Temporal trends in refractive error among children and adolescents in Germany - a large-scale analysis of spectacle sales data from dispensing opticians from 2001 to 2025.

Authors

Navid Farassat, Sven P Heinrich, Wolf A Lagrèze, Niklas Nagel

Published in

Frontiers in public health. Volume 14. Pages 1854832. Epub Jun 24, 2026.

Abstract

While the prevalence of myopia is rising globally, driven primarily by steep increases in East Asia, recent data on refractive trends in Europe suggest a plateau. This study aimed to evaluate temporal trends in refractive error and myopia progression of children and adolescents in Germany over a 25-year period from January 2001 to December 2025. Specifically, we sought to determine whether there is evidence of an accelerating "myopia epidemic" or a recent pandemic-induced myopic shift.
This retrospective observational study analyzed a large-scale dataset of real-world spectacle sales sourced from 490 independent dispensing opticians across Germany. It included ~1,250,000 prescription readings from ~440,000 individuals (~49% female) aged 3 to 18 years at baseline. Refractive error was evaluated as spherical equivalent refraction (SER), with myopia defined as ≤ -0.50 diopters (D). Cross-sectional and longitudinal analyses were conducted to evaluate shifts over time in SER, myopic progression, and the influence of age, sex, urbanization, and socioeconomic status.
Contrary to global projections, the overall pediatric spectacle-wearing cohort did not undergo a myopic shift. Instead, a mild hyperopic shift was observed, with the mean SER increasing from +0.05 D in 2001-2005 to +0.53 D in 2021-2025 (p < 0.001). Concurrently, the probability of a prescription being myopic decreased by 7.9% over the observation period. Longitudinal analyses of myopic children and adolescents revealed that progression curves remained remarkably parallel, indicating no acceleration in progression rates over the last quarter-century. Peak myopia progression consistently occurred between 8 and 12 years of age. While baseline refraction was a strong predictor for developing high myopia, environmental factors such as urbanicity and socioeconomic status exerted negligible effects on longitudinal progression rates.
This 25-year large-scale analysis found no evidence of an accelerating myopia epidemic or a pandemic-associated surge in myopia progression among spectacle-wearing children and adolescents in Germany. The mean refractive error and the incidence of myopic prescriptions have remained stable or even exhibited a slight hyperopic shift in recent cohorts, suggesting that regional environmental and lifestyle factors may effectively mitigate global myopization trends in this population.

PMID:
42422710
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

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