Myopia: Why Needing Stronger Glasses Every Year Is Not Something to Ignore

Short-sightedness. Most people know the term, and plenty of people have it. You cannot see the board clearly, you get glasses, you get on with things. Easy.

Except there is more to it than that. A lot more.

Myopia is not just a refractive error that glasses fix. It is a condition driven by the physical growth of the eyeball, and when that growth is not managed, the consequences for long-term eye health can be significant. This is something that is not talked about nearly enough, and it is something I think every parent of a short-sighted child, and every myopic adult, deserves to understand clearly.

What is myopia, exactly?

Myopia occurs when the eyeball grows too long from front to back. Instead of light focusing neatly on the retina at the back of the eye, it focuses just in front of it. The result is blurry distance vision, while near vision stays clear.

In children, the eyeball is still growing. This is normal and expected. The problem arises when the eye grows more than it should, and keeps growing, driven by a combination of genetics and environment. The result is a prescription that gets progressively stronger, often year after year throughout childhood and the teenage years.

The prescription number itself matters less than what is happening physically inside the eye. The longer the eyeball grows, the greater the stress placed on the retina, the optic nerve, and the other structures inside the eye. And that is where the real risk lies.

Myopia is not just a refractive error that glasses fix. It is a condition driven by the physical growth of the eyeball, and that growth has consequences.

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Why does it matter beyond needing glasses?

This is the conversation I find myself having regularly, and it is one of the most important ones.

Low myopia carries relatively low additional risk. But as the prescription climbs, the risk of serious eye conditions in adulthood climbs with it. High myopia, generally defined as a prescription of minus 6.00 dioptres or more, is associated with significantly elevated risk of:

• Retinal detachment. The stretched retina in a highly myopic eye is more prone to developing tears and holes, which can lead to retinal detachment. This is a sight-threatening emergency.
• Myopic macular degeneration. Stretching of the back of the eye can damage the macula, the part of the retina responsible for central vision. This is one of the leading causes of irreversible vision loss in adults with high myopia.
• Glaucoma. High myopia is an independent risk factor for glaucoma, separate from elevated eye pressure.
• Cataracts. Myopic eyes are more prone to developing cataracts at an earlier age.

These are not rare complications. They are well-documented, well-understood risks that increase as myopia increases. The goal of myopia control is to keep the prescription as low as possible, for as long as possible, to reduce the lifetime risk of these conditions.

The myopia epidemic

Myopia is becoming dramatically more common. In Australia, around 20 percent of adults were myopic a generation ago. Current projections suggest that by 2050, around half the world's population will be myopic, with a significant proportion having high myopia.

The reasons are not fully understood, but the evidence points to a combination of reduced time outdoors in natural light during childhood, and increased time spent on near tasks including screens. Genetics also plays a role. Children with one myopic parent have a significantly higher risk of developing myopia themselves. Children with two myopic parents have a higher risk again.

This is not about screen time being inherently harmful. It is about balance. Time spent outdoors, particularly in natural light, appears to be genuinely protective against the onset and progression of myopia in children. The research on this is consistent and compelling.

Time spent outdoors in natural light appears to be genuinely protective against myopia in children. This is one of the most consistent findings in the research.

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How do we measure myopia progression?

The traditional way of tracking myopia is to compare prescriptions over time. If the prescription gets stronger, the myopia is progressing. This is useful, but it is not the most sensitive or precise way to monitor what is happening.

At Outlook Eye Centre, we measure axial length. This is the physical length of the eyeball from front to back, measured in millimetres. Because myopia is fundamentally a condition of excessive eye growth, tracking the axial length directly tells us much more than the prescription alone.

Even small changes in axial length are meaningful. Each additional millimetre of axial length corresponds roughly to a significant increase in myopia and in the associated risk of complications. Tracking it over time lets us see whether myopia is progressing faster than expected, whether treatment is working, and whether we need to adjust our approach.

We review children on myopia control every six months and measure axial length at each visit. It is one of the most useful tools we have.

What can be done about it?

Quite a lot, as it turns out. Myopia control is one of the most rapidly developing areas in optometry, and the evidence base for several treatment options is now very strong.

At Outlook Eye Centre, we offer a full suite of myopia control options:

• MiYOSMART spectacle lenses, which use DIMS technology to correct distance vision while simultaneously slowing eye growth. Clinical trials show around 60 percent reduction in myopia progression compared to standard lenses.
• Orthokeratology (Ortho-K), specially designed overnight contact lenses that reshape the cornea while your child sleeps, giving clear daytime vision without glasses or contacts, while also slowing myopia progression.
• MiSight and Abiliti daily disposable contact lenses, soft lenses worn during the day that are specifically designed for myopia control in children.
• Low-dose atropine eye drops, a pharmacological option used to slow myopia progression, often in combination with an optical treatment for cases of rapid progression.

The right option depends on your child's age, prescription, lifestyle, and what they and your family are comfortable with. We will discuss all the options with you and make a recommendation based on what we think will work best for your child specifically.

What about adults with myopia?

Myopia control is primarily focused on children, because this is the period when the eye is actively growing. In most people, myopia stabilises in the early to mid twenties as eye growth slows.

For adults, the focus shifts to monitoring. If you have moderate or high myopia, regular eye examinations are important not just for updating your prescription but for keeping a close eye on the health of the retina, optic nerve, and macula. These are the structures most at risk from the long-term effects of myopia, and early detection of any changes is key.

Adults with high myopia should be seeing their optometrist at least every year, and should be aware of the warning signs that warrant an urgent review: a sudden increase in floaters, flashes of light, or any shadow or curtain across the vision. These can be signs of a retinal tear or detachment and need to be assessed immediately.

When should we start thinking about myopia control?

As soon as myopia is diagnosed in a child.

There is no minimum prescription threshold that needs to be reached before myopia control is worth considering. The earlier it is started, the greater the cumulative benefit over the years of childhood and adolescence when the eye is most actively growing.

If your child has been told they are short-sighted and the conversation stopped at which frames to choose, please book an appointment. Myopia management is a separate and important conversation, and it is one we are very happy to have.

Book a myopia assessment at Outlook Eye Centre. Call 07 4635 8844 or email andrew@outlookeyecentre.com.au. We are open Monday to Friday, 8:30am to 5:00pm, at 65 High Street, Rangeville, Toowoomba.

Shannon Smith | Optometrist | Outlook Eye Centre | 65 High Street, Rangeville, Toowoomba QLD 4350