The impact of myopic refractive error on anxiety and lifestyle among adolescents: A systematic review

Myopia constitutes a significant public health challenge worldwide, with estimates indicating that nearly half of the world’s population could be affected by 2050. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review analyzed 32 peer-reviewed articles published between 2020 and 2024 to evaluate associations among myopia, anxiety, and adolescent lifestyle behaviors. Results revealed a consistent dose–response pattern, indicating that adolescents with severe myopia had a 1.6-fold higher risk of anxiety compared to those without myopia. Significant risk factors included prolonged screen use (β = 0.43, p < 0.05), limited outdoor time (Odds Ratio, OR = 1.8), means that individuals with limited outdoor time were 1.8 times more likely to experience the negative outcome (or the odds of experiencing the outcome were 80% higher) compared to those without limited outdoor time, academic pressures, social stigma, and reduced self-worth. The prevalence of mood disorders was twice as high among myopic adolescents, especially in Asian urban areas with high myopia rates. These outcomes highlight clear gaps in anxiety-specific resources within vision care and draw attention to the economic consequences of unmanaged myopia. The review calls for timely and integrated public health measures and highlights evidence-based initiatives such as Singapore’s National Myopia Prevention Program, which reduced childhood myopia by 25% through structured outdoor-time policies, and India’s School Health Initiative, which lowered screen time by 30% through school-based screenings. Implementing these scalable strategies in collaboration with NGOs and in alignment with WHO guidelines is essential. Ultimately, cooperation between ocular and mental health providers is vital for addressing the growing psychological impact of myopia in young people.