By Dr. David Cockrell, Chairman, Health Care Alliance for Patient Safety
Myopia is a progressive childhood eye-growth condition with lifelong consequences.
Still, the best nationally representative U.S. prevalence data are more than two decades old.
Modeling published by Holden and colleagues in 2016 projected that roughly half of the world's population could be myopic by 2050, up from about 23% in 2000; the National Eye Institute's own projection estimates 44.5 million Americans will be myopic by 2050, with disproportionate increases among African American and Hispanic populations. These are global and national extrapolations, not measurements — which is precisely the point: the United States is relying on modeled projections and regional studies because it lacks current, direct, nationally representative data on its own children.
The most recent nationally representative U.S. data on refractive error come from the National Health and Nutrition Examination Survey (NHANES), conducted between 1999 and 2004. Those data found that myopia prevalence among Americans ages 12–54 had increased from 25.0% in 1971–1972 to 41.6% in 1999–2004. More recent evidence from Olmsted County, Minnesota, also indicates an increase: adult myopia prevalence rose from 33.9% in the 1960s to 57.1% in the 2010s, while high myopia increased from 2.8% to 8.3%. The Minnesota study is not nationally representative, underscoring the need for updated national surveillance.
This data gap was highlighted in the 2024 consensus report from the National Academies of Sciences, Engineering, and Medicine (NASEM), Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease. The report noted that the United States does not currently have a nationally representative, childhood-specific surveillance system for refractive error or axial length.
The implications extend beyond correcting refractive error. Myopia is a progressive eye-growth condition, and increasing axial length is associated with greater risk of vision complications later in life. NASEM recommended that myopia be classified as a disease requiring medical diagnosis rather than being treated solely as a refractive correction. This approach would support greater emphasis on prevention, risk assessment, monitoring, and management of progression.
What the United States lacks is a coordinated national strategy for surveillance, prevention, early diagnosis, equitable treatment, and public education.
There are several areas where federal policy could help address these gaps.
First, the United States needs better surveillance. CDC and state health departments should collect standardized, longitudinal refractive-error and axial-growth data, particularly in children. This would require restoring a refractive-error component to NHANES (or an equivalent mechanism) and building state-level reporting comparable to existing chronic-disease surveillance systems. Current data limitations make it difficult to establish reliable national and state-level prevalence estimates or assess trends over time.
Second, federal agencies can support evidence-based prevention. The NASEM report recommends approximately one to two hours of outdoor time each day for children and calls for evidence-based federal guidance developed in coordination with health and education agencies. Providing families, schools, and communities with consistent information about outdoor time is a practical component of a broader prevention strategy.
Third, early identification should extend beyond traditional visual-acuity screening. A child may have risk factors for myopia or early eye-growth changes before experiencing a significant reduction in distance visual acuity. Therefore, screening protocols should identify reduced age-appropriate hyperopia, parental history of myopia, early age of onset, and other markers of elevated risk — not merely detect whether a child already fails a distance visual-acuity test.
Fourth, federal policy should support access to ongoing care. Children who develop myopia will require more than an initial prescription for corrective lenses. Comprehensive eye examinations, monitoring, and evidence-based approaches to managing progression are important components of care. Access to these services is particularly relevant in rural and underserved communities. The American Optometric Association has publicly framed optometry's distributed practice footprint — doctors of optometry practicing within reach of an estimated 98% of the U.S. population — as the delivery infrastructure for closing access gaps.
There are existing federal policy opportunities that could advance these objectives. The Early Detection of Vision Impairments for Children Act, H.R. 2527, would establish a federally funded program supporting state and community efforts related to children's vision, including screening, early intervention, and coordinated follow-up care.
The policy priorities are relatively straightforward: support legislation that strengthens children's vision infrastructure, invest in national surveillance, and ensure that federal programs recognize the importance of early identification and ongoing management of myopia.
The Department of Health and Human Services has the opportunity to coordinate these efforts across federal agencies. HHS can work with CDC and education-sector partners on evidence-based prevention guidance, support improvements to national surveillance, and work with CMS on policies that recognize myopia management as disease care rather than refractive correction.
We have global and national evidence of increasing myopia prevalence, established approaches that can help reduce risk and progression, and existing health care professionals who can provide comprehensive eye care. What is missing is a coordinated national framework that connects these elements.
Congress and HHS should prioritize five actions: measure myopia nationally, promote evidence-based prevention, improve early identification, support management of progression, and expand access to comprehensive pediatric eye care.
The objective is not to establish a federal response based on projections or incomplete data. It is to establish the infrastructure necessary to obtain better data and apply the evidence that is already available.