Myopia is an escalating global health crisis

Myopia has rapidly become one of the most pressing public health challenges of the 21st century. Once considered a benign refractive error easily corrected with glasses or contact lenses, it is now recognized as a progressive, potentially sight-threatening disease. In developing countries, myopia is a leading cause of preventable blindness.¹ Beyond impairing distance vision, myopia significantly increases the risk of severe ocular comorbidities and contributes to a growing global socioeconomic burden. With prevalence rates rising rapidly among children and adolescents, particularly in urbanized and developed regions, projections estimate that by 2050, nearly half of the world’s population will be myopic.^2,3

Rising prevalence and future projections

The global prevalence of myopia has surged from 22.9% in 2000 to an estimated 34% in 2020 and is expected to reach 50% by 2050, affecting nearly 5 billion people.^2,4 High myopia (≤ −6.00 diopters [D]), which carries a heightened risk of pathological complications, is projected to affect almost 10% of the global population by 2050.⁵

Recent meta-analyses indicate that among children and adolescents, the prevalence of myopia increased from 24.3% in 1990 to 35.8% in 2023 and is forecasted to exceed 39% by 2050.³ The highest rates of myopia are currently seen in East Asia and urban areas.³

Associated comorbidities and risks

The progression of myopia, particularly to high levels, is associated with irreversible vision-threatening conditions, which include the following:

Myopic maculopathy: This is the leading cause of blindness in individuals with myopia, characterized by progressive retinal atrophy and significant loss in best corrected vision.^6-8 Even children are affected; in a study of 274 children and adolescents (ages 7 to 17) with high myopia (≤ –6.00 D), 12.2% developed myopic maculopathy over 4 years.⁹

Retinal detachment: Myopic eyes are structurally elongated, predisposing them to retinal holes, lattice degeneration, vitreoretinal traction, and detachment.^10,11

Glaucoma and early-onset cataracts: Structural changes in highly myopic eyes increase susceptibility to these conditions.^12-14 The risk of glaucoma increases by about 20% for every increase of 1 D in myopia, with a disproportionately greater risk observed in individuals with high myopia.¹⁵

Recent analyses have shown that there is no safe level of myopia.⁶ Even low to moderate myopia significantly increases lifetime risk. Each additional diopter of myopia increases the risk of myopic maculopathy by 67%, whereas slowing progression by just 1.00 D could reduce the risk by 40%.⁶ This relationship holds across all degrees of myopia, emphasizing that even seemingly mild cases carry substantial lifelong risk.

Drivers of the myopia epidemic

Although genetic predisposition plays a significant role in myopia development, particularly among children with at least 1 parent with the condition, the recent, dramatic global surge in prevalence cannot be attributed to genetics alone. The rate of increase is too rapid to be explained by hereditary shifts, implicating environmental factors as the primary drivers of this epidemic. Large-scale studies confirm that while heritability contributes substantially to risk, environmental exposures, such as near work and reduced outdoor time, are critical modulators of myopia onset and progression.^16-19

Urbanization has emerged as a major contributor, with children living in urban areas consistently demonstrating higher myopia rates than those residing in rural environments. This disparity is likely due to differences in lifestyle, including less time spent outdoors and greater engagement in near tasks such as reading and screen use.^7,20 Reduced time outdoors is a well-established risk factor for myopia progression in children and adolescents.^21-24 Exposure to natural light is believed to stimulate retinal dopamine release, a key factor in inhibiting axial elongation, thereby offering a protective effect against myopia.²⁵

Conversely, increased near work and screen time have been associated with higher risks of both myopia onset and progression.^{7,17,18,26,27} The COVID-19 pandemic exacerbated these environmental risks by shifting children’s activities indoors and dramatically increasing screen-based learning and entertainment. Studies during lockdowns revealed a marked rise in myopia incidence, especially among children aged 6 to 8 years.^3,28 One large-scale Chinese study reported a mean myopic shift of up to –0.30 D within just a few months of confinement—an acceleration unprecedented in previous years.²⁸

Early-onset myopia, particularly before the age of 10, is strongly associated with faster rates of progression and a markedly increased lifetime risk of developing high myopia and its associated sight-threatening complications. ^29-32 Younger children experience more rapid axial elongation and faster spherical equivalent changes compared with those with later onset, making early identification and timely intervention critical to mitigate future risks. Evidence indicates that children with earlier myopia onset not only have faster annual progression rates—often exceeding −0.75 D per year—but are also more likely to experience sustained, rapid progression over subsequent years if left untreated.^29-32

Economic and quality-of-life burden

The global economic burden of myopia is substantial. In 2015, the potential productivity loss from uncorrected myopia was estimated at $244 billion, with an additional $6 billion attributable to myopic macular degeneration.³³ Direct costs include refractive correction, clinical management of complications, and surgical interventions. Indirect costs include reduced work productivity, poorer school performance, and diminished quality of life (QOL).

Importantly, individuals with myopia experience significantly lower vision-related QOL compared with emmetropes, even after optical correction. Myopia adversely affects both visual functioning and socioemotional well-being, with even very low degrees of myopia associated with substantial declines in QOL.³⁴ Studies have shown that high myopia impairs QOL to an extent comparable with keratoconus, an ocular condition traditionally associated with significant disability.³⁵ Factors such as dependency on optical correction, limitations in recreational activities, reduced self-esteem, and financial burden related to ongoing care contribute to this diminished QOL.

Conclusion

The rise in myopia is not only a crisis of visual acuity but also a looming epidemic of vision impairment and blindness. It is imperative that clinicians, educators, policymakers, and parents act collaboratively to implement evidence-based strategies to address this growing burden.
Focusing efforts on delaying the onset and slowing the progression of myopia, particularly during childhood, has the potential to significantly reduce future ocular morbidity and socioeconomic costs. Immediate action is essential to protect the visual health and QOL of future generations.

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