Céline Combrouze examines how the understanding of myopia is shifting from simple refractive correction towards long-term management. Drawing on prevalence data from Saudi Arabia, Jordan and Africa, she reviews the evidence linking earlier onset and each additional dioptre to later ocular risk, and argues that continuity of care across the Middle East should now translate awareness into consistent clinical practice.
A child comes for an eye examination because the board at school has become difficult to see. Traditionally, the objective was straightforward: identify the refractive error, prescribe the appropriate correction and restore clear distance vision.
Today, that same consultation can represent something more. It can be an opportunity to understand when myopia began, assess the risk of progression, monitor change over time and consider how the child’s visual future might be influenced.
This shift matters because our understanding of myopia has changed. It is no longer viewed simply as a refractive error requiring correction, but increasingly as a long-term eye-health challenge requiring earlier attention and continued management.
A global challenge – and the Middle East is concerned too
Global estimates of myopia prevalence are well documented. Holden and colleagues estimated that 22.9% of the global population was myopic in 2000 and projected that this could reach 49.8% by 2050. High myopia was projected to rise from 2.7% to 9.8% over the same period [1].
Much of the global discussion has understandably focused on East Asia, where prevalence has reached particularly high levels. But this can create the impression that myopia is primarily an Asian issue. Evidence from the Middle East tells us otherwise.
In Saudi Arabia, a cross-sectional study involving 3,678 schoolchildren aged 7–18 years in Taif reported myopia in 33.2% of examined eyes. The proportion increased across age groups, from 26.8% among children aged 7–9 years to 43.8% among those aged 16–18 years [2]. As the study used non-cycloplegic refraction and reported data by eye, these findings should be interpreted within the study’s methodology rather than extrapolated to the Saudi population as a whole.
More recent data from Jordan provide another regional signal. A 2024 study involving 542 schoolchildren from three schools in Amman found myopia in 11% of the overall sample, based on cycloplegic refraction. Myopia was found in 8% of the six-year-olds compared with 18% of the 15-year-olds [3]. These cross-sectional data should not be interpreted as individual progression over time or as representative of all children in Jordan. They do, however, demonstrate that childhood myopia is clearly present in the Middle East.
A similar message is emerging from Africa. A systematic review and meta-analysis of 42 studies from 19 African countries, involving more than 737,000 children, found that childhood myopia prevalence in studies conducted in 2011–2021 was approximately double that reported in studies conducted in 2000–2010 [4].
These populations are different, and their epidemiological trajectories should not be assumed to be identical. But together, the evidence makes an important point: myopia is not a distant problem confined to the highest-prevalence markets of Asia. The Middle East and Africa are part of the myopia conversation too.
Why every dioptre matters
Higher levels of myopia are associated with increased lifetime risks of sight-threatening ocular disease. Bullimore and colleagues estimated that each additional dioptre of myopia is associated with a 58% increase in the risk of myopic maculopathy, a 30% increase in retinal detachment, a 20% increase in open-angle glaucoma and a 21% increase in posterior subcapsular cataract [5].
The objective is not necessarily to prevent every child from becoming myopic – something that is neither realistic nor currently possible. Rather, it is to recognise that reducing the final level of myopia can have meaningful implications for long-term ocular health.
Earlier onset deserves earlier attention
In a prospective study of 928 myopic children from the Singapore Cohort of Risk Factors for Myopia, Chua and colleagues found that younger age of myopia onset, or a longer duration of progression, was the most important predictor of high myopia later in childhood [6]. Cycloplegic refraction and axial length were measured annually during follow-up.
A child who develops myopia at a younger age potentially has more years during which progression can occur. Early identification therefore means more than providing clear vision sooner. It creates an opportunity to recognise children who may face a greater risk of developing higher levels of myopia and to consider appropriate management and monitoring earlier.
A prescription tells us how a child sees today. It does not, by itself, tell us where that child’s myopia may be heading.
From correction to management
In 2025, the International Myopia Institute clarified the terminology used in myopia care [7]. Myopia correction refers to correcting the optical focusing error to provide clear distance vision, without an intended effect on progression. Myopia control refers specifically to evidence-based interventions intended to slow myopia progression and axial elongation.
Myopia management is broader. It describes a comprehensive approach that includes prevention, risk assessment, early detection, appropriate correction, lifestyle recommendations, interventions to reduce progression and axial elongation, monitoring of refraction and axial length, and the management of emerging myopia-related complications [7].
For many years, the clinical journey could be largely reactive: a child became myopic, received spectacles and returned when vision became blurred again.
The emerging model is more proactive. When did the myopia start? Is it progressing? How quickly? What is the family history? What behavioural and environmental factors should be discussed? Is axial length being monitored where appropriate and available? Is an evidence-based myopia-control intervention indicated? And how should management evolve as the child grows?
The question is no longer only “How do we correct this child’s vision?”
It is increasingly “How do we manage this child’s myopia over time?”
Building a continuum of care
Ophthalmologists and paediatric ophthalmologists play an important role in diagnosis, ocular-health assessment and medical oversight where required. Optometrists, orthoptists and opticians can contribute across refraction, visual assessment, patient education, dispensing and follow-up according to their professional scope of practice and the regulations of each country.
The precise model will not be identical across the Middle East. Healthcare systems, professional scopes of practice, access to technology and referral pathways vary considerably between markets.
But continuity matters everywhere.
A child may interact with several eye-care professionals over many years. Information needs to move with that child. Changes in refraction and, where available, axial length need to be interpreted over time rather than as isolated measurements. Parents need to understand why follow-up matters even when their child is seeing well with the current correction.
Other stakeholders can support this pathway. Parents are fundamental to adherence and behavioural change, while schools, teachers, paediatricians and family doctors may help raise awareness or identify children who need an eye examination. Their role, however, is complementary to – rather than a substitute for – appropriate eye care.
From awareness to action
Working across markets in the Middle East and Africa, one of the clearest lessons for me has been that myopia management does not evolve at the same pace everywhere.
Awareness differs. Access differs. Professional roles differ. Measurement capabilities and referral pathways differ.
Yet the direction of travel is increasingly similar: conversations are moving beyond correction towards earlier identification, assessment of progression and longer-term management.
The next challenge is turning that awareness into consistent practice.
That means strengthening professional education, helping parents understand why myopia deserves follow-up, improving communication across the eye-care pathway and continuing to generate high-quality local evidence.
We should neither assume that the Middle East will follow exactly the same trajectory as East Asia nor wait for prevalence to reach the highest levels before acting. The evidence emerging from the region already points to the value of greater awareness and more proactive care, while further local research will help to refine that approach.
Looking ahead
The evolution of myopia care represents a broader change in vision care: from responding to a refractive measurement at one moment in time to considering the patient’s visual health across years.
We do not need to wait until prevalence reaches the levels observed in the world’s highest-risk populations before strengthening awareness, generating better local evidence and developing clearer pathways for children who are already myopic or at risk of progression.
The conversation is no longer simply about helping children see clearly today. It is about protecting the vision they will depend upon for the rest of their lives.
About the author
Céline Combrouze is Head of Medical & Partner Programs for ZEISS Vision Care Middle East & Africa. Based in the UAE, she collaborates with ophthalmologists, optometrists, healthcare institutions and professional societies across the region to support education, professional engagement and evidence-based approaches to vision care.
About ZEISS
ZEISS is an international technology company operating in the fields of optics and optoelectronics. Carl Zeiss AG is wholly owned by the Carl Zeiss Foundation, one of Germany’s largest foundations dedicated to the promotion of science. ZEISS Vision Care develops optical solutions for eye-care professionals and consumers and builds on more than 20 years of research and global implementation in myopia management lenses.
- Website: www.zeiss.ae
References
- Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–1042. https://doi.org/10.1016/j.ophtha.2016.01.006.
- AlThomali TA, AlQurashi M, AlGhamdi AS, Ibrahim A, AlSwailmi FK. Prevalence of refractive errors in school-going children of Taif region of Saudi Arabia. Saudi Journal of Ophthalmology. 2022;36(1):70–74. https://doi.org/10.4103/sjopt.sjopt_46_21.
- Gammoh Y, Moore BD. Vision screening and detection of ocular abnormalities in school children by teachers in Jordan. Journal of Multidisciplinary Healthcare. 2024;17:5047–5055. https://doi.org/10.2147/JMDH.S491644.
- Kobia-Acquah E, Flitcroft DI, Akowuah PK, Lingham G, Loughman J. Regional variations and temporal trends of childhood myopia prevalence in Africa: a systematic review and meta-analysis. Ophthalmic and Physiological Optics. 2022;42(6):1232–1252. https://doi.org/10.1111/opo.13035.
- Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The risks and benefits of myopia control. Ophthalmology. 2021;128(11):1561–1579. https://doi.org/10.1016/j.ophtha.2021.04.032.
- Chua SYL, Sabanayagam C, Cheung YB, Chia A, Valenzuela RK, Tan D, Wong TY, Cheng CY, Saw SM. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic and Physiological Optics. 2016;36(4):388–394. https://doi.org/10.1111/opo.12305.
- Flitcroft I, Bullimore MA, Gifford KL, Jonas JB, Jones D, Jones LW, Kang P, Resnikoff S, Walline J, Wildsoet CF; International Myopia Institute. Myopia correction, myopia control and myopia management: definitions and recommended usage. Investigative Ophthalmology & Visual Science. 2025;66(6):41. https://doi.org/10.1167/iovs.66.6.41.
