March 15, 2024
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Photo Credit: Klaus Vedfelt, Getty Images
The prevalence of myopia has increased significantly over the past few decades, with almost one in three individuals across the world impacted by this condition. While genetic factors play a role in the development of myopia, research has shown that environmental and lifestyle factors are also significant contributors. In this comprehensive narrative review, Biswas et al. (2024) explore the established and potential environmental and lifestyle factors that affect the development and progression of myopia.
The review points out that increased outdoor time is associated with a decreased risk of myopia in children. Exposure to natural light, such as sunlight, and the release of retinal dopamine are believed to be the primary reasons for this protective effect. Conversely, excessive engagement in near work, regardless of outdoor time, can worsen the onset of myopia. The exact mechanism behind this exacerbation has yet to be fully understood. Still, it appears to involve shifts in relative peripheral refraction, overstimulation of accommodation, or a complex interplay of these factors, leading to issues such as retinal image defocus, blur, and chromatic aberration.
The spatial frequency of the visual environment, circadian rhythm, sleep, nutrition, smoking, socio-economic status, and education are other potential factors that may impact the development of myopia, but their independent influences are debatable. For example, while some studies have shown a correlation between a higher level of education and myopia, others have not found any significant association.
The review concludes that the environment plays a significant role in the development and progression of myopia. Modifying key environmental factors, such as spending more time outdoors and reducing excessive engagement in near work, can prevent or slow the progression of myopia. However, the intricate connections between lifestyle and environmental factors often obscure research findings, making it challenging to disentangle their individual effects. Therefore, prospective studies that employ objective assessments, such as quantifying light exposure and near work, are crucial for gaining a more comprehensive understanding of how various environmental factors can be modified to prevent or slow the progression of myopia.
Overall, this review highlights the importance of environmental and lifestyle factors in the development and progression of myopia. While genetics plays a role, modifying critical environmental factors can help prevent or slow the progression of myopia. Further research is needed to gain a more comprehensive understanding of the complex interplay between various environmental and lifestyle factors and their impact on myopia development.
Abstract
The Influence of the Environment and Lifestyle on Myopia
Sayantan Biswas, Antonio El Kareh, Mariyem Qureshi, Deborah Mei Xuan Lee, Chen-Hsin Sun, Janice S.H. Lam, Seang-Mei Saw & Raymond P. Najjar
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 under‐ scores 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.
Biswas, S., El Kareh, A., Qureshi, M., Lee, D. M. X., Sun, C. H., Lam, J. S., … & Najjar, R. P. (2024). The influence of the environment and lifestyle on myopia. Journal of Physiological Anthropology, 43(1), 1-22.
DOI: https://doi.org/10.1186/s40101-024-00354-7
