{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:46:40Z","timestamp":1782283600118,"version":"3.54.5"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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 \u201cmyopia epidemic\u201d or a recent pandemic-induced myopic shift.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u2264 \u22120.50 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u20132005 to +0.53 D in 2021\u20132025 (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1854832","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:47:32Z","timestamp":1782280052000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal trends in refractive error among children and adolescents in Germany \u2013 a large-scale analysis of spectacle sales data from dispensing opticians from 2001 to 2025"],"prefix":"10.3389","volume":"14","author":[{"given":"Navid","family":"Farassat","sequence":"first","affiliation":[{"name":"Eye Center, Medical Center, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven P.","family":"Heinrich","sequence":"additional","affiliation":[{"name":"Eye Center, Medical Center, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolf A.","family":"Lagr\u00e8ze","sequence":"additional","affiliation":[{"name":"Eye Center, Medical Center, Faculty of Medicine, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Nagel","sequence":"additional","affiliation":[{"name":"Department of Economics, University of Freiburg","place":["Freiburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1167\/iovs.62.5.2","article-title":"IMI impact of myopia","volume":"62","author":"Sankaridurg","year":"2021","journal-title":"Investig Ophthalmol Vis Sci"},{"key":"B2","unstructured":"WHO\n              BHV\n            \n          \n          The Impact of Myopia and High Myopia. 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