Clinical

How to Manage Progressive Myopia in Young Adults

February 3, 2025

By Eman Alzghoul, PhD, FIACLE, FBCLA

myopia progression in young adults

Photo Credit: Getty Images

Adult myopia progression is commonly observed in clinical practice, yet there is a lack of substantial evidence to guide its management. This article examines the frequency and extent of myopia progression in adulthood and the available management options.

Myopia Progression in Adulthood
Myopia is becoming a significant public health challenge worldwide. It is particularly concerning that this condition emerges early in childhood and continues progressing into adulthood.1 Progression to high myopia increases the risk of severe eye complications later in life. Although the majority of myopia appears during childhood and stabilizes by the age of 15 to 16 years,2,3 around 13% of individuals aged 18 to 19 experience an annual progression of 0.50D.4 Additionally, a recent study reported that over one-third of young adults in Western Australia showed myopia progression of ≥0.50D in at least one eye between ages 20 and 28, with over 20% experiencing progression in both eyes.5 Myopia can also begin in early adulthood (18 years and older) in those with previously normal vision.5

Research on adult myopia progression shows mixed results. Some studies find no impact of gender or ethnicity,4 while others report that women experience more than double the progression and axial elongation rates of men, and individuals of East Asian descent exhibit 70% faster axial elongation than those of European descent.5,6 These inconsistencies likely arise from differences in study methods, including age ranges, duration, and definitions of myopia and progression. However, there is a consensus that changing lifestyles are contributing to the continued progression and onset of myopia in adulthood. The modern emphasis on education,7 the rise in indoor jobs over the past century,8 the automation of manual or outdoor occupations,9 and less time spent outdoors could drive myopia progression during young adulthood.

Adult Response to Myopia Treatments
No evidence suggests that the underlying processes driving myopia differ between children and adults. Studies have shown that short-term orthokeratology wear leads to a thickening of the choroid, a biomarker for myopia control effectiveness, in children10 and young adults.11 This suggests that myopia control methods tested in children are likely to be effective in young adults.  While research on treatments for slowing myopia progression in older teenagers and young adults is limited, experts recommend continuing myopia control treatments into early adulthood whenever possible to improve long-term outcomes.12,13

How Do You Manage Progressive Myopia in Adults? 

  1. Monitor Progression and Eye Health. Regular monitoring is crucial to maintain eye health in adults with progressive myopia. Measuring axial length, when possible, offers valuable insight into potential pathology risks. It is recommended to conduct annual retinal exams for young people with myopia, including dilated pupil exams for those with high levels of myopia or axial lengths of 26mm or more. Fundus photo documentation using B-scan ultrasonography and OCT is vital in detecting subtle pathological changes and making a timely referral.
  2. Consider Spectacles and Contact Lenses. Standard single-vision spectacles correct myopic blurred vision but do not prevent its progression over time.14 Innovative spectacle lens options have emerged recently including Hoya MiYOSMART15 and the Essilor Stellest.16 These lenses incorporate high-powered segments distributed across the lens surface, and they have effectively slowed myopia progression in children up to ages 19 and 16, respectively. While research on older teens and young adults has yet to confirm similar myopia control benefits, these specialized lenses have shown promising visual outcomes in these age groups.17Similar to single-vision spectacle lenses, single-vision contact lenses effectively correct blurred vision but do not slow myopia progression. However, specialty designed soft contact lenses with multiple focal points, such as dual-focus or multifocal lenses, have shown effectiveness in slowing myopia progression in children. However, current evidence is limited to wearers up to 16-18 years old. The MiSight 1 day contact lens has demonstrated both safety and effective myopia control up to age 18.18
  3. Orthokeratology. Research shows OrthoK reduces myopia progression by 50% in children and significantly slows it in teenagers up to 15-16 years old.19 Some studies suggest it can stabilize myopia in young adults with progressive myopia.20,21 Recent findings confirm that OrthoK is a safe and effective treatment method for adults with low to moderate myopia. It improves daytime vision without major side effects and achieves high satisfaction, particularly among those who find glasses or contact lenses restrictive or cosmetically undesirable.22
  4. Atropine Eye Drops. Research strongly supports the use of low concentrations of atropine eye drops (0.01% to 0.05%) to control myopia in children aged 4 to 16.23,24  However, no evidence currently supports their effectiveness in slowing myopia progression in older teens or adults.
  5. Managing Screen Time and Near Work. Screen time and near work, including reading, have become unavoidable for young adults due to leisure, study, and work demands. A 2021 survey found that over half of U.S.-based adults spend at least five hours daily on smartphones, excluding work-related usage. Although no direct evidence shows that spending time outdoors slows myopia progression in adults,25 taking regular breaks and maintaining a reasonable viewing distance during smartphone use are essential strategies for promoting better eye health.
  6. Communicate and Discuss Treatment Side Effects. Myopia progression can continue into young adulthood, which may be disappointing for some patients. In such cases, continuing or initiating myopia control may be necessary, particularly with rapid progression or patient concerns. However, there is less comprehensive evidence and fewer predictive tools for this age group, making it essential to manage expectations. Patients should understand that while these strategies may help, their effectiveness cannot be guaranteed. Furthermore, managing adult progressive myopes presents unique challenges due to their increased visual demands. While overnight OrthoK and daytime multifocal contact lenses are well-tolerated in children, the glare and halos often reduce their acceptance in adult myopes.26 While low-dose atropine causes only mild effects on light sensitivity and near vision in children, adults may find it more difficult to tolerate. This is due to their reduced accommodative amplitude, which makes it harder to compensate for near blur. Additionally, adults often have higher visual demands, such as night driving, university work, and extended screen use, which can further reduce their tolerance to atropine.27, 28

Take home message
Effective myopia management is a long-term effort. Along with early interventions to slow myopia progression and axial elongation in children, managing high myopia in adulthood involves regular fundus exams, monitoring posterior ocular health, and timely referrals to retinal specialists. Equally important is educating patients to set realistic expectations about visual outcomes. 

 

Eman Alzghoul, PhD, FIACLE, FBCLA, recently completed her doctorate in Vision Science from UNSW Sydney’s School of Optometry and Vision Science. With eight years of experience as an optometrist and researcher, she now serves as an Assistant Professor in the Department of Optometry at Jordan University of Science and Technology (JUST). Her work focuses on contact lens compliance and myopia control treatments.

 

Some products covered in Review of Myopia Management are prescribed off-label in the United States because they are not FDA-approved for slowing the progression of myopia in children.

MiSight 1 Day soft contact lenses are FDA-approved for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes who, at the initiation of treatment, are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with less than or equal to 0.75 diopters of astigmatism.

 

References 

1.Bullimore MA, et al. IMI-Onset and Progression of Myopia in Young Adults. Invest Ophthalmol Vis Sci. 2023.

2.Group C. Myopia stabilization and associated factors among participants in the Correction of Myopia Evaluation Trial (COMET). Invest Ophthalmol Vis Sci. 2013.

3.Polling JR, et al. Myopia progression from wearing first glasses to adult age: the DREAM Study. Br J Ophthalmol. 2021

4.Khan HA, et al. Myopia Progression in Adults: A Retrospective Analysis. Optom Vis Sci. 2023.

5.Lee SS-Y, et al. Incidence and Progression of Myopia in Early Adulthood. JAMA Ophthalmology. 2022

6.Foo LL, et al. Factors influencing myopia stabilisation in young myopic adult Singaporeans. Br J Ophthalmol. 2024.

7.Williams KM, et al. Increasing Prevalence of Myopia in Europe and the Impact of Education. Ophthalmology. 2015.

8.Dutheil F, et al. Myopia and Near Work: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023.

9.Xiong S, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017.

10.Chen Z, et al. Effects of Orthokeratology on Choroidal Thickness and Axial Length. Optom Vis Sci. 2016.

11.Lee JH, et al. Choroidal Thickness Changes after Orthokeratology Lens Wearing in Young Adults with Myopia. Ophthalmic Res. 2021.

12.Bullimore MA, Richdale K. Myopia Control 2020: Where are we and where are we heading? Ophthalmic Physiol Opt. 2020

13.Gifford KL,  et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019.

14.Donovan L, et al. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012.

15.Lam CSY, et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep. 2023.

16.Bao J, et al. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022.

17.Gao Y, et al. Impact of myopia control spectacle lenses with highly aspherical lenslets on peripheral visual acuity and central visual acuity with peripheral gaze. Ophthalmic Physiol Opt. 2023.

18.Chamberlain P, et al. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022.

19.Sun Y, et al. Orthokeratology to control myopia progression: a meta-analysis. PLoS One. 2015.

20.Gifford K, et al. Zone of Clear Single Binocular Vision in Myopic Orthokeratology. Eye & Contact Lens: Science & Clinical Practice. 2019.

21.González-Méijome JM, et al. Stabilization in early adult-onset myopia with corneal refractive therapy. Contact Lens and Anterior Eye. 2016.

22.Ren Q, et al. Orthokeratology in adults and effect on quality of life. Cont Lens Anterior Eye. 2023.

23.Yam JC, et al. Three-Year Clinical Trial of Low-Concentration Atropine for Myopia Progression (LAMP) Study: Continued Versus Washout: Phase 3 Report. Ophthalmology. 2022.

24.Lawrenson JG, et al. Interventions for myopia control in children: a living systematic review and network metaanalysis. Cochrane Database Syst Rev. 2023.

25.Harb EN, et al. Indoor and outdoor human behavior and myopia: an objective and dynamic study. Frontiers in Medicine. 2023

26.Kang P, et al. Effects of multifocal soft contact lenses used to slow myopia progression on quality of vision in young adults. Acta Ophthalmol (Copenh). 2017.

27.Kaymak H, et al. Short-term effects of low-concentration atropine eye drops on pupil size and accommodation in young adult subjects. Graefes Arch Clin Exp Ophthalmol. 2018.

28.Li H, et al. Effect of 0.01% Atropine on Accommodation in Myopic Teenagers. Front Pharmacol. 2022.

To Top