The current global prevalence has increased significantly in recent decades. The largest increase has been especially in Southeast Asian countries, where the prevalence of myopia exceeds 80% among school leavers (Morgan et al., 2012). An increasing trend has been observed in other countries as well. However, the increase has been significantly less; for example, in Nordic countries, where the prevalence of myopia in young adults is around 25% (Pärssinen et al., 2025). The recent systematic review and meta-analysis of data from 14 countries reported that myopia prevalence in Europe is lower than in Asia, with a less pronounced increase that disappears after stratifying by cycloplegic refraction and age (Moreira-Rosário et al., 2025). It is generally accepted that myopia is associated with more near work, higher education and less time spent outdoors. However, there is no definite knowledge of the mechanisms by which various external factors cause axial elongation and myopia. The joint World Health Organization–Brien Holden Vision Institute global meeting in Sydney, Australia, in 2015 (WHO, 2016) drew attention to the worldwide increase of myopia and its complications and predicted that, by 2050, myopia prevalence would rise to 4.9 billion people (52% of the world population), of whom 925 million people (10% of the world population) would have high myopia (≤−5 D; WHO, 2016). After that, studies on myopia and publications have significantly increased. From 2004, Acta has published 191 studies on myopia, and submissions per year have steadily increased through the years and peaked in 2021. Articles in this Special Issue can be divided into four different subtypes of myopia research, namely, epidemiology, pathophysiology, treatment and complications. The study of Bro showed that, from 1975 to 1995, the prevalence of myopia among Swedish conscripts increased from 22% to 29%. A higher level of education and higher verbal and visuospatial ability were risk factors for myopia. The meta-analysis of Perez et al. investigated the effectiveness of outdoor activities in reducing the onset of myopia in children and adolescents. Their study shows that outdoor activities, especially with prolonged exposure to intense light, effectively reduce or delay the onset of myopia in children and adolescents. Pärssinen, in his study, reviews the historical studies of Cohn in Germany and Widmark in Sweden. In both countries, the prevalence of myopia in the 1800s was high at the highest grades of schools. In Sweden, between the periods 1822–1883 and 1904–1905, the mean myopia prevalence decreased from 22.2% to 9.8% and from 45.3% to 17.4% in the highest grades of these same schools. Widmark suggested that the main factors causing the myopia decrease were improved lighting due to electric lights, Fraktur fonts in schools were replaced by Antiqua and the number of outdoor activities was increased. Cheong et al. investigated relationships between two dietary composite scores and myopic macular degeneration (MMD) in a high myopia adult cohort. The study did not find associations between diet and MMD in a cohort of highly myopic adults. To find that kind of association, larger and prospective studies conducted over multiple time points would be required. The review article of Li et al. summarized the association of correlated colour temperature (CCT) and myopia so that lower CCT may have a protective effect against myopia, though this is not universal and further depends on wavelength, illuminance and exposure duration. The review article of Li et al. about the studies of the connection between spatial frequency of light and myopia. Mid to high spatial frequencies were found to play an important role in the emmetropization process of the eye. Low spatial frequencies can increase the risk of myopia incidence. The results of these studies may be difficult to apply on a practical level in varying lighting conditions, but they can help to clarify the processes leading to myopia. Zhou et al. investigated relationships between axial length and the intraocular concentrations of heparin-binding epidermal growth factor (HB-EGF), epidermal growth factor (EGF) and vascular endothelial growth factor A (VEGF-A) in aqueous humour samples taken from patients during cataract surgery. Higher concentrations of HB-EGF and EGF were associated with longer axial length. The inverse relationship between VEGF-A concentration and longer axial length suggested a protective effect of longer axial myopia against diabetic retinopathy and age-related macular degeneration. The treatment trial of Chen et al. studied the effect of two different peripheral hyperopic defocus corrective spectacle lenses CARE and CARE S to slow the progression of myopia. When compared with single vision spectacle lenses, the progression of myopia in 12 months was significantly less in CARE (0.30 D) and in CARE S (0.36 D) lenses. Schmidt et al. compared the effectiveness of various interventions, low-level red-light, ortho-K, different atropine concentrations, spectacles with highly aspherical lenslets, multiple segment spectacles and combined treatments. Hayeket et al. evaluated the effects of customized corneal collagen cross-linking (CXL) compared with the same effects in healthy eyes undergoing cross-linking for low-grade myopia. Customized CXL effectively reduces high-order aberrations in keratoconus, whereas CXL for low-grade myopia tends to increase corneal spherical aberrations. Matsumura et al. evaluated changes in choroidal thickness (CT), choroidal blood flow and axial length (AL) after therapy with either 0.01% atropine eye drops (AT) or the combination of orthokeratology and 0.01% atropine. The increase in CT was more pronounced in the combination therapy group compared to the AT group. The increase in CT and choroidal blood flow was associated with a less AL progression. Kobia- Acquah et al. investigated 2-year changes in macular choroidal thickness (ChT) in children receiving 0.01% atropine eye drops and their relationship with spherical equivalent refraction (SER) progression and axial length. Choroidal thickness among the 0.01% atropine-treated group was stable, whereas in the placebo group, consistent choroidal thinning was seen, indicating a direct effect of atropine treatment on the choroid. Zhao et al. compared choroidal changes in high myopic (HM) patients with wide macular posterior staphyloma (PS) and without posterior staphyloma using ultra-wide-field optical coherence tomography angiography (UWF-OCTA). In PS eyes, attenuated choroidal perfusion and a potentially reorganized choroidal structure and circulation were found, showing that UWF-OCTA gives a promising method for non-invasive visualization of the choroidal alterations in PS. Jonas et al. studied associations between stages of myopic macular degeneration (MMD) and visual acuity and influencing parameters. Worse best-corrected visual acuity (BCVA) was associated with higher MMD stage and thinner subfoveal choroidal thickness. If only eyes with MMD grade 1 or no MMD were included, worse BCVA was associated with a higher prevalence of MMD stage 1 and thinner medium-sized choroidal vessel layer thickness. BCVA was also worse in eyes with MMD stage 1 than in eyes without MMD. The retrospective study of Carla et al. analysed highly myopic macular holes (MMH) with axial length ≥ 26.5 mm that underwent surgery with either internal limiting membrane (ILM) peeling or inverted flap technique over a 10-year period. Posterior staphyloma morphology significantly influences MMH closure patterns in highly myopic eyes, especially with the ILM inverted flap technique. The posterior segment geometry likely affects gas–retina contact during recovery, resulting in different closure patterns. The study of Ma et al. evaluated the long-term effects of implantable collamer lens V4c on the biomechanical and morphological properties of crystalline lenses in Chinese adults with high myopia using Brillouin microscopy. No significant changes in lens morphology were assessed, but a slight decrease in lenticular biomechanics was observed. Tian et al. analysed the clinical characteristics and risk factors associated with myopic retinoschisis (MR) and its severity. Several factors were associated with myopic retinoschisis, among others keratorefractive surgeries, older age, longer axial length and thinner subfoveal choroidal thickness. Lim et al. concluded that approximately 30% of bilateral high myopic patients with unilateral myopic macular neovascularization are estimated to develop the same situation in the second eye over a period of 10 years. The presence of lacquer cracks in the second eye was a significant risk factor. The first and second eyes showed comparable treatment outcomes. Butler et al. evaluated the comparative efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular AMD using monthly ranibizumab as a reference. No anti-VEGF drug or treatment regimen provided a better BCVA response compared to the reference. Jonas et al. showed that macular ridges were relatively common in myopic eyes, with macular ridge prevalence and height increasing with longer axial length and older age in a curvilinear manner. Some European children develop myopia progression into pathological myopia and need to be early diagnosed and treated. Probably some children form high-risk families, including both myopic parents, could be actively screened. More time outdoors and less near distance activities, including smartphones in young children, are recommended although their mechanisms are not clearly understood. Moreover, we are also responsible for society education, including parents and teachers. Some local education campaigns have already been conducted locally or nationally in Europe. Fortunately, all methods of inhibiting myopia are available in Europe, atropine on label and prepared as compounded product, soft contact lenses, orthokeratology, many eyeglasses, and low-level red-light therapy. With the increasing number of available therapies, there is an increasing need of objective comparisons and non-commercially biased expert opinions. Thus, we decided to support the European Myopia Network (myopianetwork.eu) as a new non-commercial initiative of sharing a knowledge between experts and practitioners. The EMN Council (https://myopianetwork.eu/european-council/) representing over 20 European countries provides both unique expertise and insight into local national problems. Everybody interested in myopia is welcome to join us!
Pärssinen et al. (Fri,) studied this question.