Myopia, or nearsightedness, is a growing global public health concern, with prevalence projected to affect nearly 50% of the world’s population by 2050. The therapeutic market is expanding rapidly, with estimates suggesting it could exceed $25 billion by the early 2030s, driven by increasing incidence in children and adolescents. Current treatments focus on slowing progression, including low-dose atropine eye drops, orthokeratology lenses, multifocal contact lenses, and lifestyle modifications like increased outdoor time. Recent R&D efforts target underlying molecular mechanisms such as scleral remodeling and retinal signaling; key targets include dopamine pathways, muscarinic acetylcholine receptors (notably M1 and M4), and adenosine receptors. Preclinical studies commonly use animal models like guinea pigs, chicks, and tree shrews to investigate axial elongation and test anti-myopia agents. Novel therapeutics under investigation include selective muscarinic antagonists, dopamine agonists, and gene or light-based interventions aimed at regulating eye growth.