AbstractPurposeTo investigate the origins of age‐related decreases in axial length in the literature.MethodsA literature review was performed, including all articles regarding axial length changes with age. These data were combined with mean body length and education level for the countries of each study to assess their influence in a multivariate analysis. Furthermore, analyses were performed of how optical path length, used by optical biometers to measure axial length, is affected by the known age‐related changes in the crystalline lens. The influence of other factors mentioned in the literature was also investigated.ResultsSeventeen cross‐sectional studies were found that met the search criteria. The decrease in axial length over time was consistent across most of these studies. However, when plotted as a function of year of birth, mean body length and number of years in school, the data indicated an increase in length. Multivariate analysis confirmed the influence of body length (P = 0.005) and birth year (P = 0.017), but not age (P = 0.50). Meanwhile, the lenticular changes due to aging and cataract formation cause a minor bias in the form of increased axial length measurements. Finally, a gradual thinning of the choroidal arteries was reported to cause an increase in axial length.ConclusionThe age‐related decrease in axial length is mainly associated with gradual changes in increased body length and education level, while attenuated by minor biases in measurement procedure and thinning of the choroidal arteries.