5-year-old has poor vision. Will eye exercises suffice or does he need glasses?

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I do not know whether you have got his cycloplegic refraction or not. Is this just auto refractometer finding or final refractive power? Anyways, I will suggest you get a repeat cycloplegic refraction done at a good center by an optometrist who is experienced. Secondly, this refractive power is significant enough to cause symptoms. Your son may be able to correct it because of high accommodation at this age but this is not good. He may develop squint or many more other problems if not treated. So get his refraction done as soon as possible and use appropriate glasses.

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As written in your prescription (attachment removed to protect patient identity), cycloplegic refraction has already been done. But his diagnosis after going through this shows he may be at risk of developing keratoconus. Start using glasses asap. Treat any allergies in eyes simultaneously. Avoid rubbing eyes. You will have to keep him on follow up for any progression as it is a progressive disease. Additional interventions may be required later if it progresses. At present, glasses are a must. Get his topography done as well which will be of help in monitoring any progression.