Pseudomyopia is not myopia in refractive terms, and its naming is controversial. A subset of children and adolescents present with a myopic state in which the distance vision is low and the near vision is normal, and the distance vision can be corrected with a concave lens. Refractive examination after paralysis of the ciliary muscle with atropine may be performed in the following three cases: (1) Pseudomyopia: normalization of distance visual acuity and disappearance of myopic state after using atropine, and ortho- or hyperopia after examination of the shadow. (2) True myopia: no significant change in myopic refractive power after using atropine. (3) Mixed myopia: After using atropine, the myopic refractive power is obviously reduced, but it is not considered as orthokeratology. The causes of the three cases are different, and the treatment methods are different. Pseudomyopia is functional and is caused by a spasm of accommodation with a normal eye axis. It is most often seen in children and adolescents who are younger, have a shorter time to develop, and have a lower refractive error. Pseudomyopia should not wear myopic glasses and can be restored to normal with rest and proper treatment. True myopia is organic, determined by the elongation of the eye axis, corneal curvature, etc., and is not significantly related to regulation. It is most often seen in older adolescents who have been around longer and have a higher refractive error. True myopia should be corrected by wearing myopic lenses to correct distance vision. Mixed myopia is true myopia with a pseudomyopia component, both organic changes and functional factors, and can be partially improved by treatment, but requires glasses to correct distance vision. Careful identification of these three conditions has practical implications for myopia prevention and treatment.