There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80–90%, and an accompanying high prevalence of high myopia in young adults (10–20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of “acquired” high myopia appearing around the age of 11–13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.

东亚和东南亚流行近视，年轻人中的近视患病率约为80-90％，年轻人中高度近视的患病率较高（10-20％）。由于病理性近视，这可能预示着视力低下和失明的增加。这两种流行病是相关的，因为近视的发病率越来越高，再加上高进展率，自然会引起高度近视的流行，“后天性”高度近视的患病率很高，出现在11-13岁左右。确定的主要风险因素是强化教育和有限的户外活动时间。该流行病的本地化似乎是由于该地区较高的教育压力和有限的户外活动时间，而不是由于对这些因素的遗传敏感性提高。通过随机临床试验证明了户外时间的因果关系，在这种情况下，学校户外时间的增加阻止了近视的发作。在教育压力的情况下，因果关系的证据来自在以色列东正教学校就读的犹太男孩与在宗教学校就读的姐妹以及在世俗学校就读的男孩和女孩相比，近视和高近视的患病率较高。结合在学校增加户外活动时间以减缓近视的发作以及减慢近视进展的临床方法，应可控制这种流行病，否则将对健康构成重大挑战。对学校系统的组织进行改革以减少对加快学习路径的激烈竞争也可能很重要。