The Myopia Epidemic in Children: Environmental Factors and Current Evidence

The progression of refractive errors during childhood, particularly the increasing prevalence and severity of myopia, has emerged as a major global public health concern. The phenomenon commonly referred to as the “myopia epidemic” has accelerated over recent decades, with especially high prevalence rates reported in East Asian populations. Childhood myopia progression is primarily driven by axial elongation of the eye and is influenced by a complex interaction between genetic predisposition and environmental factors. This narrative review summarizes current evidence on the key mechanisms underlying the increase in spectacle prescription in children. Major contributing factors include genetic susceptibility, reduced time spent outdoors, increased near work activities, seasonal variation, environmental pollution, reduced ocular blood flow, lifestyle-related factors such as physical activity and sleep patterns, and socioeconomic influences. Emerging evidence also suggests potential associations with vitamin D levels, nutritional status, and exposure to second hand smoke, although causal relationships remain incompletely understood. Overall, while genetic factors provide a fundamental basis for myopia development, modifiable environmental and behavioral factors play a decisive role in determining disease progression. Early identification, regular follow-up, and the implementation of evidence based environmental interventions, particularly increased outdoor exposure, remain central strategies for controlling childhood myopia progression.