Refractive Errors in Children
How does the eye focus light?
The eye works a lot like a camera. Light enters through the pupil (the dark spot in the colored part of the eye). The cornea (the clear outer layer) and the lens (a round clear part inside the eye) help focus the light. The retina, at the back of the eye, receives the focused light and sends the image to the brain. To see clearly, the light must focus directly on the retina. If it doesn’t, the person may have a refractive error.
There are three main types of refractive
error: myopia, hyperopia and astigmatism [See figures below].
Figure. 1: Myopia
Light focuses in front of the retina because the eye is too long or the lens/cornea focuses too strongly. Far-away objects look blurry. Glasses or contact lenses with minus (-) power help by moving the focus back onto the retina.
Figure. 2: Hyperopia
Light focuses behind the retina because the eye is too short or the lens/cornea doesn’t focus enough. Near and far objects may both look blurry. Plus (+) power lenses help by moving the focus onto the retina.
Figure. 3: Astigmatism
The front of the eye is shaped more like a football than a basketball. Light doesn’t focus at one point, but at different spots, causing vision to look blurry or stretched. Special cylinder-shaped lenses help correct this.
WHAT IS MYOPIA ( NEARSIGHTEDNESS)?
Myopia is when the eye is too long or has too much focusing power. This makes far-away things look blurry, but things up close are clear. It often starts in childhood and gets worse each year until the late teen or early adult years. Glasses with minus power are the most common treatment. Contact lenses may be used if the child is old enough to care for them. In older teens or adults, laser surgery might be an option once the eyes stop growing. There is no approved treatment to stop it from getting worse, but doctors are studying treatments like eye drops (atropine) and encouraging kids to spend more time outdoors.
WHAT IS HYPEROPIA ( FARSIGHTEDNESS)?
Hyperopia means the eye is too short or does not focus light strongly enough. This makes near objects (and sometimes far ones too) look blurry. It is more common in children under 7 years old.
Small amounts of hyperopia are normal and often don’t need treatment. Children can usually focus on their own using their eye muscles. If the hyperopia is high, the child’s eyes are crossed or vision is blurry, they may need plus (+) power glasses.
Hyperopia often gets worse until around age 7–8 and then may improve as the child grows. Contacts or laser surgery may help later, but surgery usually isn’t done until the eye stops growing.
WHAT IS ASTIGMATISM?
Astigmatism happens when the cornea or lens is curved unevenly, like a football instead of a round ball like a basketball. This causes blurry or distorted vision at all distances. It is common in babies and young children and may run in families.
Cylindrical lenses in glasses can correct astigmatism. Some people may also use contact lenses or laser surgery when they are older.
MANAGEMENT OF REFRACTIVE ERRORS
Kids often do not complain about blurry vision, especially if only one eye is affected. Parents may not notice any signs. However, If not treated, refractive errors can cause permanent vision problems in children. This is called amblyopia (lazy eye).
The best way to find a refractive error is with a complete eye exam. During the exam, the doctor will use eye drops to make the pupils bigger. This helps the doctor get an accurate reading of the child’s refractive error. If needed, glasses or contacts will be prescribed.
If you have questions about your child’s eyes or glasses, talk to your eye doctor.
Summary for Patients and Caregivers
The eye needs to focus light directly on the retina to see clearly. If it doesn't, your child may have a refractive error like nearsightedness (myopia), farsightedness (hyperopia), or astigmatism. These are common and can usually be treated with glasses, contact lenses, or later, laser surgery. Children often don’t complain about blurry vision, so regular eye exams are important. If not treated early, vision problems can become permanent. If you notice your child squinting, holding things too close, or struggling to see, talk to an eye doctor for help.
Updated 11/2025
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