Introduction
Myopia, defined both qualitatively and quantitatively, is a refractive error where light focuses in front of the retina during relaxed accommodation. Quantitatively, it is often identified as a spherical equivalent (SE) of −0.50 diopters (D) or less in at least one eye. Globally, myopia is the most common refractive error and poses risks for future ocular diseases if not detected and managed early. This article summarizes a cross‑sectional study conducted in Beirut, Lebanon, to determine the prevalence and demographic profile of myopia among school children aged 6 to 15 years, addressing a data gap in the Eastern Mediterranean Region (EMR).
Methodology at a glance
The study screened 3,564 students from Beirut’s three geographic clusters, using stratified cluster sampling to include public, private, and semi-private schools. Vision screening began with objective refraction using QuickSee, followed by distance and near visual acuity testing and non-cycloplegic dry refraction. To ensure reliability, examiners underwent standardized training, and non-cooperative children or those with ocular pathology were excluded. Data collection occurred from November 2022 to March 2023, during Lebanon’s economic crisis.
Key findings: prevalence and who is affected
The overall prevalence of myopia was 14.22% (507 of 3,564 students). Several demographic patterns emerged:
- Age: Myopia was more common in older children (11–15 years) with a prevalence of 19.9%, compared with 6–10 years at 10.3%.
- Gender: The prevalence was slightly higher in girls (15.1%) than in boys (13.4%), though this difference was not statistically significant in multivariate analyses.
- Socioeconomic status: A higher risk was observed among children from lower-income families; middle- and high-income groups showed no significant difference, while low income carried a higher risk compared with high income.
- Geography and religion: Myopia distribution varied by cluster, with Cluster 3 showing higher prevalence than Cluster 1. Religion (Muslim vs Christian) did not show a significant difference in prevalence, suggesting lifestyle, environment, and genetics as shared drivers rather than religious affiliation alone.
- Associated ocular findings: A high proportion of myopic children also had astigmatism, and low myopia was the most common dioptric category observed in this cohort.
In terms of regional context, Eastern Mediterranean data have shown relatively lower childhood myopia prevalence than East Asia and parts of Europe. The Beirut findings align with this regional trend but underline a concerning rise that warrants public health attention given the potential for progression during school years.
Interpretation and public health implications
The study demonstrates that Beirut children are not only affected by myopia at a meaningful rate but that several modifiable factors—outdoor activity, near work, and screen exposure—likely influence progression. The higher rate in older children corresponds with accumulating near work and educational demands, underscoring the need for early detection, routine vision screening in schools, and interventions to balance near work with outdoor time.
Lebanon lacks a government-led school eye health program, and existing data come mainly from facility-based studies. The current results support the push for comprehensive school eye health programs, including regular screenings, access to affordable corrective lenses, and education for parents, teachers, and healthcare providers about myopia control strategies.
Recommendations for policy and practice
– Implement nationwide school-based vision screening with pathways to affordable eye care and corrective lenses.
– Promote outdoor activities in school curricula and daily routines to counteract near-work-driven progression, while managing screen time.
– Consider cycloplegic refraction in future research to improve accuracy in measuring refractive error and reduce hyperopic defocus or pseudo myopia.
– Establish surveillance to monitor prevalence trends and assess the impact of interventions across demographics, including income levels and geographic clusters.
Limitations and next steps
The study employed non-cycloplegic refraction, which may overestimate myopia in some cases due to latent hyperopia or pseudomyopia. Nonetheless, standardized procedures and large, diverse sampling strengthen the relevance of the findings for Beirut and similar urban settings. Future work should incorporate cycloplegic refraction and longitudinal follow-up to evaluate progression and the effectiveness of targeted prevention strategies.
Conclusion
This Beirut study provides the first population-based glimpse at myopia prevalence among schoolchildren in Lebanon, reporting a 14.22% rate and highlighting age, income, geography, and evolving educational demands as key factors. The results advocate for urgent public eye health initiatives to protect children’s vision and long-term eye health in Lebanon and the broader EMR.
