Adult Myopia: Another Pandora’s Box

Share

Tweet

Share

Share

Email

August 10, 2026

By Liesl Forward, BSc, OD

Myopia management in childhood is now established as best practice in modern eyecare. It is natural, then, that clinicians encountering adults with progressive myopia feel there must be something to help them too, and adult myopes themselves are often concerned about worsening eyesight and seek solutions. 

How prevalent is adult myopia progression?

While a finding of the Correction of Myopia Evaluation Trial (COMET) study is that the mean age of myopia stabilisation is 15.6 years old,¹ a proportion of myopes continue progressing in their twenties. A recent study of 18-25 year old high myopes (>-6.00D) in Shanghai found that 18.6% continued to progress at least 0.50D a year.² Similarly, another study in an Irish population found 19.9% of all 18-25 year old and 10.7% of all 18-39 year old myopes progressed at least 0.50D a year.³ This data shows that progressing young adult myopes are not rare. 

What are the risk factors for adult progression? 

Identified non-modifiable risk factors for adult myopia progression across a range of studies include higher refractive myopia, longer axial length, parental myopia, East Asian ethnicity and female sex.^2-4

Some modifiable risk factors do exist. Near work is associated with adult myopia progression, as seen in many studies on adult myopia progression in university students or similar cohorts.^5,6 Conversely, there is evidence to suggest that increased outdoor time is associated with reduced adult myopia progression. A cohort of Australian young adults was found to be more likely to have progressive myopia if they had a smaller conjunctival UV autofluorescence area (a marker for less sunlight),⁴ and a study in Danish medical students found outdoor physical activity was associated with less myopic progression.⁵

Of course, pathological causes of myopic shift, such as cataract and keratoconus, can occur.^7,8  A careful assessment of a patient’s ocular health should be conducted to determine if unique individual aetiology is present. Corneal topography, ocular biometry and cycloplegic refraction are all available tools to confirm diagnosis of adult myopia progression. 

Can adult progressing myopes be managed the same as progressing children? 

While there is established evidence for myopia control with atropine, orthokeratology, soft contact lenses and peripheral defocus spectacles,⁹ definitive evidence for these interventions past adolescence is still lacking. The IMI report on adult myopia explains that research in adult age groups is more challenging due to the difficulty of calculating efficacy when average progression rates are lower, and it being more onerous to recruit and follow young adults.¹⁰

However, the natural history of adult myopia progression does appear to mirror that of progression in childhood. Both appear to be caused by a similar mix of genetic and environmental risk factors, and both are observed to be primarily due to axial elongation.^11,12 It may then be reasonable to offer similar myopia management options to reduce the risk of future ocular pathology and vision impairment. Many adult patients will be able to understand the evidence gap, but still be motivated to take up the intervention that is more likely to stabilize their vision. 

Talk About Lifestyle Factors

When offering myopia control to an adult, consideration of visual tasks and lifestyle is important. Adults may be more intolerant of the effects of atropine due to already decreasing accommodative amplitudes,¹³ and any photophobia experienced may impact tasks such as driving. However, adults may be more accepting of soft contact lenses or orthokeratology as methods that also reduce dependence on glasses, and many will already be using these products as their primary optical correction. For adults who prefer glasses, changing to peripheral defocus lenses, which have been recently FDA approved for use in children and already commonly utilized outside the U.S., may be an attractive option despite adult use being off-label.¹⁴ 

Increased outdoor time should also not be overlooked. A study of young adult myopes in Denmark found that just one hour of outdoor time appeared to have a protective effect against myopia progression, which was similar in magnitude to the detrimental effect of three hours of near work.⁵ The addition of a relatively modest amount of outdoor time to the routine of adults whose work or study necessitates heavy near work could therefore help to reduce the risk of progression. 

Where to from here? 

Clinicians should be aware that a significant proportion of their myopic adult patients will still progress, and have conversations with these patients that takes into account the difficulty of applying an evidence base that is primarily in younger age populations, but also educates them about lifestyle changes and off-label treatments that are available. Looking forward, further research into myopia control options for adult patients will provide a firmer evidence base for recommendations. 

 

Dr. Liesl Forward is an Australian clinical optometrist who graduated from the University of Melbourne. After working in regional private practice, she now works for the Australian College of Optometry in Melbourne. Additionally, she is strongly interested in ocular disease management and public health and is also involved in clinical teaching and outreach eye care.

 

References 

1. Hyman L, Gwiazda J, Marsh-Tootle WL, Norton TT, Hussein M; COMET Group. The Correction of Myopia Evaluation Trial (COMET): design and general baseline characteristics. Control Clin Trials. 2001;22(5):573-592. doi:10.1016/s0197-2456(01)00156-8
2. Wu H, Ni Z, Qi Z, et al. Adult myopia progression in high myopes aged 18-25 years: evidence from a population-based cohort. Br J Ophthalmol. 2026;110(6):684-690. Published 2026 May 20. doi:10.1136/bjo-2025-328046
3. Moore M, Lingham G, Flitcroft DI, Loughman J. Patterns of Myopia Progression in European Adults. Ophthalmol Sci. 2025;5(3):100713. Published 2025 Jan 17. doi:10.1016/j.xops.2025.100713
4. Lee SS, Mackey DA. Prevalence and Risk Factors of Myopia in Young Adults: Review of Findings From the Raine Study. Front Public Health. 2022;10:861044. Published 2022 Apr 27. doi:10.3389/fpubh.2022.861044
5. Jacobsen N, Jensen H, Goldschmidt E. Does the level of physical activity in university students influence development and progression of myopia?–a 2-year prospective cohort study. Invest Ophthalmol Vis Sci. 2008;49(4):1322-1327. doi:10.1167/iovs.07-1144
6. Kinge B, Midelfart A, Jacobsen G, Rystad J. The influence of near-work on development of myopia among university students. A three-year longitudinal study among engineering students in Norway. Acta Ophthalmol Scand. 2000;78(1):26-29. doi:10.1034/j.1600-0420.2000.078001026.x
7. Bobba S, Wood A, Males J, Kerdraon Y. Patterns in refractive error and treatment delay in keratoconus-An Australian study. PLoS One. 2024;19(1):e0297268. Published 2024 Jan 11. doi:10.1371/journal.pone.0297268
8. Pesudovs K, Elliott DB. Refractive error changes in cortical, nuclear, and posterior subcapsular cataracts. Br J Ophthalmol. 2003;87(8):964-967. doi:10.1136/bjo.87.8.964
9. Vagge A, Baldi M, Musolino M, Rivarone V, Catti C, Iester M. Current and Emerging Strategies for Myopia Control in Children: A Comprehensive Evidence-Based Review. J Clin Med. 2026;15(4):1545. Published 2026 Feb 15. doi:10.3390/jcm15041545
10. Bullimore MA, Lee SS, Schmid KL, et al. IMI-Onset and Progression of Myopia in Young Adults. Invest Ophthalmol Vis Sci. 2023;64(6):2. doi:10.1167/iovs.64.6.2
11. Lin LL, Shih YF, Lee YC, Hung PT, Hou PK. Changes in ocular refraction and its components among medical students–a 5-year longitudinal study. Optom Vis Sci. 1996;73(7):495-498. doi:10.1097/00006324-199607000-00007
12. Kinge B, Midelfart A, Jacobsen G, Rystad J. Biometric changes in the eyes of Norwegian university students–a three-year longitudinal study. Acta Ophthalmol Scand. 1999;77(6):648-652. doi:10.1034/j.1600-0420.1999.770608.x
13. Kasthurirangan S, Glasser A. Age related changes in accommodative dynamics in humans. Vision Res. 2006;46(8-9):1507-1519. doi:10.1016/j.visres.2005.11.012
14. FDA Authorizes Marketing of First Eyeglass Lenses to Slow Progression of Pediatric Myopia. News Release. FDA. September 25, 2025. https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-first-eyeglass-lenses-slow-progression-pediatric-myopia

 

 

Read more about the clinical aspects of myopia management here