
This content is brought to you thanks to unrestricted educational grant from
- Chung K, Mohidin N, O'Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision research. 2002 Oct 1;42(22):2555-9. (link)
- Sun YY, Li SM, Li Si, Kang MT, Liu LR, Meng B, Zhang FJ, Millodot M, Wang N. Effect of uncorrection versus full correction on myopia progression in 12-year-old children. Graefe's Arch. Clin. Exp. Ophthalmol. 2017; 255, 189-195. (link)
- Logan NS, Wolffsohn JS. Role of un-correction, under-correction and over-correction of myopia as a strategy for slowing myopic progression. Clin Exp Optom. 2020 Mar;103(2):133-137. (link)
- Chua SY, Sabanayagam C, Cheung YB, Chia A, Valenzuela RK, Tan D, Wong TY, Cheng CY, Saw SM. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016;36(4):388-94. (link)
- Liao C, Ding X, Han X, Jiang Y, Zhang J, Scheetz J, He M. Role of Parental Refractive Status in Myopia Progression: 12-Year Annual Observation From the Guangzhou Twin Eye Study. Invest Ophthalmol Vis Sci. 2019;60(10):3499-3506. (link)
- Jiang X, Tarczy-Hornoch K, Cotter SA, Matsumura S, Mitchell P, Rose KA, Katz J, Saw SM, Varma R; POPEYE Consortium. Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age. JAMA Ophthalmol. 2020 May 1;138(5):501-509. (link)
- Yam JC, Jiang Y, Tang SM et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study. Ophthalmol. 2019;126:113-24. (link)
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