Trends in myopia prevalence and projected visual impairment in Western Europe: a pooled analysis of Dutch population-based cohorts (1900-2000)

Abstract

Importance: The global prevalence of myopia, a major cause of visual impairment and blindness, is on the rise. Understanding its trajectory and contributing factors in Europe is essential for implementing effective public health interventions.

Objective: To assess the trend of myopia prevalence in Europe over the last century, examine the role of education across generations, and project future rates of myopia-related visual impairment and blindness.

Design: This observational study used data from population-based cohorts in Rotterdam, Netherlands, including the Rotterdam Study I-IV, Generation R and Generation R Next.

Setting: Population-based cohort studies conducted in Rotterdam, Netherlands.

Participants: A total of 18 686 individuals born between 1900 and 2000, who underwent comprehensive ophthalmologic examinations.

Exposures: Participants were stratified by birth year (1900-1920, 1920-1940, 1940-1960, 1960-1980 and 1980-2000) and analysed for associations between birth year and myopia prevalence, axial length (AL) and spherical equivalent (SE). The potential mediating and moderating role of education was examined using a four-way decomposition approach. Prevalence of severe visual impairment caused by myopia-related complications was estimated for the Netherlands and Europe.

Main outcomes and measures: The primary outcomes were the prevalence of myopia (SE ≤-0.5 diopters (D)) and high myopia (SE ≤-6 D), and the projected prevalence of severe visual impairment due to myopia up to 2075.

Results: Myopia prevalence increased 2.5 times (from 22% to 56%) and high myopia 3.5 times (from 2% to 7%) between 1900 and 2000. Compared with individuals born in 1900-1920, those born in 1980-2000 had significantly higher odds of being myopic (OR 4.79 (95% CI 3.72 to 6.18)) and highly myopic (OR 3.30 (95% CI 1.79 to 6.21)). Mean AL increased by 0.9 mm in men and 0.8 mm in women over the century. Education significantly mediated the association between birth year and myopia. By 2075, the prevalence of severe visual impairment or blindness due to myopia in Europe is projected to rise from 0.12% in 2015 to 0.84%, causing an estimated 3.6 million severely visually impaired.

Conclusions and relevance: Myopia prevalence has risen dramatically in Europe, now affecting over 50% of young adults, with a corresponding increase in eye elongation over time. The burden of myopia-related visual impairment is expected to rise sharply as the population ages. By 2075, 0.84% of the European population is projected to be severely visually impaired or blind due to myopia-related complications. These findings underscore the urgent need for targeted public health interventions.

Keywords: Causality; Epidemiology; Preventive Medicine; Public Health; Risk Assessment.

Figure 1. Prevalence of myopia (spherical equivalent refraction (SER) ≤–0.5 D; blue bars) and high myopia (SER ≤–6.0 D; yellow bars), and mean axial length in millimeters (right y-axis) across birth years.

Figure 2. Spherical equivalent (A) and axial length (B) by birth year. Curves represent linear regression lines, with 95% CIs shaded in grey. Red lines indicate males; blue lines indicate females.

Figure 3. Visual impairment due to myopia in the Netherlands (A) and in Europe (B). Yellow bars depict the absolute number of visually impaired, the blue line depicts the prevalence (%) of visual impairment due to myopia.