Stopping the rise of myopia in Asia

Graefes Arch Clin Exp Ophthalmol. 2020 May;258(5):943-959. doi: 10.1007/s00417-019-04555-0. Epub 2019 Dec 23.


This review discusses the rapid rise of myopia among school-age children in East and Southeast Asia during the last 60 years. It describes the history, epidemiology, and presumed causes of myopia in Asia, but also in Europe and the United States. The recent myopia boom is attributed primarily to the educational pressure in Asian countries, which prompts children to read for long hours, often under poor lighting and on computer screens. This practice severely limits the time spent outdoors and reduces exposure to sunlight and far vision. As a consequence, the eyes grow longer and become myopic. In a breakthrough study in Taiwan, it has been found that by increasing the time spent outdoors, the incidence of new myopia cases was reduced to half when children were sent onto the schoolyard for at least 2 h daily. This protection is attributed to the light-induced retinal dopamine, which blocks the abnormal growth of the eyeball. Once myopia has set in, low-dose atropine and orthokeratology have shown positive results in slowing myopia progression. Also, prismatic bifocal lenses and specially designed multifocal soft contact lenses have recently been tested with promising results. Treatment, however, must be initiated early as the disease progresses once it has started, thereby enhancing the risk for severe visual impairment and ultimately blindness.

Keywords: Atropine; Axial myopia; Dopamine; Educational pressure; Excessive eye growth; Excessive reading; Multifocal soft contact lenses; Near-work; Orthokeratology; Outdoors activity; Peripheral undercorrection; Poor lighting.

Publication types

  • Review

MeSH terms

  • Asia / epidemiology
  • Asian People / statistics & numerical data*
  • Atropine / administration & dosage
  • Humans
  • Incidence
  • Leisure Activities
  • Mydriatics / administration & dosage
  • Myopia / epidemiology*
  • Myopia / therapy*
  • Orthokeratologic Procedures
  • Sunlight


  • Mydriatics
  • Atropine