Twenty-five-year trends in adolescent myopia: are we approaching a plateau? Real-world evidence from 1.46 million Israeli adolescents

Abstract Background/Objectives: To characterise 25-year trends in adolescent myopia and examine whether myopia prevalence and temporal trends differed according to educational characteristics. Subjects/Methods: This nationwide repeated cross-sectional study included 1,462,999 adolescents aged 16 to 20 years, born between 1976 and 2000, using data from the Israel Defense Forces conscription registry. Myopia was defined as spherical equivalent ≤ − 0.5 D. Temporal trends were assessed across 5-year birth cohorts and according to educational level and educational system. Associations were evaluated using multivariable logistic regression. Results Myopia prevalence increased from 27.0% in the 1976–1980 birth cohort to 33.0% in the 1996–2000 cohort (P < 0.001), with most of the increase occurring between the first two birth cohorts and relative stability thereafter. Prevalence was higher with greater educational attainment, and participants with at least 12 years of education had higher adjusted odds of myopia than those with 9 years or less (OR 1.88, 95% CI 1.81 to 1.95; P < 0.001). Participants educated in the religious system also had higher adjusted odds of myopia than those educated in the secular system (OR 2.16, 95% CI 2.14 to 2.18; P < 0.001). The relative increase across the study period was smaller in the religious than in the secular system (+ 7.3% vs + 23.4%). Conclusions Myopia prevalence increased across successive Israeli birth cohorts, with findings suggesting a relative plateau after the early study period, particularly among adolescents educated in the religious system. Marked differences in prevalence and temporal trends across educational groups suggest that population-specific characteristics should be considered when interpreting long-term myopia trends.