> Source: https://www.thenycoptometrist.com/blog/myopia-management-nyc (last updated 2026-07-24) # How to Slow Your Child's Nearsightedness: A Parent's Guide to Myopia Management **By Dr. Joanna Latek** · Published 2026-07-21 > If your child's glasses prescription keeps getting stronger every year, that's not just annoying, it's a sign the eye is growing too long. Myopia management can slow that growth. Here's what works, what doesn't, and what to realistically expect. # How to Slow Your Child's Nearsightedness: A Parent's Guide to Myopia Management If your child was just diagnosed with myopia — nearsightedness — and the prescription has already crept up at the last two visits, you're probably wondering whether this is just going to keep going. The honest answer is: probably yes, unless we do something about it. That's a recent change in optometry. For most of my career, the standard response to a child whose glasses were getting stronger was to shrug and write a new prescription. We don't do that anymore. Myopia management is the umbrella term for treatments that slow the progression of childhood nearsightedness. Not cure it — slow it. The goal is to land your child at age 18 with a smaller, more stable prescription than they would have had otherwise. That matters more than it might sound, and I'll explain why below. ## Why childhood myopia is exploding \(and why "just stronger glasses" isn't enough\) The prevalence of childhood myopia has risen sharply over the past few decades, and it's accelerating. In parts of East Asia, more than 80% of teenagers are now myopic. In the U.S., the rate has roughly doubled since the 1970s. NYC kids are not immune — I see it in my chair every week, and the ages are getting younger. A myopic eye is one that has grown too long front-to-back. Light focuses in front of the retina instead of on it, which makes distance vision blurry. Glasses and standard contact lenses fix the focus problem. They do nothing about the underlying eye growth, which is the actual disease process. This is the key thing to understand: myopia isn't a refractive inconvenience. It's an anatomical change. As the eye elongates past normal — anything beyond about 25 millimeters, or a prescription past about -6.00 diopters — the retina, the choroid, and other delicate structures get stretched thinner. The risk of retinal detachment, glaucoma, macular degeneration, and other serious problems goes up. A child who ends up at -8.00 is not just "more nearsighted" than one who ends up at -2.00. They're at materially higher lifetime risk of sight-threatening disease. That's why the goal of myopia management isn't cosmetic. It's risk reduction. Every diopter we prevent is meaningful. ## What we measure to predict progression A myopia management evaluation starts with the same building blocks as a pediatric eye exam, but I add a few specific measurements. The most important one is **axial length** — the physical length of the eye, measured in millimeters, using a quick non-contact device called a biometer. Axial length is the number I track over time, and it tells me more than the prescription alone. Two children with the same prescription can be on very different trajectories. Axial length is what tells me whether what we're doing is working. I also measure: - **Cycloplegic refraction** — the prescription measured after dilating drops, which relax the eye's focusing muscle. This gives me the "true" prescription, especially important in kids whose focusing system can mask farsightedness or understate nearsightedness. - **Corneal curvature** — relevant for choosing between treatments, especially Ortho-K. - **Family history and lifestyle factors** — one or both parents being myopic raises the risk substantially; heavy near work and limited outdoor time raise it further. With those numbers, I can give you a reasonable estimate of where your child is likely to land by age 18 if we do nothing, and what we might be able to achieve with treatment. ## The evidence-backed options: Ortho-K, MiSight, atropine drops Three treatments have enough published evidence to be considered first-line. None of them work for every child, and the right choice depends on age, prescription, lifestyle, and which one your child will actually use consistently. **Low-dose atropine drops.** One drop of 0.01% to 0.05% atropine in each eye at bedtime. Atropine is a long-standing medication; at these very low concentrations, it has minimal side effects and a solid evidence base. The largest placebo-controlled trial to date, CHAMP, followed children on 0.01% and 0.02% atropine for three years and found meaningfully more children stayed under key progression thresholds compared to placebo, with a fourth year of follow-up in 2024 showing the effect held up and didn't rebound after stopping. The drops don't correct vision — your child still wears glasses during the day — but they slow the eye's elongation. Treatment is daily, ongoing, and easy. This is often my first choice for younger kids \(under 8\) or any child who isn't ready for contact lenses. **MiSight soft daily contact lenses.** The first FDA-approved soft contact lens specifically for myopia control. It's a daily disposable, worn during the day. The original 3-year trial showed roughly a 60% reduction in progression, and a 6-year follow-up published in 2022 found the slowing effect held up over the full six years with no signs of fading — good for motivated kids \(typically age 8 and up\) and parents who are comfortable with daily lens hygiene. A contact lens exam for kids follows the same fitting process as for adults, with extra attention to handling. **Orthokeratology \(Ortho-K\).** Rigid lenses worn overnight that reshape the cornea, giving clear vision during the day without glasses or contacts. Two recent meta-analyses — one pooling 14 randomized trials in 2023, another reviewing 45 studies in 2024 — confirmed Ortho-K shows comparable slowing to MiSight and atropine, though the 2024 review also found the effect fades if a child stops wearing the lenses. It's the right choice for sporty kids, swimmers, and kids who really don't want to wear anything during the day. It's also the most involved in terms of lens care. I cover it in detail here. Some kids benefit from combining approaches — for example, Ortho-K plus low-dose atropine — but we start with one and reassess. ## Realistic expectations — slowing, not curing This is the conversation I have most carefully with parents. None of these treatments stops myopia completely. A child on treatment whose prescription would have reached -8.00 by age 18 might land at -5.50 instead. That's a meaningful reduction — three diopters of myopia they won't carry for the rest of their life, with the associated reduction in retinal risk — but they're still myopic. They still need correction. They still need monitoring. I track axial length every six months. If we're slowing progression meaningfully, we keep going. If we're not, we adjust — switch treatments, add atropine, or revisit the lens fit. Myopia management is not a one-and-done decision; it's a multi-year plan we update as your child grows. I also want to be honest about cost. These treatments are not always covered by vision insurance, because they're considered elective by most plans. We'll discuss the options and the realistic out-of-pocket range at the consult. Many families find the investment worth it given the lifetime risk reduction. ## Lifestyle changes that genuinely help Two lifestyle factors have decent evidence behind them, and both are free. **More outdoor time.** Studies consistently show that 90 to 120 minutes a day of outdoor light exposure is associated with slower myopia progression. The mechanism appears to involve retinal dopamine, which is stimulated by daylight and slows eye growth. This isn't a cure, and it's not always easy in a NYC school year, but it's a real effect. **Less sustained near work.** The 20-20-20 rule — every 20 minutes, look 20 feet away for 20 seconds — is the simple version. The bigger picture is breaking up long stretches of close focus. Reading distance matters too; kids who hold books or tablets very close tend to progress faster, and I'll often coach them toward a 14-to-16-inch working distance. None of this replaces medical treatment once myopia has started, but it stacks with it. The kids who do best in my practice are usually the ones whose parents combine treatment, outdoor time, and reasonable screen boundaries. For everything else, we start with a baseline evaluation — usually as part of a comprehensive eye exam — and design the plan from there. ## Thinking about your child's nearsightedness? I see patients at Eye & Health in the East Village. If your child's prescription keeps changing and you'd like a myopia management evaluation, you can book online — usually within the week. _This is not medical advice. Please consult your eyecare professional or schedule an eye appointment today._ --- ### Bibliography Zadnik, Karla, et al. "Efficacy and Safety of 0.01% and 0.02% Atropine for the Treatment of Pediatric Myopia Progression Over 3 Years: A Randomized Clinical Trial (CHAMP)." JAMA Ophthalmology, 2023. Chamberlain, Paul, et al. "Long-Term Effect of Dual-Focus Contact Lenses on Myopia Progression in Children: A 6-Year Multicenter Clinical Trial." Optometry and Vision Science, vol. 99, no. 3, 2022, pp. 204-212. Li, Xue, et al. "Orthokeratology in Controlling Myopia of Children: A Meta-Analysis of Randomized Controlled Trials." BMC Ophthalmology, vol. 23, 2023, Art. 441. Sartor, Lauren, et al. "Benefits and Risks of Orthokeratology Treatment: A Systematic Review and Meta-Analysis." International Ophthalmology, vol. 44, 2024, Art. 239. Walline, Jeffrey J., et al. "Interventions to Slow Progression of Myopia in Children." Cochrane Database of Systematic Reviews, no. 1, 2020, CD004916.