Abstract / Summary
Abstract Myopia is a childhood-onset condition driven by excessive axial ocular elongation, associated with increased risk of sight-threatening complications and irreversible visual impairment. Despite rising global prevalence, epidemiological data on long-term trends in Europe remain limited. This study examines temporal trends in myopia prevalence and axial length (AL) across European adult birth cohorts. We conducted a comparative birth-cohort analysis using harmonised data from 28 population-based studies (n = 81,828) across nine countries participating in the European Eye Epidemiology (E3) Consortium. Myopia prevalence (overall, by severity, and sex) were estimated using individual participant data random-effects meta-analysis. AL distributions were assessed by estimating percentiles across birth cohorts. Myopia prevalence more than tripled across 20th-century birth cohorts, rising from 18.0% (95% confidence interval [CI]: 15.2%, 21.3%) in the 1900s to 61.4% (95% CI: 55.5%, 66.9%) in the 1990s (p < 0.001), with increased prevalence across all severity levels. Standardised to the 2024 European population, myopia prevalence was estimated at 42.7% (95% CI: 40.2%, 45.1%). Myopia prevalence was similar between males and females overall. AL was longer in successive decades (1920–1970) across all population centiles (p < 0.001), indicating a population-wide shift. Myopia prevalence and AL have increased markedly across European birth cohorts throughout the twentieth century, affecting all severity levels and both sexes. These findings underscore the importance of preventive strategies targeting modifiable environmental risk factors, alongside continued evaluation of interventions intended to slow myopia progression, as continued increases may strain healthcare systems and society.