Quick summary: About 36% of children and teenagers worldwide were short-sighted in 2023, and because myopia usually begins between the ages of 6 and 13 and can keep worsening through the school years, early and regular eye checks matter. Glasses and contact lenses correct blurred distance vision, while newer myopia-control lenses, orthokeratology and more time spent outdoors can help slow the lengthening of the eye that drives the condition. For families, the practical priorities are regular sight tests, which are free on the NHS for under-16s, frames that genuinely fit a child’s face, and a specialist’s view on which option suits their child.

Short-sightedness, or myopia, is now one of the most common health conditions of childhood. A large 2024 meta-analysis of 276 studies estimated that around 36% of children and adolescents worldwide were myopic in 2023, up from roughly 24% in 1990. According to the NHS, it usually starts somewhere between the ages of 6 and 13, which is why it so often comes to light soon after a child starts school and begins to struggle with the board. That timing is also why school vision programmes reaching thousands of children can make such a difference, since a child who cannot see clearly rarely thinks to say so. Once it appears, myopia tends to progress most quickly during the primary school years.

Managing it means correcting a child’s sight with glasses or contact lenses, but it also means looking at how they spend their day. Time outdoors seems to protect young eyes: in a trial in Guangzhou, adding one 40-minute outdoor class to each school day cut the proportion of six-year-olds who became short-sighted over three years from 39.5% to 30.4%. Long stretches of close work on tablets and phones bring their own strain on the eyes and the mind, so balancing screen time with daylight and play is a sensible habit for any family.

Appointments with the eye specialist

Throughout childhood, parents, family doctors and school or community eye services all keep an eye out for signs of a vision problem such as myopia. If anything seems wrong, the child is referred to an eye specialist, usually an ophthalmologist in hospital care or an optometrist on the high street. At the first appointment the specialist asks the child and parents about symptoms and about any family history of eye problems, because many eye conditions, short sight included, can run in families.

The examination itself normally includes a check of visual acuity, a measurement of the eye’s focusing power, a test of the pressure inside the eye and a look at the retina at the back of the eye (fundus examination), along with a general assessment of eye health. At the end, the specialist explains what they have found to both the parents and the child and sets out how the problem can be corrected.

Monitoring myopia as the child grows

The earlier myopia starts, the further it has room to progress, so a short-sighted child needs regular follow-up. If their vision is deteriorating quickly, the specialist can suggest options designed to slow things down, and there are now glasses and lenses made specifically for this purpose that work well from an early age. Another option is orthokeratology, in which the child wears rigid contact lenses overnight that gently reshape the cornea. The lenses come out in the morning and the child sees clearly all day, although the cornea gradually returns to its original shape, so the lenses have to be worn every night. A Cochrane review of 64 trials involving more than 11,000 children found that orthokeratology, special defocus spectacle lenses, multifocal soft contact lenses and low-dose atropine eye drops may slow the progression of myopia and the lengthening of the eye, though results varied between studies and the longer-term evidence is thinner.

Routine checks are just as important for children who have no obvious problems. An examination at around two years old can pick up issues that were missed earlier and allow a lazy eye (amblyopia) to be treated in good time, even if it is usually too early to detect myopia. After that, a sight test every two or three years until the age of 18 is a reasonable minimum, given that most myopia develops during school and student years, and children who are already short-sighted should be seen more often. In the UK, NHS sight tests are free for children under 16 and for 16 to 18-year-olds in full-time education.

Glasses or contact lenses?

Traditionally, myopia is corrected with concave single-vision lenses, which are thicker at the edges than in the centre. These lenses focus the central image neatly on the retina, but images in the peripheral field fall slightly behind it, and that blur is thought to encourage the eye to keep growing longer. Newer lenses with a special geometry create what is called myopic defocus, bringing peripheral images in front of the retina to slow that stretching while keeping central vision sharp. Keeping progression in check matters because adults with severe short-sightedness are more likely to develop problems such as a detached retina, which is one reason a retina specialist may become part of the care team for children with high myopia.

Contact lenses are very thin concave lenses placed directly on the eye, and they suit short sight well. Most are worn during the day and removed at bedtime. Some new-generation soft lenses both correct vision and produce myopic defocus, which can slow the progression of myopia and the elongation of the eye. When the ophthalmologist judges it appropriate, even young children and infants can be fitted with contact lenses, which is particularly useful for strong prescriptions that would otherwise need thick glasses. They also cannot be sat on or snapped during a game in the way glasses can. Whatever the choice, strict hygiene is essential.

Only the eye specialist can decide on the most suitable treatment after examining the child. They record their recommendation on a prescription, which the parents take to the optician when buying the glasses or lenses. The decision takes into account the type and severity of the myopia, but also how the child and parents are likely to manage the routine.

The role of the optician

Fitting glasses for a child depends on close teamwork between the eye specialist, the parents and the optician, who has to allow for the child’s face shape and behaviour. According to JL Rohatgi Eye Hospital, glasses for young children must suit the shape and proportions of their faces, and opticians generally recommend the following.

• A low bridge or non-slip silicone nose pads. Small noses give adult-style frames very little to rest on.
• A tall lens shape. It should cover the whole field of vision, because young children often have to look up at the world around them.
• Plastic frames with flexible arms and hinges. They are sturdier and more comfortable for an active child.
• A retaining cord or flat elastic strap. This stops the glasses falling off during play.
• Frames that do not rub. Pressure on the ears and nose irritates delicate skin, and a stable fit keeps the lenses in the right position.

For the lenses themselves, opticians usually suggest plastic (organic) or polycarbonate lenses, which are light and impact-resistant. Depending on the child’s age, they may also offer anti-scratch, anti-reflective or blue-light filtering coatings, although a Cochrane review found that blue-light filtering lenses probably make little or no difference to eye strain from computer use, at least in adults, so parents can reasonably ask whether that extra is worth paying for.

A good optician also pays attention to the child. Are they calm or lively, do they listen to their parents, and have they accepted that they need glasses? The fit of the frame and its adjustments are checked every time the child comes in, and parents are asked to watch for any changes in their child’s behaviour over the following weeks and to come back if something seems wrong. Small signs, such as a child pushing their glasses up constantly or taking them off to read, are often the first clue that the fit or the prescription needs another look.

Shantanu Rohatgi writes about health and fitness, with a particular interest in eye care.