The influence of the environment and lifestyle on myopia

Abstract

Background Myopia, commonly known as near-sightedness, has emerged as a global epidemic, impacting almost one in three individuals across the world. The increasing prevalence of myopia during early childhood has heightened the risk of developing high myopia and related sight-threatening eye conditions in adulthood. This surge in myopia rates, occurring within a relatively stable genetic framework, underscores the profound influence of environmental and lifestyle factors on this condition. In this comprehensive narrative review, we shed light on both established and potential environmental and lifestyle contributors that affect the development and progression of myopia. Main body Epidemiological and interventional research has consistently revealed a compelling connection between increased outdoor time and a decreased risk of myopia in children. This protective effect may primarily be attributed to exposure to the characteristics of natural light (i.e., sunlight) and the release of retinal dopamine. Conversely, irrespective of outdoor time, excessive engagement in near work can further worsen the onset of myopia. While the exact mechanisms behind this exacerbation are not fully comprehended, it appears to involve shifts in relative peripheral refraction, the overstimulation of accommodation, or a complex interplay of these factors, leading to issues like retinal image defocus, blur, and chromatic aberration. Other potential factors like the spatial frequency of the visual environment, circadian rhythm, sleep, nutrition, smoking, socio-economic status, and education have debatable independent influences on myopia development. Conclusion The environment exerts a significant influence on the development and progression of myopia. Improving the modifiable key environmental predictors like time spent outdoors and engagement in near work can prevent or slow the progression of myopia. The intricate connections between lifestyle and environmental factors often obscure research findings, making it challenging to disentangle their individual effects. This complexity underscores the necessity for prospective studies that employ objective assessments, such as quantifying light exposure and near work, among others. These studies are crucial for gaining a more comprehensive understanding of how various environmental factors can be modified to prevent or slow the progression of myopia.

An Insight into Knowledge, Perspective, and Practices of Indian Optometrists towards Childhood Myopia

“…The consideration of the child’s age, current refractive status, and rate of progression over the past year as “very important” or “important” by the majority (>70%) of the participants was consistent with the evidence available on the factors influencing myopia development [ 8 , 23 ]. However, to consider the ethnicity, parents’ refractive status, and time spent on near work as “moderate/somewhat important” was contrary and dismissive of the available evidence.…”

“…However, to consider the ethnicity, parents’ refractive status, and time spent on near work as “moderate/somewhat important” was contrary and dismissive of the available evidence. The rate of myopia progression is faster among younger Asian children compared to other ethnicities [ 24 ], the risk of myopia is higher with one or more myopic parents [ 25 ], and clinical trials show that increasing time spent outdoors can reduce the development of myopia [ 8 , 26 ]. Over 83.7% of the respondents rightly indicated noting the family history of myopia, which, although was a relatively common practice, was lower than those reported in Australia and Spain (94.8–97.1%) [ 14 , 15 ].…”

“…Australian optometrists seem to contradict the cessation criteria with most reporting 21 or 25 years of age, with no myopic progression for 24 months as the criteria to cease active intervention [ 14 ]. Myopia typically starts and progresses during childhood and adolescence (5–16 years), making this age group pivotal for understanding early detection and management strategies [ 8 ]. However, it should be recognized that myopia can still develop and progress in adolescents and young adults (>16 years), especially in those with high near-work demands [ 38 ].…”

“…In addition, optometrists’ respective roles and competencies within each surveyed country we discussed were different, and their responses varied accordingly [ 48 ]. We limited this investigation to children aged 5–16 years, as this is the commonly reported age group when myopia develops and progresses [ 8 ]. Understanding how optometrists diagnose and manage myopia in this vulnerable age group provides deeper insights into early intervention strategies.…”

“…There is an increasing interest in myopia management and control among practitioners worldwide [ 7 ]. Although refining environmental factors and lifestyle remains the optimal strategy for preventing or postponing the development of myopia, there are now various optical and pharmacological treatments accessible to decelerate the progression of the condition [ 8 ]. An array of childhood myopia control options exists, including glasses (single, bifocal, multifocal), contact lenses (soft, rigid, orthokeratology, peripheral defocus), pharmacological (topical atropine), and lifestyle changes (increased outdoor time) [ 8 , 9 , 10 , 11 ].…”