Over the past decade, myopia has shifted from a common childhood inconvenience to what global health leaders now call a “public health emergency in slow motion” [1]. According to Professor Serge Resnikoff, former Head of Eye Health at the World Health Organization (WHO) and current Chair of the International Myopia Institute (IMI), “we are living in a turning point.”
Professor Serge Resnikoff.
In East and Southeast Asia, countries like China, Singapore, Japan and South Korea are already seeing complications of myopia as the leading cause of visual impairment, outpacing cataract and diabetic retinopathy [1]. Meanwhile, across Europe, Latin America and South Asia, the prevalence of childhood myopia is rising fast, especially in urban areas. “It’s not a question of if, but when,” Resnikoff warns, “and the real issue is: will we act in time?”
Myopia is coming earlier, and faster
The myopia story is no longer confined to high-income East Asia. Children are becoming myopic younger than ever before, and the condition is progressing more rapidly [1]. “Even in places with traditionally low prevalence, we’re now seeing clear trends: younger onset, earlier progression and an urban-rural divide,” Resnikoff explained. “We used to see school myopia emerge around age 10. Now, in many places, it’s appearing years earlier.”
Several interrelated factors are likely at play: increased educational pressure, long hours spent indoors and reduced exposure to natural light. Seasonal studies show faster progression during winter months, when outdoor time is limited. The role of digital screens remains controversial – Resnikoff is cautious to assign them primary blame but concedes they likely exacerbate other risk factors [2].
Reframing myopia: not just a refractive error
One of the strongest messages from Resnikoff is the need to redefine myopia as more than an optical inconvenience. “Myopia is both an optical error and a disease of the eye – we must treat it as such.”
High myopia (≥-5.00D) dramatically increases the risk of sight-threatening complications including retinal detachment, myopic macular degeneration, cataract and glaucoma [3]. Yet the public, and many healthcare professionals, continue to view it as a benign condition fixed with glasses. “This misconception,” Resnikoff argues, “is dangerously outdated.”
The 2025 International Myopia Summit (which Resnikoff co-led) reached consensus on three critical shifts:
- Define myopia as a disease with distinct stages and risk levels.
- Prevent progression to high myopia through early intervention.
- Treat complications of pathological myopia as a public health priority [4].
Evidence-based interventions: what works
There’s good news: we don’t have to wait for more research before acting. “Evidence is already sufficient to act – we shouldn’t wait for perfect data and miss opportunities for today’s children.”
Population-wide
Outdoor time (~2 hours/day) is one of the most effective, scalable interventions. Ideally split across the day, time spent outside helps delay myopia onset and slow progression in children. A 2012 meta-analysis by Sherwin, et al. found that each additional hour spent outdoors per day reduced the odds of developing myopia by 13% (odds ratio=0.87, 95% confidence internal 0.85–0.90) [5]. Similarly, Xiong, et al. showed a significant refractive shift of -0.30D over three years [6], and Mei, et al. reported a relative risk of 0.84 for incident myopia with outdoor interventions [7].
Individualised
Four strategies have strong evidence for slowing myopia progression in children:
- Specially designed spectacle lenses
- Myopia control contact lenses
- Orthokeratology (overnight corneal reshaping)
- Low-dose atropine eye drops [8].
Barriers to implementation
Despite growing awareness, Resnikoff mentioned that “parents, GPs and paediatricians need clearer awareness that childhood myopia carries long‑term risks,” highlighting key challenges:
- Limited practitioner training in myopia control
- Product availability (especially in rural or underserved areas)
- Affordability
- Low-risk awareness among parents and even primary care professionals [1].
Organisations like the IMI are stepping in to provide practitioner-friendly resources, infographics and white papers to bridge the knowledge gap.
Clinic checklist
For clinicians managing myopic children:
- Recommend 2+ hours of outdoor time daily
- Monitor axial length/progression annually
- Initiate myopia control if progressing >0.50D/year
- Consider early use of low-dose atropine or specialty lenses
- Use IMI white papers for evidence-based guidance [9].
The cost of doing nothing
Myopia progression isn’t just a medical issue: it’s a costly economic one. “It doesn’t cost more over a lifetime to manage myopia proactively – it costs more to ignore it.” Between lost productivity, caregiving needs and the cost of treating complications, the burden is immense. Studies show that intervening early is highly cost-effective, even when specialised lenses or pharmacologic treatments are more expensive upfront [4].
Policy checklist
For governments and public health planners:
- Mandate daily outdoor activity in school curricula.
- Include myopia in school vision screening programmes.
- Subsidise evidence-based myopia control products.
- Train paediatricians and general practitioners in myopia risk counselling.
- Fund public education campaigns targeting parents and educators.
A global systems approach
Managing myopia effectively requires action across the eye health spectrum:
- Health promotion: outdoor time, reduced screen use, school awareness.
- Early detection: school screening and referral systems.
- reatment access: trained providers, affordable options, supply chains.
- Complication care: retinal monitoring, surgery, and low-vision rehab.
“It’s the full spectrum from prevention to rehabilitation, that must be built into systems.” Resnikoff praised China’s national myopia strategy, which includes prevalence reduction targets set by the head of state. However, he warned that “in many countries, the window for early action is now. We must integrate myopia into existing systems before it’s too late” [1].
Looking ahead: tech and collaboration
Emerging technologies like artificial intelligence (AI)-assisted screening, scleral strengthening, and next- generation optics show promise. “AI is a great tool,” Resnikoff said, “but it needs to be implemented in the most appropriate way.” He noted that while AI may assist with image analysis and decision-making, it’s no substitute for thoughtful application of evidence-based strategies [3].
For young professionals or researchers looking to contribute, he encourages collaboration with groups like IMI and the International Agency for the Prevention of Blindness, particularly through communication and advocacy roles. “Even at a junior level, you can make a difference by raising awareness and helping others understand the scale of the challenge.”
Final word
When asked for his key takeaway message, Resnikoff didn’t hesitate: “Act now.” We already have the knowledge and the tools. What’s needed now is coordinated, committed implementation – before millions of children lose their chance at a lifetime of clear sight.
References
1. Resnikoff S. Personal communication. Interview conducted September 2025.
2. Gifford KL, Richdale K, Kang P, et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci 2019;60(3):M184–203.
3. Resnikoff S. Public health approaches to myopia prevention and progression control. Proceedings from the International Myopia Institute 2025.
4. Eppenberger LS, Davis A, Resnikoff S, et al. Key strategies to reduce the global burden of myopia: Consensus from the International Myopia Summit. Br J Ophthalmol 2025;109(5):535–42.
5. Sherwin JC, Reacher MH, Keogh RH, et al. The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis. Ophthalmology 2012;119(10):2141–51.
6. Xiong S, Sankaridurg P, Naduvilath T, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol 2017;95(6):551–66.
7. Mei Z, Jiang Y, Han X, et al. Efficacy of outdoor interventions for myopia in children and adolescents: A systematic review and meta-analysis. Front Public Health 2024:12:1452567.
8. Wu PC, Chuang MN, Choi J, et al. Update in myopia and treatment strategy of atropine use in myopia control. Eye (Lond) 2019;33(1):3–13.
9. https://myopiainstitute.org/imi-white-papers-clinical-summaries/
[Link last accessed February 2026]
Declaration of competing interests: None declared.
