The aetiology of myopia is complex, but the major form of myopia results from an interplay between genetic factors and environmental influences. Although there are clear patterns of family inheritance and high heritability values in studies from all over the world,environmental factors are increasingly important in determining myopic outcomes in East Asia, and perhaps elsewhere. This is not paradoxical, as high heritability does not preclude strong environmental influences. The lower heritability values obtained from parent-offspring correlations in populations of East Asian origin where there are marked differences in the environmental exposures (education and urbanization) of parents and children, and where there has been a major shift in the population distribution of myopia, are consistent with this view. Despite the impact of environmental pressures in East Asia, there is evidence that parental myopia influences the position of their offspring within that new population distribution.