The epidemiological status of myopia as a leading refractive error

In the 21st century, myopia (nearsightedness) has transitioned from a benign refractive anomaly into one
of the most significant global public health challenges, reaching epidemic proportions particularly in East Asian
regions. According to the standards established by the International Myopia Institute (IMI), it is defined as a
condition where the spherical equivalent (SE) is ≤ -0.50 diopters (D), typically resulting from the axial elongation
of the eyeball. Current epidemiological models project that by 2050, approximately 5 billion people, or 50% of the
global population, will be myopic. Even more concerning is the forecasted increase in high myopia (≤ -6.00 D),
which is expected to affect 1 billion people. High myopia is strongly associated with pathological structural
changes in the posterior segment, including myopic maculopathy, glaucoma, and retinal detachment, positioning it
as a leading cause of irreversible visual impairment. The etiology of myopia is multifactorial, arising from a
complex interplay between genetic susceptibility and environmental factors. While genetic risk is substantial (with
the risk doubling if one parent is myopic), the rapid escalation in prevalence underscores the dominant role of
altered modern lifestyles. Intensive education and "near work" specifically sustained tasks at a distance of less than
30 cm have been identified as potent risk factors. Conversely, time spent outdoors (exceeding 2 hours daily)
demonstrates a proven protective effect, likely mediated by light-stimulated retinal dopamine release. This paper
provides a detailed evaluation of contemporary progression control strategies. Pharmacological interventions, led
by low-dose atropine (0.05%), exhibit an optimal balance between efficacy and safety. Optical innovations, such as
orthokeratology (Ortho-K), defocus lenses (DIMS and HAL), and repeated low-level red-light (RLRL) therapy,
offer effective non-invasive alternatives for slowing axial growth. A specific focus of this study is directed toward
the situation in the Republic of North Macedonia. Due to a chronic lack of national epidemiological data, original
research was conducted, encompassing a wide range of respondents. The results reveal a distinct national profile of
"late-onset" myopia, with diagnoses frequently occurring in young adulthood (ages 19–30). This is strongly
correlated with lifestyle: respondents report extreme digital screen exposure (over 8 hours per day) and critically
low levels of outdoor activity (less than 2 hours). Furthermore, a low level of awareness regarding alternative
treatment methods and irregular ophthalmic examinations were detected. Based on these findings, the paper
concludes that the urgent implementation of a national strategy for systematic screening and the promotion of active
clinical management is essential to prevent a forthcoming wave of visual impairment within the population.
Keywords: myopia, risk factors, treatment, research.