Adult myopia progression linked to high sphere and astigmatism

Paper title: Myopia progression in young adults: insights from real-world clinical data

Authors: Manoharan MK (1), Tivari UP (1), Reddy JC (2,3), Verkicharla PK (1)

1. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India
2. Cataract and Refractive Surgery Services, L V Prasad Eye Institute, Hyderabad, India
3. Pristine Eye Hospitals, Madhapur, Hyderabad, India

Date: Published online September 2025

Reference: Manoharan MK, Tivari UP, Reddy JC, Verkicharla PK. Myopia progression in young adults: insights from real-world clinical data. Clin Exp Optom. 2025 Sep;108(7):873-879.

Link to paper

While most studies on myopia progression focus on children and adolescents, myopia may also continue to progress in early adulthood. Previous longitudinal studies have shown that a subset of adult myopes experience meaningful progression,^1-3 but the exact proportion and associated risk factors remain unclear. This study aimed to determine what proportion of young adults with myopia demonstrate progression of more than –0.50 D over one year and to identify risk factors using clinical data from a large cohort.

This was a retrospective analysis of electronic medical records from 2,683 myopic adults aged 18–30 years in India. Myopia progression was calculated as the difference between current cycloplegic subjective refraction, and the spectacle prescription issued 1 year prior. Only data from right eyes were analysed. The sample included individuals with a spherical equivalent refraction between –0.50 D and –14.75 D. Mean age was 24.5 years. Key findings were as follows.

• 12.7% of myopes progressed more than 0.50 D over one year; 4.6% progressed by ≥1.00 D.
• Progression was most prevalent in the 18–20 year age group and least prevalent in the 26–30 year group.
• High spherical equivalent (≤–6.00 D) was associated with 2.37x greater odds of progression.
• High cylinder (<–2.00 DC) was associated with 6.60x greater odds of progression.
• Gender and apparent age of myopia onset were not associated with progression.

The study findings indicate that it is important to monitor young adult myopes, especially those aged 18–20 years, as a proportion may still experience progression. Specifically, about 1 in 8 young adult myopes in the referenced clinical cohort progressed by more than -0.50 D annually, and nearly 1 in 20 progressed by at least -1.00 D. High myopia (≤-6.00 D) and high astigmatism (<-2.00 DC) were strongly associated with greater odds of progression.

The authors speculated that the progression in adults may be due to excessive near work, less time spent outdoors or perhaps lower illumination. Hence, discussion of the visual environment may also be warranted in adults and not just myopic children.  

It is well-established now that no level of myopia is considered safe.⁴ Even low levels of myopia increase the risk of serious ocular complications, such as myopic maculopathy, retinal detachment, and glaucoma. Each additional dioptre of myopia further elevates these risks, emphasizing the need to minimize progression at all stages of life.⁵

This study provides valuable insights but has several limitations that affect how its findings should be interpreted clinically. First, axial length data were not recorded, meaning it is unclear whether the myopia progression observed was axial or refractive in nature. This limits the ability to identify the mechanism of myopia progression, which is critical when considering the risk of long-term ocular pathology.

Second, the retrospective design relied on previous spectacle prescriptions to assess progression, which may introduce variability depending on how accurately refractions were recorded, or whether undercorrection or overcorrection occurred. Although institutional protocols helped minimise this variability, the absence of standardised biometric follow-up reduces precision.

Additionally, potential risk factors were not captured, such as family history of myopia, outdoor time, near work habits, or screen exposure. Finally, the study assessed progression over just one year. It remains unknown whether the observed changes represent ongoing progression or short-term fluctuations. Prospective, longitudinal studies incorporating axial length and lifestyle variables are needed to understand the true nature myopia progression in young adults.

Clinical relevance: Myopia may progress even during adulthood. Clinical trials are required to evaluate the effectiveness of myopia control interventions in adults.

Purpose: This study aimed to investigate what proportion of young adults undergo myopia progression of <-0.50 D and the factors associated with this progression based on data from real-world clinical settings.

Methods: This retrospective study included 2,683 myopes with spherical equivalent (SE) ranging from -0.50D to -14.75D. The spherical and cylindrical components were separately categorised into mild, moderate, and high-magnitude groups. Myopia progression was calculated as the difference between the previous spectacle prescription (obtained from a 1-year-old spectacle) and the current refraction. A binary logistic regression model was used to obtain the odds ratio.

Results: The mean ± standard deviation age of myopic individuals was 24.45 ± 2.74 years (range: 18-30) and annual myopia progression was -0.22 ± 0.38D. Out of 2,683 myopes, 2,341 (87.3%) had stable refraction (annual change: ≤0.25 to ≥-0.50 D), and 342 (12.7%) myopes had progression of <-0.50 D. Overall, 4.6% (n = 124/2,683) of myopes had a change in refraction of ≤-1.00 D. The younger age group (18-20 years, OR 1.63 [95% CI 1.03-2.57], p = 0.04), high-spherical equivalent (OR 2.37 [95% CI 1.28-4.38]), and high-cylinder (OR 6.60 [95% CI 3.40-12.81]) were found to be significantly (p < 0.05) associated with increased odds of myopia progression. Age of apparent myopia onset, gender, and spherical components were not associated with myopia progression (p > 0.05).

Conclusion: About 1 out 20 myopes in clinical settings tend to have progression of one dioptre even during adulthood. Regular monitoring of biometry in young adults with high-spherical equivalent and astigmatism could aid in the identification of those with myopia progression.