Childhood myopia has become a significant global public health concern, especially in urbanized regions, with adolescent prevalence rates at 80–90%. This increase poses clinical challenges and significant socioeconomic burdens, necessitating effective prevention strategies. Recent research has demonstrated that genetic predisposition and environmental exposure, such as increased screen time, intensive near work, and reduced outdoor activity, are crucial in the onset and progression of myopia. Parental myopia and specific loci identified through genome-wide association studies (GWASs) contribute to susceptibility and disease severity; however, environmental factors can accelerate or attenuate these genetic risks. Emerging strategies have focused on integrating genomic and epigenetic information to advance personalized prevention and treatment. Therefore, childhood myopia arises from the complex gene–environment interactions. Ongoing research and policy innovation are essential to safeguard the vision and health of future generations.