Myopia Trends in Europe: A Reappraisal of Current Evidence.

Our commentary critically examines whether the widely accepted projection of a global myopia epidemic, most prominently proposed by Holden et al. (2016), adequately reflects the European context. These projections assume that most regions outside Africa and Oceania will follow an East Asian-type trajectory, implying that Western populations with prolonged formal education are on a similar path. By reviewing recent European epidemiological evidence, including meta-analyses, we highlight that myopia prevalence in European young adults remains approximately 20-30%, substantially lower than the 70-90% levels reported in East Asia. We further examine how differences in educational systems, lifestyle patterns, and environmental exposures, particularly time spent outdoors, may contribute to this divergence. Importantly, this commentary evaluates the extent to which methodological factors influence reported prevalence, particularly in pediatric populations where most epidemiological data are generated. Variation in age structure, sampling strategies, and especially the use of non-cycloplegic refraction can inflate prevalence estimates and contribute to the perception of increasing trends. When analyses are restricted to comparable age groups and cycloplegic data, evidence for a substantial temporal increase in Europe becomes less consistent. Through this analysis, we question whether current global projections may overestimate future risk in Europe by extrapolating from fundamentally different populations. Finally, we propose that monitoring strategies combining pragmatic school-based screening with standardized cycloplegic assessment may provide a more accurate and context-specific understanding of trends. Overall, this commentary suggests that a myopia epidemic is not inevitable and that Europe represents a critical test case for understanding how environmental, educational, and cultural factors shape myopia development.