Since June this year, many media have claimed that the prevalence of myopia in China has surpassed that of Japan and become the first in the world. Myopia, a product of human adaptation to the environment, mild myopia is not only harmless, but sometimes a good thing. However, myopia continues to deepen, not only is it cumbersome to wear glasses, but it can also cause a series of lesions that are difficult to recover from, and even blindness. Therefore, it should be the duty of every ophthalmologist to control the increase of myopia. Usually, doctors always ask myopic eyes to wear glasses to control the increase of myopia. However, many elderly people are actively opposed to seeing their children wearing glasses. Why is there such a big difference between what the doctor says and what the elderly say? It is true that some people’s myopia continues to increase even after wearing glasses, while more people’s myopia increases even without glasses. Why is this? The elderly see only a minority of the phenomenon, while doctors’ claims are for most myopic patients. Many seniors have seen and experienced a lot, and what they see and hear is alarming, even though it is an isolated phenomenon. A child, who has been wearing glasses for only a few years, already has an unacceptable increase in myopia. It is painful in anyone’s case, whether it is the child of a close neighbor or the first grandchild of his own family. Complaints were made about the doctor’s faulty advice, about the teacher’s ruthlessness, and even more about their children’s dereliction of duty, leaving their grandson hanging on to a pair of thick glasses. These things crossed more and more widely in the neighborhood, among family and friends. Naturally, these elderly people would adamantly refuse to let their children wear glasses. But what happens when they don’t wear glasses? The fact is that most children with posterior myopia wear glasses to help control the increase in myopia. The development of myopia can go through a process of change from pseudomyopia to true myopia. Pseudomyopia is like a rubber band that is temporarily stretched and cannot be retracted. Without the rubber band to actively retract conditions, it will remain. Once this state is maintained for a long time, it can no longer return to its original length, and a band that is a little longer than the original is like true myopia. After the appearance of pseudomyopia, there are two ways to make it disappear, one is to use medication, and the other is to look far away. Relaxing the ciliary muscle with atropine-like medication is like having the strip passively relaxed. It can be used, but not often, because you can’t see near after the medication, and you are also afraid of light. Long-term use will not only affect your vision, but may also affect your eye pressure. Active looking away should be the best choice. When a child’s vision is below 1.0, it is possible to get back above 1.0 by just taking him to do more outdoor activities. However, when a child’s vision falls below 0.6, true myopia may be present. At this point, it is impossible to see distant targets clearly. Without a clear viewing environment, they cannot focus at a distance, even if they are allowed to actively look away. With glasses, there is a clear image on the retina to see the distant target clearly, and the myopic state (pseudomyopia) caused by the ciliary muscle spasm can then disappear. Without glasses, this spasm, which is superimposed on the original myopia, will remain, and after 3 months no method will be able to relax it again. This part of the pseudomyopia becomes true myopia again. In fact, the dilated eye examination before wearing the lens is also a treatment. After eliminating the pseudomyopia, you can wear a pair of really useful glasses. We know that true myopia is irreversible, just like it is impossible for a child to shrink back when he grows taller. The developmental pathway of change from pseudophakic to true myopia exists in almost every myopic patient. Therefore, correction with lenses is the most effective way to control the increase in myopia. Because this pathway is well established, almost all optometrists will recommend that children wear a proper pair of glasses as early as possible and have regular checkups. There are still some half-educated “ophthalmologists” who tell students and parents, “Wear them when you need them, but take them off when you don’t.” This is true. This is true, myopic eyes can see more clearly and less effort without glasses. This can be interpreted as “when not in use”. Nearsightedness is not clear when you look at a distance, but when you wear glasses, a clear image is formed on the retina, and it is the time to use it. However, this statement creates a cognitive bias, as many children only think it is useful during class, but not after class. On the contrary, wearing glasses to see far after class is essential to control the development of myopia. Children with recessive exotropia are also advised to wear glasses when looking close to help control exotropia. Since recessive exotropia accounts for a large percentage of the myopic population, glasses need to be worn often and not removed whenever possible. An effective method should work for all myopia. Why do some children’s myopia levels continue to rise even after wearing glasses? And why does it look like they are growing faster than those who do not wear glasses? For many years, doctors have been puzzled by this. This is also a regret that doctors could not convince those elderly people that their children could not wear glasses in time. With the development of science and technology, this has been recognized in recent years. It turns out that there is a special case of occult internal strabismus at work. Most of the recessive internal strabismus is related to heredity; some of it is caused by excessive eye use; it is mostly found in hyperopic eyes, and the original recessive internal strabismus is retained after myopia is formed as we grow older. These recessive internal strabismus is the internal cause of the rapid development of myopia, while prolonged reading and writing near the eyes is the external cause. There is an image analogy: hidden internal strabismus is like a pile of dry firewood under the roof, reading and writing for a long time is like scratching a match and throwing it up, and the fast developing myopia is like a house on fire, after extinguishing it, it cannot be restored to its original state. Pseudomyopia takes 3 months to develop true myopia, but myopia from occult internal strabismus develops overnight into irrecoverable true myopia. This pathway is much faster than the pathway from pseudomyopia to true myopia. What can be done to stop the rapid progression of this type of myopia? Neither can we cure cryptorchia nor keep the child from not reading. There is only one way to do this, and that is to keep these two factors from colliding. When the internal and external factors are separated, this pathway may be stopped. What is the best way to isolate these two factors? Let’s start by looking at how these two factors come together. In general, the younger the child is, the shorter the tolerance time for reading and writing. In the case of junior high school students, for example, children with cryptic strabismus will experience bilateral polarization abnormalities when they spend more than 3 hours a day reading and writing cumulatively. In myopia with hidden internal strabismus, after this abnormality appears, the senses of both eyes will wrongly dominate the eye movements. The more staggered the eye is, the harder it is, and the harder it is, the more staggered it appears. Not only does this deepen myopia, but more frighteningly, it causes transient high intraocular pressure. The long-term impact of high intraocular pressure deepens the cup-shaped depression of the optic papilla and may damage the visual field. So, it is possible to isolate these two factors by addressing the time spent looking close? Since the problem may not occur until 3 hours later, let your child look less close. This is certainly good, but middle school students are never likely to spend less than 3 hours a day near eye use. There is another way to do this, and that is to reduce accommodation. When using the eyes in the near area, the chance of having a convergence and divergence abnormality is related to the amount of accommodation in addition to the time spent in the near area. Adjustment can be reduced with a pair of distance vision lenses (ortho-phthalmoscope). This method has been proven to be effective for myopia with occult internal obliquity. Students who have been using progressive multifocal lenses for more than 10 years have been able to use this method to look closer at any time with a pair of near optics with an additional +1.50 Ds. However, this method has had many problems exposed after years of use. For example, irregular astigmatism increased, best corrected visual acuity decreased, the child’s stereopsis function was affected, etc. These defects arise for one reason only, that is, the inability to remove that optical zone for seeing near when looking far. To avoid these problems, we designed a reading add-on lens, which adds another half pair of glasses to the glasses when looking near, only when using the eyes near, and takes them off normally. As shown in the figure: On the additional half of the near-use glasses, in addition to the ortho-phthalmoscope, there is a bottom-facing trigeminal lens to address the promotion of increased myopia by the downward turning of the eye. Of course, the development of myopia is much more than these two pathways; there are also irregular astigmatism, peripheral defocus, regulatory disorders, refractive interstitial clouding, form deprivation, and genetic, environmental, lighting, nutritional, and social factors, among others. Each of these causes may be a different pathway. There is a chance to control the progression of myopia if the main problem can be found. A little work on glasses can yield good results, mainly thanks to the breakdown of myopia. I believe that as people’s understanding of myopia deepens, different measures are taken for different conditions, and different glasses are worn for different conditions, myopia can definitely be controlled.