Identifying and Managing Pre-Myopia: A Narrative Review

Proactive management of children at risk of developing myopia (pre-myopia) can be more impactful than treatment after onset. The aim of this narrative review is to identify risk factors associated with pre-myopia, explore predictors of myopia development in pre-myopic children, and discuss effective prevention strategies.

A comprehensive search was conducted in several databases and clinical trial registries, using keywords related to pre-myopia prevention and control.

266 studies were included. Risk factors associated with pre-myopia development include parental myopia, female gender and insufficient outdoor time. Near work and screen time have a modest link to myopia development, and the role of physical activity remains unclear. Predictive models can categorize children as low, moderate, or high risk of developing myopia. Lifestyle changes, such as increasing outdoor time and limiting near work may be sufficient to stave off myopia onset. Low-dose atropine or myopia control spectacles may be the most effective options for clinicians considering active intervention. Although effective for myopia prevention, repeated low-level red light should be used cautiously in children until its safety profile is better understood.

Effective myopia prevention involves managing the hyperopic reserve alongside axial elongation. Behavioural, pharmacological and optical treatments can be effective for preventing myopia, though more evidence is needed before it changes standard practice for pre-myopia management.