Myopia Progression


First Glasses to Adulthood: Myopia Progression                                         

February 16, 2021

By Dwight Akerman, OD, MBA, FAAO

Researchers from the Erasmus Medical Center Department of Ophthalmology in Rotterdam sought to examine myopia progression in Europeans as a function of age and degree of myopia from the first prescription to the final refractive error. The Drentse Refractive Error and Myopia (DREAM) retrospective study evaluated myopia progression in 2,555  children who received glasses during childhood or teenage years and were followed until age 25. The spherical equivalent refraction (SER) at adult age ranged from -0.50 D to -12.75 D, with a median of -3.00 D.

Of those who developed high myopia, 60 percent had their first pair of glasses before age 10. Children who developed -3.00 D or worse in the first decade all developed high myopia. High myopes at adult age had been faster progressors during their entire youth. Those with lower refractive errors virtually ceased progression after age 15 years.

The trajectories of the natural course of myopia progression can guide the management of myopia in children. Spherical equivalent of refraction at 10 years is a significant prognostic indicator and can help inform treatment choices and intensity in myopia management programs.


Jan Roelof Polling, Caroline Klaver, Jan Willem Tideman

Purpose: Data on myopia progression during its entire course are scarce. The aim of this study is to investigate myopia progression in Europeans as a function of age and degree of myopia from first prescription to final refractive error.

Methods: The Drentse Refractive Error and Myopia Study assessed data from a branch of opticians in the Netherlands from 1985 onward in a retrospective study. First pair of glasses prescribed was defined as a spherical equivalent of refraction (SER) ≤-0.5 D to ≥-3.0 D. Subjects with prescriptions at an interval of at least one year were included in the analysis.

Results: A total of 2,555 persons (57.3 percent female) met the inclusion criteria. Those with first prescription before the age of 10 years showed the strongest progression (-0.50 D; IQR: -0.75 to -0.19) and a significantly (p<0.001) more negative median final SER (-4.48 D; IQR: -5.37 to -3.42). All children who developed SER ≤-3 D at 10 years were highly myopic (SER ≤−6D) as adults, children who had SER between -1.5 D and -3 D at 10 years had 46.0 percent risk of high myopia, and children with SER between -0.5 D and -1.5 D had 32.6 percent risk of high myopia. Myopia progression diminished with age; all refractive categories stabilized after age 15 years except for SER ≤-5 D who progressed up to -0.25 D annually until age 21 years.

Conclusion: Our trajectories of the natural course of myopia progression may serve as a guide for myopia management in children. SER at 10 years is an important prognostic indicator and will help determine treatment intensity.

Polling, J. R., Klaver, C., & Tideman, J. W. (2021). Myopia progression from wearing first glasses to adult age: the DREAM Study. British Journal of Ophthalmology.

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