Myopia, hyperopia, astigmatism — clear vision at every distance

The eye screening recommended in France includes three key visits: at 9 months (mandatory health check-up), between 2 and 3 years, and between 5 and 6 years (before starting school). Optical correction is needed as soon as the refraction warrants it, to preserve visual acuity and normal visual development.

No. Myopia mainly progresses until about age 22–25. It then stabilizes. High myopia may continue to progress a little longer, particularly in people who spend a lot of time on screens or little time outdoors.

Yes. A myopic child should be examined every year. Myopia control refers to strategies that slow progression: low-dose atropine (0.05% as first-line treatment, LAMP study), orthokeratology lenses worn overnight (which I fit at the practice), defocus spectacle lenses or contact lenses, and ≥ 2 hours of outdoor activity per day. Depending on the concentration and strategy, the reduction in refractive progression ranges from 30 to 70%.

Both correct vision well. Contact lenses offer better optical quality, especially with astigmatism. Glasses are easier to care for and don't require touching the eye. Moderate astigmatism is generally better corrected with toric contact lenses. The choice depends on your lifestyle, your visual needs and your comfort.

After age 20–22, once the refraction is stable. Laser surgery (LASIK, SMILE, PRK) is legally possible after age 18, but I wait for adulthood and stability. Phakic lenses (ICL) can be considered from about age 21. The decision depends mainly on how much your vision bothers you and on your corneal anatomy (thickness, curvature).

Toric contact lenses compensate for two unequal meridians. They have an orientation axis that must remain stable to correct properly. They require a more complex fitting than spherical lenses, but visual acuity is excellent.

Yes, it is possible — this is called late-onset myopia. It usually appears in young adults (students, jobs with heavy near-vision demands) and generally progresses less than childhood myopia. More rarely, myopia acquired after age 40 should prompt a search for an early cataract (which changes the refractive index of the crystalline lens) or a blood sugar imbalance. A consultation helps identify the cause.

Axial myopia is caused by an eye that is too long (axial length greater than 24 mm). It is the most common form, especially in children and teenagers. Refractive myopia is due to excess optical power (a cornea that is too steep, or a crystalline lens that is too converging) in an eye of normal length. The distinction matters: in high axial myopia, the retina is monitored very closely (see the high myopia section above). Optical biometry (measurement of axial length) helps tell them apart.

Regular astigmatism is generally very stable in adulthood, unlike myopia, which can progress. Rapidly changing astigmatism, especially if it differs between the two eyes or comes with image distortion that glasses cannot correct, should raise suspicion of early keratoconus. That is why I routinely perform corneal topography in young adults whose astigmatism is changing, and before any refractive surgery. Eye rubbing can cause or worsen astigmatism.

Yes. Children don't know they see poorly, since they have nothing to compare with. Hyperopia compensated by accommodation can go completely unnoticed. Accommodative strabismus, amblyopia or early myopia can develop silently and compromise visual development. That is why routine screening is recommended at 9 months (mandatory check-up), 2–3 years and 5–6 years, even if the child seems to see well. The eye examination measures refraction objectively under cycloplegia (with accommodation relaxed).