Myopia has emerged as a major global public health concern with a rapidly increasing prevalence, particularly among school-aged children. The epidemiological data, experimental and clinical evidence on emmetropization, peripheral refraction, genetic predisposition, environmental influences, and progression patterns of myopia need to be understood in detail. The prevalence of myopia in Indian school-aged children ranges from 6.4% to over 21%, with urban regions showing significantly higher rates. Myopia progression occurs in approximately 48–56% of children aged 5–15 years, largely driven by axial elongation. Key risk factors include parental myopia, excessive near work, increased screen time, reduced outdoor activity, urban living, and early age of onset. Peripheral hyperopic defocus plays a critical role in ocular growth regulation, while genetic factors predominantly confer susceptibility rather than direct causation. Premyopia represents an identifiable high-risk state, where early intervention may significantly reduce future progression. Axial length should be the preferred endpoint for monitoring progression. Even modest reductions in myopia progression can substantially lower the lifetime risk of visual impairment.