August 31, 2026
By Charles Morris
A decade after the paper that reorganized the field, the man who built its projection went back to the model. It held.
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In 2016, a team of researchers published a projection the vision industry could not unsee. By 2050, they calculated, nearly half the world’s population, 4.76 billion people, would be myopic. Nearly one billion of them would be high myopes, facing an elevated risk of retinal detachment, glaucoma and irreversible blindness.1 The headline wrote itself: 50% by 2050.
What most people don’t realize is that the team didn’t set out to land on 50%.
“It was fascinating the number would round out so perfectly as 50%,” says Dr. Monica Jong, one of the paper’s co-authors and now head of medical affairs, North America, at EssilorLuxottica. “That is what is truly frightening when you consider how many people will have myopia and develop the sight threatening complications in their working life.”
The figure didn’t emerge from a vacuum. For decades Professor Brien Holden and the Sydney research group that became the Brien Holden Vision Institute had watched myopia spread: first in China, then across East Asia, then everywhere. What the field lacked was a number authoritative enough to force a response.
What Holden saw that the field did not was where to look. “Most people were looking at the problem from a patient perspective,” says Professor Kovin Naidoo, who succeeded Holden as chief of the institute and now leads advocacy and partnerships at the OneSight EssilorLuxottica Foundation. “We were looking at the problem from a societal perspective—saying, what does this data mean for society?” Education was climbing across the developing world; screens were arriving everywhere. “By looking at society rather than just the individual, we were able to see that. It was not genius. It was just focusing on the right thing.”
Finding the Number
Focusing on the right thing still required a number. The dataset they assembled was unprecedented: 145 studies, 2.1 million participants, projected forward using U.N. demographic models.1
Brien Holden died in 2015, a year before the paper was published. He did not get to see what it became.
Professor Serge Resnikoff, a co-author and the former WHO medical officer who led the agency’s first global estimate of refractive error, describes a problem that had already split in two. “There are two different planets,” he says. “There’s East Asia—China, Singapore, Hong Kong, Taiwan, South Korea, Japan—maybe a third of the world population, with extremely high levels of myopia. They can’t go much higher, because it’s almost the entire population becoming myopic. Then you have the rest of the world, where it’s not growing as fast as it grew in Asia, but it is growing. The age of onset keeps going down, which leaves more time for kids to progress.”
This spring the man who built the original number answered it. At ARVO 2026, Dr. Timothy Fricke, a co-author of the 2016 study and the modeler behind its projection, presented a reanalysis: Had the curve moved?
“Yes and no,” he says. “We have adapted our models over the last 10 years. We haven’t been sitting still and sitting on the prevalence data.” This time Fricke and his collaborators modeled not just myopia prevalence but the entire distribution of refractive error, an approach that “gives a better indication of the pattern over time and the pattern between places.” The refined method offered no reprieve. “We think now that the myopia epidemic is sharper than what we expected,” he says, “affecting more people in East Asia, and less people in other places like Sub-Saharan Africa, where it happens in pockets.”
Two planets, and the gap between them widening. The destination had not moved.
The Curve Has Barely Bent
That sharpens the puzzle the field keeps circling. A decade of new treatments, and the global curve barely bent. Why? Fricke’s answer is arithmetic. “The numbers build up over time, so you’ve got to wait,” he says. Myopia control works on the young. The adults who already carry the world’s myopia are still in the count. “The older adults are still going through the system and still carrying the weight of the numbers of 10 years ago, before we had good tools for myopia control.”
For Jong, the confirmation lands as something personal. She does not dispute the model. She helped build the field that was meant to bend it. “The modeling was accurate, even with the gaps in data we had at the time, such as in Central Asia, Sub-Saharan Africa and Latin America, which we addressed using nearest-neighbor linear interpolation between age groups,” she says.1 “Even today there is a lack of data in those places. It was a very, very good model for that time.” Then a pause. “But I guess it is a little bit heartbreaking that we are still expected to have a prevalence of myopia of 50% by 2050, in spite of there being greater awareness about the risks, a whole portfolio of treatments available in different parts of the world that doctors can use.“2
Ten years later, the question isn’t whether the paper was right. It is what we did with it.
Download a PDF of a full 10-year retrospective of the BHVI paper here.
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Charles Morris is president of Red Monarch, a Phoenix marketing agency serving the vision and medical device industries. He spent seven years at CooperVision as Global Brand Director for Myopia Management and Specialty Lenses. There he led brand and product strategy for the company’s specialty contact lens portfolio across global markets. He later served as general manager for North America at RevitalVision. Morris teaches marketing at Grand Canyon University and holds an MBA from North Central College. |
References
- Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–1042.
- This content is provided for educational and informational purposes only and is not intended to promote off-label use. Readers should seek their own guidance regarding off-label treatments.
Disclosures
Charles Morris is president of Red Monarch, a Phoenix-based marketing agency serving the vision and medical device industries. He was global brand director for myopia management and specialty lenses at CooperVision from 2016 to 2024. Red Monarch currently provides marketing services to Euclid Vision Group for the Be Free® Day lens, a myopia care contact lens based on a design developed by Brien Holden and the Brien Holden Vision Institute. Dr. Monica Jong is head of medical affairs, North America, at EssilorLuxottica. Professor Kovin Naidoo is global head of advocacy and partnerships at the OneSight EssilorLuxottica Foundation, the philanthropic arm of EssilorLuxottica. Each source reviewed and approved only their own quoted material.
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