Myopia is a refractive error in which the eye focusing light in front of the retina, causing distant objects to appear blurry. The global prevalence of myopia is rapidly increasing, particularly among children and adolescents in East Asia. In Taiwan, >50% of teenagers reportedly have myopia [1]. Data from the 2008–2012 Korea National Health and Nutrition Examination Surveys revealed a pediatric myopia prevalence of 64.6%, including 5.4% with high myopia [2]. This rising trend represents a major public health concern that will affect an estimated 49.8% of the global population by 2050 [3]. High myopia, defined as a refractive error greater than -6.0 diopters, markedly increases the risk of severe, vision-threatening complications such as retinal detachment, myopic maculopathy, and glaucoma that can cause irreversible vision loss. Thus, myopia is not a simple visual impairment but rather a condition with potential long-term consequences for visual health and quality of life that demands urgent and proactive management.
The primary pathogenesis of high myopia typically involves excessive elongation of the eyeball's axial length. Therefore, childhood axial-length interventions are essential to preventing its development. Several therapeutic strategies for managing pediatric myopia are currently used in ophthalmological practice. Optical interventions such as defocus-incorporated multisegment spectacle lenses and orthokeratology can control axial-length elongation and subsequent myopia progression [4]. More recent pharmacological treatments, particularly low-dose atropine eye drops, are safe and effective [5]. However, these optical and pharmacological approaches carry complications such as corneal ulcer or systemic side effects such as fever.
Behavioral interventions, including increased outdoor activities and reduced near-focus work and digital device use, are equally important because of their noninvasive and practical nature. Notably, a national policy in Taiwan that promoted 120 minutes/day of outdoor activity significantly reversed the rising trend of reduced visual acuity among primary-school children [6]. This result suggests that increasing daily outdoor time is a highly effective and scalable public health strategy for preventing myopia onset in early childhood.
The management of pediatric myopia requires a broader understanding of its multifactorial etiology. The review by Chung [7] in a recent issue of Clinical and Experimental Pediatrics highlights the multifaceted nature of pediatric myopia, emphasizing the critical interplay between genetic, environmental, and systemic factors in its development and progression. This comprehensive review emphasized that myopia is not merely an ophthalmologic disorder but significantly affected by nonophthalmological factors such as body stature, sleep patterns, and nutritional status (Fig. 1).
That review highlighted the critical role of systemic health conditions, notably obesity and nutrition, in myopia development. The correlation between a taller body stature/obesity and axial-length elongation suggests that general pediatric healthcare approaches, including routine monitoring of a child's growth and nutrition, can play a pivotal role in identifying children at risk of developing myopia [8]. Thus, pediatricians also play a vital role in a holistic approach to myopia prevention.
Understanding the association between sleep patterns and myopia is also essential. Substantial evidence indicates that short sleep duration and irregular sleep are correlated with a higher risk of myopia progression [9]. These findings support the hypothesis that circadian rhythm disturbances are involved in ocular growth regulation. Therefore, encouraging healthy sleep hygiene practices, such as consistent bedtimes and sufficient sleep, should be integrated into comprehensive prevention strategies. Similarly, a child's nutritional status plays a significant role: diets high in sodium and carbohydrates but lacking essential nutrients such as omega-3 fatty acids and vitamins may increase the risk of myopia, while balanced diets rich in fruits and nutrient-dense foods appear protective [10]. These insights underline the importance of physicians actively discussing dietary and lifestyle habits, including sleep, with patients and their families.
An especially important point addressed in this review is the importance of early detection and intervention at the premyopia stage. Once the eyeball's axial length increases, it cannot be shortened. Refractive surgeries such as laser-assisted in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) do not alter axial length; thus, post-LASIK/LASEK patients still carry a higher risk of the ocular complications associated with high myopia. Therefore, regular visual acuity screenings in schools and primary care settings can serve as an early warning system. Specifically, any reduction in the uncorrected distance visual acuity should prompt an immediate ophthalmology referral, which can significantly reduce the risk of high myopia and its associated complications and offer children the opportunity to maintain optimal lifelong visual health.
Several actionable strategies can be incorporated into routine pediatric clinical practice to prevent myopia onset and progression. These include counseling children and their families to increase outdoor activity to at least 2 hours/day and limit excessive near-focus work and digital device use, particularly at distances closer than 30 cm. Pediatricians should encourage healthy sleep patterns and provide balanced dietary guidance. Regular assessments of the child's visual acuity can detect problems early. If any decrease in visual acuity is detected in patients with a family history of high myopia, a prompt ophthalmology referral is warranted. These practical measures place pediatricians at the forefront of multidisciplinary efforts to mitigate the increasing burden of pediatric myopia.
In conclusion, the increasing prevalence and severity of pediatric myopia require a multifaceted proactive approach. Regular visual screening and prompt ophthalmology referrals are essential to detecting early issues. Combined with comprehensive lifestyle guidance and systemic health management, these strategies provide a robust framework for preventing and mitigating the long-term consequences of myopia.
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