What is myopia and can it be caused by children spending too much time on screens?

Childhood myopia appears to be on the increase, and could be due to looking at small screens and less time spent outdoors

10-year-old Hollie Lawlor, whose myopia was caught early. Picture: Gareth Chaney.

Pamela Lawlor's 10-year-old daughter, Hollie, had very little chance of escaping myopia.

“Both my husband and I are short-sighted, so we knew there was no hope she’d escape,” says the mum-of-one, an optometrist with Specsavers in Finglas.

“I was always keeping an eye — saying ‘I can see this, can you see it?’. One day, when Hollie was seven, she couldn’t see what I could see, so I brought her in, and yes, her vision was a bit reduced. She was short-sighted.”

Hollie herself had said nothing to indicate she was near-sighted. “She didn’t complain at all. Children think the way they’re seeing is how they should be able to see,” says Lawlor.

There is no doubt myopia is on the rise in children, says Mr Sean Chen, consultant ophthalmic and oculoplastic surgeon at Blackrock Health Galway Clinic and Barringtons Hospital Ireland.

“The consensus from [most] studies is that myopia overall in childhood does seem to be on the increase. There’s a suggestion it might be increasing by 15% in children in Northern Ireland, the closest population to us,” says Chen, who specialises in paediatric ophthalmology.

He points to a systematic review of data from 14 countries, which found the prevalence of myopia in Europe increased significantly between the years 2000–2010, and between 2011–2022, though age-specific trends remained stable. Research found a lower prevalence in six- to 11-year-olds (at 5.5%) compared with 12- to 17-year-olds at 25.2%.

“It’s not yet determined why it’s increasing, but we believe it has to do with spending less time outdoors and increased time looking at small screens,” says Chen, who confirms that during the pandemic, a lot of myopia-related problems emerged in children. “It was a spike within a trend of increased myopia before covid.”

Chen, a member of the Irish College of Ophthalmologists, says ethnicity plays a part in myopia-predisposition. “China or any of the far-eastern countries will have a higher incidence of myopia in any age group,” he says, adding that genetics is a factor too. “Myopic parents are more likely to have a child who becomes myopic.”

Specsavers ran a recent awareness-raising campaign, highlighting the increasing myopia in children. Kerril Hickey, Specsavers Ireland chairman, says optometrists see it as a growing health concern, mirroring a global trend. “The primary reasons for this increase are quite clear — children are spending too much time on screens and not enough time outdoors in natural daylight.

“This fundamental shift in lifestyle is directly impacting their eye health.”

Chen says myopia typically begins to emerge around age 11. It happens gradually.

School eye tests — which in Ireland are at the start of primary, at age four or five, and again at the age of 11 — are appropriately timed to children’s visual development. “The second one is meant to pick up myopia and other refractive errors requiring glasses,” says Chen.

However, he explains that these assessments are more visual screening than actual eye tests. “They check the vision in each eye, how far down the vision chart the child can read. If they achieve a pass in both eyes, they’ve passed — it doesn’t check for anything else, though there’ll be a quick observation for any misalignment of the eye. So, because of the nature of the screening, realistically a lot can be missed.”

At the same time, says Chen, vision is “a barometer of eye health, rather like the vitals for the eye”, so if there is something amiss with the vision, the child will be referred for a more comprehensive eye test.

Eye tests are essential

Research conducted by Specsavers in July 2024 among parents of four- to 16-year-olds found a quarter had never had an eye test. And one in five had not had an eye test in two years or longer. “This is despite over one in four parents saying their child had experienced problems at school, which could be linked to vision. Common issues include struggling to see the interactive whiteboard, having to move to the front of the classroom to see, or experiencing headaches,” says Hickey.

In Chen’s experience, parents often don’t understand the importance of eye assessments for children. “They don’t understand its importance. A lack of appreciation of childhood visual development is quite prevalent in many countries. It’s a complex sequence of events — not well understood by doctors or the public.”

Because myopia progresses gradually, early detection is essential, allowing for proactive steps to be taken to slow its progression.

“Myopia-control aims to slow down the acceleration. The myopia [once you have it] is going to proceed, but you’re trying to slow the rate of growth of the eye,” says Chen, explaining that myopia or near-sightedness is associated with eye size.

“If the eye is growing quickly, the tissues inside — especially the retina — get stretched thinner and thinner. You want to slow the rate of growth of the eye so as to retard the myopia progression.”

Pamela Lawlor with her daughter Hollie. Picture: Gareth Chaney.

Which is essential, he says, because of the serious consequences of a high degree of myopia “These can create quite a burden from age 40 on. As the person gets increasingly myopic there’s higher risk of [problems] that can affect vision, like retinal detachment and myopic maculopathy — which causes loss of central vision, though it is improvable. [Worsening] myopia also means spectacles become more expensive.”

Chen says parents cannot rely on children to tell them there is something amiss with their vision. 

“Children are notorious for assuming their vision is typical. They automatically assume what they see is what everyone sees — they’re not reliable witnesses of visual problems, not until they get older.”

And even then, it depends on social development and the individual. “One will say, ‘I’ve a problem’. Another will soldier on. It depends on personality.”

Instead, Chen urges parents to listen to what their child is saying. “If they’ve a headache, their vision is blurred — if it becomes a persistent report, it should be investigated.” 

And if there is a family history of amblyopia (lazy eye) or strabismus (squint) — a parent or child has one or both of these — it is recommended all siblings be assessed as early as possible, certainly after six months of age, says Chen. 

“Both myopia and long-sightedness can cause amblyopia, and amblyopia is often associated with strabismus,” he explains.

Parents must observe behaviour

Hickey agrees that it is crucial for parents to observe their child’s behaviour, rather than wait for them to report a problem.

“Some key indicators include squinting, complaining of headaches, sitting unusually close to screens, rubbing their eyes frequently, complaining of eye strain, blurred vision or sore eyes or having difficulty seeing the board at school.”

For children, he says the implications of myopia include distant objects appearing blurry, while close objects remain clear. “This can significantly impact their learning, their ability to participate in sports, and generally affect their everyday life.”

He reiterates that unmanaged myopia can worsen over time and potentially lead to more serious eye health issues later in life. “However, it’s important for parents to know there are effective treatments, and myopia can be managed.”

Parents can also take some preventive steps. Hickey recommends:

• Prioritise time outdoors — perhaps the most crucial: “Spending more time outside in natural daylight has been scientifically shown to support healthy eye development. Many children simply aren’t getting enough outdoor time in their daily routine.”
• Follow the 30-30-out rule: “Especially when your child is using handheld screens — encourage them to hold the device no closer than 30cm from their face. They should also take a break after no more than 30 minutes of continuous use. Additionally, aim for them to spend at least two hours outdoors daily. These practices help protect their eyes — and promote overall wellbeing.”
• Limit excessive screen time: “While screens are an undeniable part of modern life, reducing prolonged screen use is key, especially for developing eyes.”
• Testing: “We recommend children’s eyes be tested every year to ensure they remain healthy during this important developmental stage.”

Meanwhile, Lawlor is happy that catching Hollie’s myopia early will reduce her potential myopia prescription in later years. Her daughter’s glasses have a special myopia-management lens, which is “a treatment plan rather than a short-term solution”.

And Hollie’s transition to wearing glasses happened pretty much instantly. “Straightaway, she was delighted at how clearly she could see. You could see the wow in her face when she put them on — like ‘Oh, this is what I’ve been missing’.”