When a child starts squinting at the blackboard, holds books unusually close when reading or watches TV from very near, this may signal the onset of myopia. A visit to an eye doctor follows, resulting in a prescription and a pair of glasses.
For many parents, this seems to settle the matter. But the reality is often more complex.
The prevalence of myopia among Chinese students has been quite high, but in recent years China has made steady progress in addressing this problem.
The overall myopia rate declined from 53.6 percent in 2018 to 49.9 percent in 2025, marking five consecutive years of decline.
The progress is encouraging, but a lower prevalence rate should not lead to complacency. Myopia is a visible problem, but its underlying causes are often misunderstood. We notice the blurred vision, but do not see the gradual changes taking place inside the eye.
Children's eyes keep developing, and how this development unfolds matters. Genetics play a role, but so do daily habits and the surrounding environment: the amount of time spent outdoors, the duration of close-up work, and the use of screens. As the eye gradually elongates, a child may not notice any symptom till the vision has blurred significantly.
That is why I believe preventing myopia effectively begins before the first pair of glasses. The strategies are quite straightforward: more outdoor activities, less continuous close-up work, improved lighting and better reading habits.
Regular eye examinations should check how vision changes over time rather than simply record whether a child can read the bottom line of an eye chart. These interventions are not dramatic, which is why their impact is often underestimated.
The responsibility for myopia does not lie with children. They do not control their homework load, classroom lighting or the time spent indoors. They also do not set the rules for smartphone use. Parents, schools and healthcare providers must share this responsibility.
China's recent progress underscores this collaborative approach.
The improvement did not result from a single breakthrough, but from treating myopia as a public-health issue and integrating prevention into daily life — within schools, homes and routine healthcare.
This also means changing the way doctors look at a child's eyes. Visual acuity is only one aspect of eye health. For children with rapidly changing vision, doctors need to track refractive development and measurements such as axial length.
A child who can see reasonably well may be moving steadily toward myopia. Identifying that trend early allows families to take proactive steps.
Once myopia develops, the goal shifts from prevention to slowing its progression. Depending on the child, treatments may include low-dose atropine, orthokeratology or specially designed spectacle lenses. None of these are a universal solution; factors like age, refractive error, progression rate and the child's ability to follow the treatment plan are all important. Regular follow-up matters just as much.
At Tianjin University Aier Eye Hospital, myopia management is viewed as a long process. Risks are assessed, changes are tracked and treatment is adjusted when needed. The aim is not to overwhelm families with a long list of possible interventions but to help them make informed decisions at the right time.
This approach may sound less impressive than a new device or a new drug, but it is often more effective. Parents must also change their perspective toward myopia. The question is not simply how good a child's vision is today, but how it changes over time. A stable condition and a rapidly increasing myopia are two very different situations.
This is why the decline in the prevalence of myopia should be treated as an encouraging checkpoint, but not as a conclusion.
Future success should be measured by whether children develop myopia later, whether progression slows, whether fewer children suffer from high myopia, and whether families are able to get reliable eye-health services early. These questions take us beyond the clinic.
Improvements in public health rarely happen because of one spectacular intervention. They result from consistent measures taken over a long time.
A child spending more afternoons outdoors, a school making room for that, a parent noticing a change early, and a doctor following up instead of simply handing over a prescription.
These steps don't offer instant results, but they do something better: provide an opportunity to change the course of a child's visual development before the stakes become higher.
As myopia rates among children rise across the world, China's experience shows that prevention works best when it becomes part of daily life, rather than something families resort to after a child cannot see the blackboard. The goal is not to promise every child a life without glasses, but to delay the onset of myopia, slow down its progression and prevent the more serious consequences of high myopia.
Ultimately, the decline in the number of myopia cases does not mean that the battle is over, but that persistent efforts are paying off.
The author is the vice-president of Tianjin University Aier Eye Hospital.
The views don't necessarily reflect those of China Daily.
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