Global perspectives on myopia and pathologic myopia: From environmental drivers to precision medicine

The global prevalence of myopia and pathologic myopia (PM) has dramatically increased, raising significant public health concerns due to associated vision-threatening complications, such as myopic maculopathy (MM). This comprehensive review integrates the latest evidence regarding the environmental, genetic, and epigenetic factors contributing to myopia, as well as recent advances in precision medicine and therapeutic approaches aimed at mitigating the disease's impact. We examine how environmental factors interact with polygenic risk factors and epigenetic changes to influence disease progression. The application of artificial intelligence (AI) enhances the integration of genomic, environmental, and clinical data, thereby improving risk assessment and personalizing treatment options. Therapeutic strategies, including the use of low-dose atropine, orthokeratology, and repeated low-level red-light therapy, have shown promise in controlling myopia. Furthermore, emerging gene-editing techniques are being developed, although they are unlikely to be implemented as treatments for myopia and PM in the near future. Despite these advancements, disparities in resource availability and the implementation of interventions continue to hinder global equity, underscoring the need for scalable solutions such as mobile health applications and community-based preventive programs. This review emphasizes the importance of interdisciplinary collaboration to merge precision medicine with public health strategies, ensuring that scientific breakthroughs are equitably translated into clinical care. By aligning environmental preventive measures, genetic discoveries, and AI-powered innovations, this review outlines a strategic plan for reducing the global burden of myopia and its complications.