Chapter 1 of 8
What Is Myopia?
Myopia or short-sightedness, is a common vision condition where children can see nearby objects clearly, but distant objects appear blurred.
It often develops during childhood and can progress as the eyes grow.
Children's Myopia
Management Guide
Chapter 1
Many children with myopia do not realise their distance vision has become blurry because the change often happens gradually.
What Does a Child with Myopia See?
What Every Parent Should Know About Myopia
1
Myopia is becoming more
common
Many children develop myopia during their school years.
2
It often increases as children grow
Myopia can continue to progress as a child grows.
3
Glasses correct blurred vision
Standard single vision spectacles provide clear vision but are not designed specifically to slow myopia progression.
4
Early care makes a difference
Regular comprehensive eye examinations allow changes to be detected early and appropriate management to begin.
Why Understanding Myopia Matters
Understanding myopia is the first step towards protecting your child's vision for the future.
Helping children see clearly today, Protecting their vision for tomorrow.
Chapter 2 of 8
Children's Myopia
Management Guide
Chapter 2
Why Does Myopia
Develop?
Myopia develops from a combination of genetic and environmental factors that influence how the eye grows over time.
1
FAMILY HISTORY
Children with one or both myopic parents have a higher risk.
Factors Associated With Myopia
2
NEAR WORK
Frequent or prolonged close-up activities are associated with a higher risk of myopia.
3
DIGITAL DEVICES USE
Prolonged screen use often involves sustained close-up viewing and may reduce time spent outdoors.
4
LIMITED OUTDOOR TIME
Children who spend less time outdoors have a higher risk of developing myopia.
What Happens as Myopia Develops?
The eye may gradually grow longer from front to back. As the eye becomes longer, light focuses in front of the retina instead of directly on it.
Why This Matters?
High myopia increases the risk of serious eye conditions later in life, such as myopic maculopathy, retinal detachment, cataract and glaucoma.
That is why early detection and appropriate myopia management are so important for protecting your child's long-term eye health.
What Happens Inside The Eye?
Chapter 3 of 8
Children's Myopia
Management Guide
Chapter 3
Signs Parents
May Notice
Children often do not recognise or communicate changes in their vision.
Occasionally, subtle shifts in their everyday behaviour can be the initial indicators that parents observe.
Common Signs To Look Out For
Especially when looking at something far away.
Holding books or objects unusually close to the face.
Sitting very close to the TV or leaning forward often.
Particularly after reading or prolonged visual tasks.
Complaining of headaches, eye strain or discomfort.
Difficulty staying engaged during visually demanding activities.
Closing or covering one eye, or tilting the head to see more clearly.
Difficulty seeing distant objects clearly.
A Sign Is A Clue, Not A Diagnosis.
Children may show similar behaviours for a variety of reasons.
Some of these may be related to refractive errors, while others could be linked to focusing, eye coordination, visual comfort, or even factors unrelated to vision.
What parents notice is valuable, but an eye examination helps determine the cause.
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Children do not always know what clear vision should look like.
A child may adapt by moving closer, squinting or changing the way they perform a task rather than saying.
"I can't see clearly."
That is why changes in everyday behaviour are worth paying attention to.
Chapter 4 of 8
Children's Myopia
Management Guide
Chapter 4
Understanding
Your Child's
Eye Growth
Myopia is more than a change in spectacle prescription.
As children grow, their eyes grow too. In many children with myopia, the eye becomes longer from front to back,
causing light to focus in front of the retina rather than directly on it.
Understanding and monitoring this growth can help us see how a child's myopia is changing over time.
4.1
What Is Axial Length?
Axial length refers to the distance from the front of the eye to the retina located at the back of the eye.
It is measured in millimetres (mm).
Some increase in axial length is normal as a child grows.
However, if the eye grows longer than anticipated, light may focus in front of the retina, which can lead to myopia.
Think of axial length as a measurement of how long the eye is.
4.2
Track eye growth, not only spectacle prescription.
When it comes to myopia, we look at two important numbers.
Each tells us something different about your child's eyes.
Two Different Ways Of
Looking At Myopia
1
SPECTACLE PRESCRIPTION
Tells us the optical correction needed for clear vision.
-
Measured in diopters (D)
-
Tells us how strong the lenses need to be
-
Helps your child see clearly today
Right (OD)
Left (OS)
-3.00D
-2.75D
Example
Spectacle prescription can vary between measurements.
It tells us how much optical correction is needed for clear vision, not how long the eye is.
2
AXIAL LENGTH
Tells us about the physical length and growth of the eye.
-
Measured in millimetres (mm)
-
Indicates how long the eye is
-
Helps us understand myopia progression risk
Right (OD)
Left (OS)
24.02 mm
23.78 mm
Example
Axial length usually gets longer as the eye grows.
Longer eyes are more likely to develop or progress myopia.
Both numbers are important, but they tell us different stories.
Prescription tells us how your child sees today.
Axial length helps us understand how your child's eyes are growing over time.
As a general guide
1 mm of axial elongation may correspond to approximately
-2.5 to -3.0 D
of myopic change.*
* This is an approximate relationship
and varies between individuals.
4.3
Why We Track Eye Growth Over Time
The trend matters.
Small changes over time can be more meaningful than looking at one measurement alone.
A single axial length measurement gives us a starting point.
What matters most is how your child's eye growth changes over time.
FIRST VISIT
24.02 mm
Date: 8 Aug 2026
6 MONTHS LATER
24.10 mm
Date: 8 Feb 2027
12 MONTHS LATER
24.14 mm
Date: 8 Aug 2027
+0.08 mm
in 6 months
+0.04 mm
in 6 months
A child's axial length is influenced by factors such as age, refractive status, and individual eye-growth pattern.
This is why we interpret measurements in context,
rather than judging myopia progression from one number alone.
Consistency makes a difference.
Regular follow-ups help us build a clearer picture of your child's individual eye-growth pattern.
Early detection gives us more opportunity to monitor changes and consider appropriate management when needed.
4.4
Age
Current Refractive Status
Previous Measurements (Trend)
Family & Risk Factors
Overall Clinical Findings
Is My Child's Eye Growing
Too Quickly?
There is no single number that applies to every child.
Eye growth is assessed in context, not by one measurement alone.
We consider multiple factors:
Every child is different.
Some children naturally grow faster.
Some are at higher risk of myopia progression.
This is why we look at the whole picture, not just one change in axial length.
We may take closer action if we observe
-
Consistent increase over time
-
Increase beyond expected range for age
-
Higher risk child with faster progression than before
For reference only
Axial length growth varies with age, refractive status and the individual child.
Your child's measurements are interpreted together with previous results and overall clinical findings.
Eye-growth context
Approximate axial elongation
Slower / typical physiological growth
Often associated with normal eye growth
~0.1
mm / year
~0.2 - 0.3
mm / year
Growth often associated with increasing myopia
May require closer monitoring
These figures are general clinical references, not diagnostic cut-offs.
Axial length growth should be interpreted according to the individual child.
* Data sources: IMI Clinical Myopia Management Guidelines (2023); Tideman JWL et al. Acta Ophthalmologica. 2018;96(3):301-309;
Lam CSY et al. Ophthalmic & Physiological Optics. 2017;37(6):715-721.
4.5
What Happens If Eye Growth
Is Faster Than Expected?
Early recognition gives us more opportunity to respond.
By monitoring eye growth over time, meaningful changes can be identified earlier, helping us make more informed decisions about your child's myopia care.
If faster-than-expected eye growth is observed, the next step depends on your child's overall findings.
01
Review the findings
We compare your child's current results with previous measurements to look for consistent patterns over time.
02
Reassess the whole picture
We consider vision, refractive status, treatment or spectacle wear, family history, lifestyle and other relevant clinical findings together.
03
Decide the next step
Depending on the overall findings, we may continue monitoring, review sooner, discuss myopia management, or adjust an existing management plan as appropriate.
Every child is different. Management decisions are personalised to your child's individual findings and needs.
Chapter 5 of 8
Children's Myopia
Management Guide
Chapter 5
History &
Initial Screening
Every child is different.
Understanding your child is an important first step.
We start by learning about your child's vision history, family background, daily habits and previous eye care to build a complete picture of their visual needs.
We take the time to understand every aspect of your child's visual lifestyle.
This helps us tailor the examination and recommend the most suitable myopia management plan.
Vision History
Previous prescriptions, symptoms and changes noticed in your child's vision.
Family History
Information about myopia or other eye conditions in parents or siblings.
Daily Visual Habits
Details about schoolwork, screen use, working distance, reading habits and outdoor time.
Previous Eye Care
Existing spectacles, previous myopia management or past eye examinations.
This helps us build a clearer picture of your child's visual needs before we interpret the examination findings.
5.1
Measuring Vision & Refraction
Why this step matters
Accurate measurement today helps us plan the right management approach and monitor meaningful changes over time.
Understanding how clearly your child sees today.
Refraction is an important part of the assessment that helps us determine your child's current refractive status and establish a reliable baseline for future monitoring.
1
How clearly can your child see?
We measure visual acuity at distance for each eye individually and together.
Each Eye Individually
We gently cover one eye at a time to check each eye individually.
Both Eyes Together
We then check how clearly your child sees with both eyes together.
Age-Appropriate Chart
We use age-appropriate charts so the test is accurate and reliable.
2
What is the current refractive status?
We use both objective and subjective refraction to determine the most accurate prescription.
Objective Measurement
We start with an autorefractor to get an initial measurement.
Refine The Prescription
We then refine the prescription using the trial lenses for the best clarity.
Best Corrected Vision
We confirm the clearest vision with the refined prescription.
A prescription is not determined by one machine reading alone.
We combine measurements with your child's responses to arrive at the most accurate result.
3
Establishing Today's Baseline
We combine all the information to create a reliable reference for future reviews.
Visual Acuity
How clearly your child sees at distance.
Refractive Status
The most accurate prescription for your child today.
Previous Results
Any past records or measurements
(if available).
Today's Baseline
A complete picture of your child's vision today.
Together, these findings give us a reliable picture of your child's vision today.
This becomes the reference point for future reviews.
The important part is not one number. It is how your child's vision changes over time.
5.2
Measuring Eye Growth
We measure your child's axial length - the distance from the front to the back of the eye, to establish their current eye length.
One quick measurement.
Another important piece of the picture.
Axial Length Measurement
Records the current length of each eye.
Both Eyes
Measured
Each eye is assessed
individually.
Added To Today's Baseline
The measurement becomes part of your child's clinical record for future comparison.
5.3
Eye Health & Visual Function
Clear vision is more than just having the right prescription.
Beyond measuring spectacle power and axial length, we also check that your child's eyes are healthy and functioning comfortably together.
Eye Health
Making sure the eyes themselves are healthy.
Front of the eye
We examine the cornea, lens and other visible structures of the eye.
Back of the eye
We assess the retina and optic nerve for signs that may need further attention.
Further imaging when needed
Retinal photography or OCT may be recommended when clinically indicated.
Why this matters
Healthy eyes provide the foundation for clear vision. Eye health findings can also help us decide whether further assessment or referral is needed.
Visual Function
Understanding how your child's two eyes work together.
Eye alignment & coordination
We check whether the eyes are aligned and working together appropriately
Focusing ability
We assess how comfortably the eyes focus and accommodate, particularly during near tasks.
Depth perception
We may check how well both eyes combine their information
to support three-dimensional vision.
Why this matters
A child can see the chart clearly and still experience difficulties with focusing or eye coordination. These findings help us understand their visual needs more completely.
Chapter 6 of 8
Children's Myopia
Management Guide
Chapter 6
Myopia Management
Options
Clear vision is just one aspect of the goal.
Myopia management focuses on correcting your child's vision while also aiming to slow the progression of myopia over time.
Currently, there are several evidence-based approaches available. We will guide you through the options and discuss which may be suitable for your child.
Correct Vision
Clear, comfortable vision for everyday activities.
Manage Progression
Approaches designed to help slow myopia progression.
Monitor Over Time
Follow vision and eye growth to evaluate progress.
6.1
Myopia Management
Spectacle Lenses
More than correcting blurred vision.
Myopia management spectacle lenses provide clear vision while using specially designed optics to help slow myopia progression.
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How are they different from ordinary spectacle lenses?
Standard Single-Vision Lens
Corrects blurred vision.
Myopia Management Spectacle Lens
Corrects vision + incorporates specialised optics designed to help slow excessive eye growth.
Two Different Optical Technologies
Different designs. A shared goal: to help slow myopia progression.
Essilor® Stellest®
H.A.L.T. Technology
Many small lenslets
Highly aspherical lenslets surrounding a clear vision zone to create a myopia control signal designed to help slow excessive eye growth.
ZEISS MyoCare
C.A.R.E. Technology
Ring-shaped elements
Cylindrical annular refractive elements surround a central clear zone to create simultaneous competing myopic defocus for myopia management.
Lenslets or rings -
what is the difference?
Both technologies are supported by clinical evidence for slowing myopia progression.
They use different optical designs to influence retinal signalling associated with eye growth, and the evidence for each continues to evolve.
How do we choose?
There is no single lens that is automatically the right choice for every child.
We consider the available clinical evidence together with your child's prescription, visual needs, fitting requirements and practical considerations.
Clinical Evidence
Essilor® Stellest®
Long-term clinical evidence
Supported by long-term clinical studies demonstrating reductions in myopia progression and axial elongation compared with single-vision lenses.
ZEISS MyoCare
Multi-year clinical evidence
Supported by multi-year clinical studies demonstrating reductions in myopia progression and axial elongation compared with single-vision lenses.
*Results are from separate clinical studies with different study designs and should not be directly compared.
* Data sources: IMI Clinical Myopia Management Guidelines (2023); Tideman JWL et al. Acta Ophthalmologica. 2018;96(3):301-309;
Lam CSY et al. Ophthalmic & Physiological Optics. 2017;37(6):715-721.
Accurate Fitting Matters
Accurate fitting is essential in myopia management spectacle lenses.
The right frame, precise centration and a stable wearing position help ensure the lens design is positioned as intended.
Frame Selection
Choosing the right frame size, shape and fit for your child.
A stable, comfortable frame helps maintain the intended lens position.
Precise Centration
Accurate measurements align the optical centre and lens design with your child's eyes.
Precise positioning helps the lens perform as intended.
Position of Wear
We check how the spectacles naturally sit on your child's face.
A secure wearing position helps maintain the intended lens alignment.
Accurate fitting is not just about comfort.
It helps ensure the lens design is positioned as intended.
6.2
Myopia Management Contact Lenses
Myopia management contact lenses are soft daily lenses designed to correct your child's vision while helping to slow myopia progression.
MiSight® 1 day
by CooperVision Malaysia
What is MiSight® 1 day?
MiSight® 1 day is a daily disposable soft contact lens specially designed for children with myopia. It provides clear vision while helping to slow myopia progression.
Clear Vision
Correct short-sightedness for clear everyday vision.
Myopia Management
Specialised optics designed to help slow myopia progression.
Daily Disposable
A fresh pair every day. No lens cleaning or storage required.
ActivControl® Technology
A specialised optical design that corrects short-sightedness while helping to slow myopia progression.
FDA Approved*
The first soft contact lens in the U.S. approved to slow myopia progression in children aged 8-12 years at the initiation of treatment.
Clinical Evidence
Long term clinical evidence showing slower myopia progression and axial elongation.
3-years randomised clinical trial in children aged 8-15 years
Designed with children in mind
Contact lenses can seem challenging at first, but children can learn safe lens handling with proper instruction and practice.
* As reported by parents.
1. Chamberlain P, et al. Clinical evaluation of a dual-focus myopia control 1 day soft contact lens - 3-year results BCLA 2017.
6.3
Other Myopia Management Approaches
Different children have different needs.
In addition to myopia management spectacle and contact lenses, other approaches may also be considered depending on the child’s individual needs.
Low-Dose Atropine
Prescription Eye Drops
Low-dose atropine eye drops may be prescribed to help slow myopia progression in some children.
Prescribed & monitored by ophthalmologist
Suitability, concentration and treatment should be determined and monitored by the prescribing doctor.
Prescription treatment only.
Orthokeratology (Ortho-K)
Specialised contact lenses
Ortho-K lenses are worn overnight to gently reshape the cornea. They provide clear vision during the day without glasses.
Fitted and monitored by optometrist
Not every child is suitable for Ortho-K.
Regular follow up is important to ensure safety and effectiveness.
6.4
Combination Management
Sometimes, more than one approach may be considered.
In some children with continuing myopia progression, an ophthalmologist may consider low-dose atropine alongside myopia management spectacle lenses.
Myopia Management Spectacle Lenses
Essilor® Stellest® / ZEISS Myocare
Low - Dose Atropine
Prescribed and monitored by opthamologist
+
Combination management is not essential for every child.
It may be considered based on your child's age, myopia progression rate, axial-length growth, treatment response and individual clinical findings.
Chapter 7 of 8
Children's Myopia
Management Guide
Chapter 7
Monitoring Your Child's Eye Growth Process
Regular follow-up allows us to monitor your child's progress and understand how their eyes are changing over time.
Myopia management is an ongoing process, not a one-time prescription.
Each visit builds on the previous.
We compare your child's latest vision, prescription and axial-length measurements with previous result to understand how their eyes are changing over time.
Follow-up intervals may vary according to your child's individual needs
Measure
We take accurate measurements of your child's eyes.
Compare
We compare results with previous visits to see how your child's eyes are changing.
Discuss
We discuss the findings and plan the next steps together based on your child's progress.
Myopia management is an ongoing journey.
Regular follow-up allows us to monitor your child’s progress and adjust the management plan when appropriate.
Chapter 8 of 8
Children's Myopia
Management Guide
Chapter 8
Taking The Next Steps
When Should My Child Have a Myopia Assessment?
You don't need to wait for a significant change in your child's prescription.
A myopia assessment can help determine your child's current status and whether monitoring or myopia management is necessary.
01
Newly Diagnosed With Myopia
Your child has recently been found to be short-sighted.
02
Prescription Keeps Increasing
The spectacle prescription has continued to increase between visits.
03
Low Hyperopia Reserve
Your child has less farsightedness than expected for their age, which may indicate a higher risk of developing myopia.
04
You're Concerned About Their Myopia Risk
Family history or other risk factors may make early assessment worthwhile.
An assessment does not mean treatment must be started.
It helps us understand your child's eyes and discuss whether monitoring or myopia management may be appropriate.
8.1
Start Your Child's Myopia Management Journey
Every child's eyes are different.
Their myopia management should be too.
PERSONALISED TO YOUR CHILD
Care based on your child's eyes, eye growth and individual needs.
EVIDENCE-BASED CARE
Recommendations guided by clinical findings and current evidence.
WITH YOU ALONG THE JOURNEY
We continue to monitor your child's progress over time.
The first step is to understand your child's eyes.
Early assessment.
Early understanding.
More time to manage myopia.