Temporal trends in refractive error among children and adolescents in Germany - a large-scale analysis of spectacle sales data from dispensing opticians from 2001 to 2025.

BACKGROUND: While the prevalence of myopia is rising globally, driven primarily by steep increases in East Asia, recent data on refractive trends in Europe suggest a plateau. This study aimed to evaluate temporal trends in refractive error and myopia progression of children and adolescents in Germany over a 25-year period from January 2001 to December 2025. Specifically, we sought to determine whether there is evidence of an accelerating "myopia epidemic" or a recent pandemic-induced myopic shift.

METHODS: This retrospective observational study analyzed a large-scale dataset of real-world spectacle sales sourced from 490 independent dispensing opticians across Germany. It included ~1,250,000 prescription readings from ~440,000 individuals (~49% female) aged 3 to 18 years at baseline. Refractive error was evaluated as spherical equivalent refraction (SER), with myopia defined as ≤ -0.50 diopters (D). Cross-sectional and longitudinal analyses were conducted to evaluate shifts over time in SER, myopic progression, and the influence of age, sex, urbanization, and socioeconomic status.

RESULTS: Contrary to global projections, the overall pediatric spectacle-wearing cohort did not undergo a myopic shift. Instead, a mild hyperopic shift was observed, with the mean SER increasing from +0.05 D in 2001-2005 to +0.53 D in 2021-2025 (p < 0.001). Concurrently, the probability of a prescription being myopic decreased by 7.9% over the observation period. Longitudinal analyses of myopic children and adolescents revealed that progression curves remained remarkably parallel, indicating no acceleration in progression rates over the last quarter-century. Peak myopia progression consistently occurred between 8 and 12 years of age. While baseline refraction was a strong predictor for developing high myopia, environmental factors such as urbanicity and socioeconomic status exerted negligible effects on longitudinal progression rates.

CONCLUSION: This 25-year large-scale analysis found no evidence of an accelerating myopia epidemic or a pandemic-associated surge in myopia progression among spectacle-wearing children and adolescents in Germany. The mean refractive error and the incidence of myopic prescriptions have remained stable or even exhibited a slight hyperopic shift in recent cohorts, suggesting that regional environmental and lifestyle factors may effectively mitigate global myopization trends in this population.