Clinical Article Synopsis

In this article, Annegret Dahlmann-Noor explains how our perception of myopia is changing from a mere inconvenience to a sight-threatening condition, with earlier onset and faster progression. Compelling figures are presented on the prevalence of myopia across Europe and Asia, and it is predicted that 50% of the global population will be myopic by 2050,1 with an associated rise in the number of people suffering permanent loss of vision due to myopia-related pathology.2

One impact of myopia not often discussed in clinical articles is the financial burden, and this report tells us that in 2018, worldwide costs associated with myopia exceeded 670 billion USD and were estimated to rise to levels beyond those of heart failure and lung or breast cancer.3

Annegret then shares some fascinating statistics around the relationship between outdoor time, electronic devices and myopia onset, posing this question: If at population level myopia is largely caused by environmental factors, can it be prevented in the individual child? The two parts to this problem are identifying those at risk and taking preventative action. Factors which help to identify potential myopes include parental myopia and a greater axial length and lower refractive error than other children the same age,4,5 but these are not assessed in current vision screening programmes. 

Once a child is identified as being at risk of myopia, the only evidence based preventative strategy we have to delay onset is increased outdoor time,6 and as Annegret says, it may be some time until the ethical question of whether an intervention which can potentially cause problems (blurred near vision, light sensitivity from pharmaceutical interventions and the rare but serious complication of keratitis from contact lens wear) is justified in children who do not yet have the target condition.

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Dr Annegret Dahlmann-Noor

Article author information:

Dr Annegret Dahlmann-Noor is a consultant in the Children’s Service at Moorfields Eye Hospital in London and also the Clinical Trials Lead for Paediatric Ophthalmology as well as Honorary Clinical Associate Professor at University College London. Her clinical practice includes children’s eye conditions and eye movement disorders in children and adults. Her research interest focusses on common eye conditions in children, such as myopia, amblyopia and allergic eye disease.


  1. Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology 2016;123:1036–42. doi:10.1016/j.ophtha.2016.01.006
  2. Tideman JWL, Snabel MCC, Tedja MS, et al. Association of axial length with risk of uncorrectable visual impairment for europeans with myopia. JAMA Ophthalmology 2016;134:1355–63. doi:10.1001/jamaophthalmol.2016.4009
  3. Predicting Costs and Disability from the Myopia Epidemic – A Worldwide Economic and Social Model.|IOVS|ARVOJournals. 2744765 (accessed 28 Nov 2020).
  4. Sheppard AL, Wolffsohn JS. Digital eye strain: Prevalence, measurement and amelioration. BMJ Open Ophthalmology. 2018;3. doi:10.1136/bmjophth-2018-000146
  5. Anshel JR. Visual ergonomics in the workplace. AAOHN journal : offi cial journal of the American Association of Occupational Health Nurses. 2007;55:414–20.doi:10.1177/ 216507990705501004
  6. Wu PC, Chen CT, Lin KK, et al. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Ophthalmology 2018;125:1239–50. doi:10.1016/j.ophtha.2017.12.011
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