Myopia, or near-sightedness, is a refractive error in which the eyeball grows too long relative to the focusing power of its optical system. When the axial length of the eye exceeds the distance at which the cornea and lens can bring light to a focus, distant images land in front of the retina instead of directly on it, blurring far vision while near vision remains sharp. The condition typically emerges in childhood, progresses through adolescence and often stabilises in early adulthood. Spectacles and contact lenses can correct the blurred vision, but they do nothing to reverse the underlying structural elongation of the eye, which is the true source of long-term risk.

That structural change matters because a longer eye is a more fragile eye. Excessive axial elongation stretches the retina and its supporting tissues, sharply raising the lifetime risk of cataract, open-angle glaucoma, myopic macular degeneration and retinal detachment. Each of these complications can cause irreversible vision loss, and their management places a heavy load on patients and health systems alike. Globally, the burden of vision impairment from uncorrected myopia was estimated at US$244 billion in 2015, a figure expected to climb as prevalence rises. Projections cited in the study suggest that 1.4 billion people were myopic in 2000 and that 4.8 billion, more than half of humanity, could be by 2050.

The new analysis was designed to fill a conspicuous gap. Most large-scale myopia epidemiology has focused on Asian populations, where prevalence in some urban settings reaches 80 to 90 percent among young adults. European data existed but were fragmented: earlier population-based studies reported prevalence ranging from 27 percent in the United Kingdom to 39 percent in France, and a recent meta-analysis of 14 European countries found estimates varying from 11.9 percent in Finland to 49.7 percent in Sweden. To cut through this heterogeneity, the E3 Consortium researchers used individual participant data rather than published summary statistics, harmonising refraction measurements across 28 studies collected between 1990 and 2024.

Methodologically, the team defined myopia as a spherical equivalent of refraction of -0.50 dioptres or worse, following International Myopia Institute criteria, and subdivided cases into low, moderate and high myopia. Participants born between 1900 and 2000 were grouped into birth decades, and pooled prevalence estimates for each decade were derived using random-effects meta-analysis with inverse variance weighting and restricted maximum likelihood estimation. People with artificial lenses or a history of refractive surgery were excluded, as were those with retinal detachment from the axial length analysis, since surgery can alter eye dimensions. Strata with fewer than 50 observations were dropped to keep estimates robust.

The headline result is stark: myopia prevalence more than tripled across twentieth-century birth cohorts, with the steepest acceleration occurring from the 1950s onward. Low myopia climbed from 12.5 percent in the 1900s cohort to 35.0 percent in the 1980s cohort, moderate myopia from 3.3 percent to 11.4 percent, and high myopia from 2.2 percent to 3.9 percent. When the decade-specific estimates were weighted according to the actual age structure of the European population, the standardised prevalence for 2024 came out at 42.7 percent, well above the consortium’s earlier estimate of 30.6 percent and approaching the widely cited global projection of 50 percent by mid-century.

Perhaps the study’s most important technical contribution is its demonstration that the generational rise is written into the physical dimensions of the eye itself. Analysing axial length data from 56,876 participants, the researchers found that every percentile of the distribution, from the 5th to the 95th, shifted longer across birth cohorts from the 1920s to the 1970s. Between the 1920s and 1970s cohorts, mean axial length increased by 0.49 millimetres at the 5th percentile and 1.05 millimetres at the 95th percentile in men, and by 0.37 and 0.67 millimetres respectively in women. This population-wide shift indicates not merely that more people cross the myopia threshold, but that eyes in general are getting bigger, including among people who would otherwise be long-sighted or only mildly myopic.

Some of that elongation could reflect simple growth: axial length correlates with body height, adding roughly 0.03 millimetres per centimetre of stature, and Europeans gained about one centimetre of height per decade over the last century. But that accounts for only 0.03 millimetres of axial growth per decade, whereas the observed increase at the median was 0.07 millimetres. The remainder points to environmental drivers, chief among them the modern lifestyle of prolonged near work, reading and screen use combined with limited time outdoors, patterns amplified by extended years in education. Intriguingly, the sex pattern also shifted: men born in the early twentieth century were slightly more myopic than women, but the trend reversed after the 1950s, a crossover the authors link to rising female participation in higher education and its associated near-work demands.

The authors are careful about the limits of their data. Between-study heterogeneity was substantial, with the I-squared statistic often exceeding 90 percent, meaning pooled figures should be read as averages across diverse settings rather than a single number applicable everywhere. Non-cycloplegic refraction can slightly overestimate myopia through residual accommodation, though recent work suggests the effect, around 0.31 dioptres in young adults, is unlikely to have changed classification across the broad severity categories. And because cohorts born after 2000 were excluded, the youngest generations, whose eyes may not yet have finished elongating, remain outside the analysis; an apparent dip in axial length in the most recent cohorts likely reflects incomplete growth rather than a genuine reversal.

Even with those caveats, the trajectory is unmistakable and the implications are serious. If prevalence continues to climb, Europe faces not only more spectacle prescriptions but a growing reservoir of high myopia and its attendant complications, threatening irreversible vision loss in working-age adults and straining ophthalmic services. The study’s authors argue that the evidence now justifies preventive strategies targeting modifiable environmental risk factors, particularly increasing time spent outdoors and reducing prolonged near work in children, alongside continued evaluation of clinical interventions designed to slow myopia progression. What was once an inconvenience corrected by a pair of glasses is, on current trends, becoming one of the century’s most consequential chronic eye diseases, and the generations now in school will determine just how heavy that burden becomes.

Subject of Research: Temporal trends in myopia prevalence and axial length across European birth cohorts

Article Title: The growing burden of myopia in Europe: evidence from population-based cohorts

Article References: Tiemens, A., van Hemert, D. J., Lemma, S. T., Quist, S. W., Shi – van Wielink, K., Agius, D., Arnould, L., Berendschot, T. T. J. M., Beuse, A., Bikbov, M. M., Birtel, J., Bountziouka, V., Breteler, M. M. B., Carbonaro, F., Chakravarthy, U., Coimbra, R., de Vries, V. A., Delcourt, C., Farinha, C., … Lotery, A. J. (2026). The growing burden of myopia in Europe: evidence from population-based cohorts. European Journal of Epidemiology. https://doi.org/10.1007/s10654-026-01435-w

Image Credits: AI Generated

DOI: 10.1007/s10654-026-01435-w

Keywords: myopia, axial length, refractive error, epidemiology, birth cohorts, E3 Consortium, Europe, public health, high myopia, vision impairment, meta-analysis, eye health