Introduction
Myopia, defined both qualitatively by the eye’s light focus in front of the retina and quantitatively as a spherical equivalent (SE) of −0.50D or less, is a leading global refractive error. Beyond blurred distance vision, myopia is linked to higher risks of cataracts, glaucoma, myopic maculopathy, and retinal detachment. The Eastern Mediterranean Region (EMR) has shown relatively lower childhood myopia rates compared with East Asia, yet regional data remain sparse, limiting public health planning.
This article summarizes a large cross-sectional study conducted in Beirut City, Lebanon, assessing the prevalence and demographic profile of myopia among school children aged 6–15 years. By identifying who is most affected and where risk concentrates, the findings aim to guide school eye health programs and policy decisions in Lebanon and the broader EMR.
Study design and setting
The study used a quantitative, cross-sectional, descriptive design with 3,564 students drawn from Beirut’s three geographic clusters, representing diverse socio-economic and religious backgrounds. Schools included private, public, and semi-private institutions. Participants were selected through stratified cluster sampling, with every third student on class lists in grades 1–9 invited to participate, ensuring gender representation and broad coverage across the city.
Methods: how myopia was defined and measured
Myopia was diagnosed using International Myopia Institute criteria, with SE ≤ −0.50D in each eye under relaxed accommodation. Screening began with objective refraction (QuickSee), followed by distance and near visual acuity assessments and a dry subjective refraction to refine refractive status. Non-cycloplegic methods were used, and clinicians were trained to standardize measurements, minimizing inter-examiner variability.
Key findings: prevalence and age patterns
The overall myopia prevalence among the 6–15-year-olds was 14.22% (507 of 3,564 participants). Age was a strong predictor: 11–15-year-olds showed higher prevalence (19.9%) than 6–10-year-olds (10.3%). The data align with the global pattern of increasing myopia with age during childhood and adolescence, likely reflecting cumulative near-work demands and changing outdoor activity patterns during these years.
Demographic correlates
Gender
Myopia was slightly more common in girls (15.1%) than in boys (13.4%), but this difference was not statistically significant after adjustment (p > 0.05). Across age groups, the gender gap did not meaningfully alter risk, suggesting similar exposure to myopiogenic factors among boys and girls in urban Beirut.
Socio-economic status
Socio-economic analysis showed a nuanced picture. No significant difference emerged between middle- and high-income groups. However, children from low-income families had a higher risk of myopia compared with those from higher-income households (odds ratio ≈ 0.79 for higher income vs. low income, p ≈ 0.025). Potential explanations include reduced outdoor time due to urban living constraints, limited access to preventive eye care, and greater near-work pressures in low-income settings.
Geography and religion
clustering revealed higher prevalence in Cluster 2, with significant differences when comparing Cluster 3 to Cluster 1 (p = 0.039). Religious composition showed Muslims comprised the majority (84.6%), with Christians comprising about 15.4%. Myopia rates were similar across religious groups (13.92% Muslims vs 15.87% Christians, p = 0.229), indicating that religion alone did not drive risk in this urban setting.
Interpretation and public health implications
The Beirut study provides the first population-based estimate of childhood myopia in Lebanon, placing prevalence at 14.22% among 6–15-year-olds and highlighting age and socio-economic disparities. The relatively higher risk among older children suggests that school environments, increased near work, and lifestyle shifts toward indoor activities may be central drivers. Urban planning that expands safe outdoor spaces, coupled with school-based eye health programs, could mitigate progression and improve visual outcomes for children.
Recommendations for policy and practice
- Implement routine school-based vision screening and ensure access to affordable refractive care and corrective lenses.
- Promote outdoor-time policies in schools and communities to balance near-work demands with daylight exposure, potentially reducing onset and progression of myopia.
- Educate parents and teachers about early signs of refractive error and the importance of timely eye examinations.
- Establish a national or city-level school eye health program to monitor prevalence, risk factors, and intervention outcomes across socio-economic strata.
Limitations and future research
The study used non-cycloplegic refraction, which may overestimate myopia due to latent hyperopia or pseudo-myopia. Future work should consider cycloplegic measurements when feasible and track progression to evaluate interventions such as increased outdoor time and reduced near work.
