The global prevalence of myopia has surged, and is expected to affect nearly 5 billion people by 2050

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 recognised 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 urbanised 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 D), which carries a heightened risk of pathological complications, is projected to afflict 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 individuals residing in East Asia and urban areas.3

Associated comorbidities and risks

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

Myopic maculopathy: The leading cause of blindness in myopic individuals, characterised 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 7-17) 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 1-D increase 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%, while slowing progression by just 1 D could reduce the risk by 40%.6 This relationship holds across all degrees of myopia, emphasising that even seemingly mild cases carry substantial lifelong risk.

Drivers of the myopia epidemic

While genetic predisposition plays a significant role in myopia development, particularly among children with one or two myopic parents, 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

Urbanisation 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 than 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/y—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 €216 billion ($244 billion), with an additional €5.32 billion ($6 billion) attributable to myopic macular degeneration.33 Direct costs include refractive correction, clinical management and surgical interventions. Indirect costs include reduced work productivity, school performance and diminished quality of life.

Importantly, individuals with myopia experience significantly lower vision-related quality of life (QOL) than those with emmetropia, 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 to 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 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.

By focusing efforts on delaying the onset and slowing the progression of myopia, particularly during childhood, there is potential to significantly reduce future ocular morbidity and socioeconomic costs. Immediate action is essential to protect the visual health and QOL of future generations.

Gregory Ostrow, MD

Ostrow is the director of paediatric ophthalmology at Scripps Clinic and the founder of Sydnexis, a biotechnology company focused on paediatric myopia. He holds multiple patents related to paediatric myopia and ophthalmic formulations, and he regularly lectures and presents on myopia management at national and international conferences. Dr Ostrow also serves as head of corporate relations for the American Association for Pediatric Ophthalmology and Strabismus, where he supports industry collaboration and advances in paediatric ophthalmology.

Laura Kirkeby, CO

Kirkeby is a certified orthoptist and clinical researcher at Scripps Clinic in San Diego. She has published and presented extensively in ophthalmology and currently serves as a consultant for Sydnexis on their phase 3 clinical trial evaluating low-dose atropine for myopia.

Kirkeby has held executive leadership roles in orthoptic organisations across the US and Canada.

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