Materiały źródłowe

• #1 The Science Behind Myopia – Webvision – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470669/

  Myopia (near-sightedness) is the most common refractive vision disorder in children. It is characterized by blurring of objects viewed at a distance, and is commonly the result of abnormal elongation of the eyeball which causes the refractive image formed by the cornea and the lens to fall in front of the photoreceptors of the retina. […] The underlying biological cause of myopia is unknown, and there is no widely accepted means of prevention or cure. The optical error of myopia can be corrected only by using spectacle or contact lenses or corneal surgery. If left untreated, moderate myopia is one of the leading causes of visual impairment worldwide. The greater the degree of myopia, the greater the risk of complications such as macular degeneration, retinal detachment, cataracts, and glaucoma; the risk is especially great when the negative refractive error is more negative than -6.00 D (diopters), a condition called high myopia.

• #2 Myopia – Wikipedia

  https://en.wikipedia.org/wiki/Myopia

  Myopia, also known as near-sightedness and short-sightedness, is an eye condition where light from distant objects focuses in front of, instead of on, the retina. As a result, distant objects appear blurry, while close objects appear normal. Other symptoms may include headaches and eye strain. Severe myopia is associated with an increased risk of macular degeneration, retinal detachment, cataracts, and glaucoma. […] Myopia results from the length of the eyeball growing too long or less commonly the lens being too strong. It is a type of refractive error. Diagnosis is by the use of cycloplegics during eye examination. […] The underlying cause of myopia is believed to be a combination of genetic and environmental factors. Risk factors include doing work that involves focusing on close objects, greater time spent indoors, urbanization, and a family history of the condition.

• #3 Myopia (Short-Sightedness): Symptoms, Causes, and Treatment

  https://patient.info/eye-care/short-sight-myopia

  Myopia (also known as short-sightedness or near-sightedness) is a refractive error that occurs when light coming from distant objects is 'overfocused’, so that the point of focus is in front of the retina. […] It occurs because either the eyeball is too long or, less commonly, because the cornea is too curved. Despite maximum flattening of the lens, the eye is not able to focus the light rays further back and on to the retina. […] In myopia, the eye focuses light from near objects more effectively than light from objects further away. This means that short-sighted people can see close objects clearly because the light rays from these objects enter the eyes at an angle and focus correctly on the retina. In contrast, distant objects appear more blurry as their light rays do not focus properly in the eye.

• #4 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4

  Myopia is a common refractive error, characterized by an excessive increase in axial length relative to the refractive power of the eye. […] Despite much research, the mechanisms underlying the development of myopia are unknown. […] A large body of work on animal models (such as chicks, guinea pigs, and monkeys) has been instrumental to our understanding of visually guided ocular growth, and potential mechanisms leading to myopia. […] Ocular changes in response to form-deprivation and lens induced defocus are primarily associated with changes in axial length (mainly due to changes in vitreous chamber depth) and choroidal thickness. […] Physiological changes in retinal cells and neurotransmitters (such as dopamine), presence of ocular aberrations, altered accommodative response to visual stimuli, and even subtle variations in natural circadian rhythms of axial length may all influence ocular growth, and hence susceptibility to myopia.

• #5 Lesson: Mechanisms of Myopia: What We Know & What We Wonder

  https://www.revieweducationgroup.com/ce/mechanisms-of-myopia-what-we-know-and-what-we-wonder

  Myopia is a result of a mismatch between the refractive power of the eye and its axial length, most commonly from the eye growing too long. […] With an increase in prevalence and severity, the interest in the pathophysiology and mechanisms of myopia follows. […] While there has been an exponential increase in myopia literature over the last few decades, the main focus has been on slowing myopia progression. And so, there are still several unknowns regarding the pathophysiology of this condition and the roles both genetics and the environment play in myopia development and progression. […] Higher-order aberrations (HOAs) can degrade retinal image quality and may interact with lower-order aberrations to change the optics of the eye. These changes may play a role in refractive development and the emmetropization process.

• #6 Myopia (Short-Sightedness): Symptoms, Causes, and Treatment

  https://patient.info/eye-care/short-sight-myopia

  Myopia (also known as short-sightedness or near-sightedness) is a refractive error that occurs when light coming from distant objects is 'overfocused’, so that the point of focus is in front of the retina. […] It occurs because either the eyeball is too long or, less commonly, because the cornea is too curved. Despite maximum flattening of the lens, the eye is not able to focus the light rays further back and on to the retina. […] In myopia, the eye focuses light from near objects more effectively than light from objects further away. This means that short-sighted people can see close objects clearly because the light rays from these objects enter the eyes at an angle and focus correctly on the retina. In contrast, distant objects appear more blurry as their light rays do not focus properly in the eye.

• #7 Near-sightedness Facts for Kids

  https://kids.kiddle.co/Near-sightedness

  Near-sightedness, also known as myopia and short-sightedness, is an eye disease where light focuses in front of, instead of on, the retina. […] Myopia results from the length of the eyeball growing too long or less commonly the lens being too strong. It is a type of refractive error. Diagnosis is by eye examination. […] The underlying cause is believed to be a combination of genetic and environmental factors. Risk factors include doing work that involves focusing on close objects, greater time spent indoors, urbanization, and a family history of the condition. […] Because myopia is a refractive error, the physical cause of myopia is comparable to any optical system that is out of focus. Borish and Duke-Elder classified myopia by these physical causes: Axial myopia is attributed to an increase in the eye’s axial length; Refractive myopia is attributed to the condition of the refractive elements of the eye.

• #8 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4

  Studies have found a strong correlation between the rapid reduction in hyperopia and the changes in axial length during early ocular development. […] Together, these studies suggest that axial length is the most influential factor for emmetropization in human eyes. […] The choroid is typically thinner in myopic compared to non-myopic eyes (most pronounced at the fovea) and thins with increasing myopia and axial length in both adults and children. […] Significant choroidal thinning is also observed in high myopia (6.00 D) or eyes with posterior staphyloma, and has been associated with the presence of lacquer cracks, choroidal neovascularization, and reduced visual acuity. […] The choroid also appears to be a biomarker of ocular processes regulating eye growth given that the central macular choroid thins during the initial development and progression of myopia and thickens in response to imposed peripheral myopic retinal image defocus, topical anti-muscarinic agents, and increased light exposure.

• #9 The influence of the environment and lifestyle on myopia | Journal of Physiological Anthropology | Full Text

  https://jphysiolanthropol.biomedcentral.com/articles/10.1186/s40101-024-00354-7

  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. […] Myopia or near-sightedness is a refractive error that is predominantly caused by a mismatch between the optical power of ocular components (i.e., the cornea and the crystalline lens) and the axial length (AL) of the eye whereby light entering the eye is focused anterior to (in front of) the retina, leading to the blurred vision of distant images. […] This excessive axial elongation is hypothesized to trigger sub-foveal chorio-retinal stretching, increasing the risk of sight-threatening ocular diseases such as posterior staphyloma, retinal degeneration, and glaucoma.

• #10 Myopia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK580529/

  Myopia, or nearsightedness, is the most common refractive error in children and young adults. […] The classification of myopia is essential for its appropriate management. Axial myopia is the most common type observed in clinical practice and is caused by an increase in the axial length of the globe. A 1-mm increase in the axial length correlates with a myopic shift of 3 D, also known as spherical myopia. […] The crystalline lens undergoes substantial modifications with age, eventually contributing to changes in refractive error. Thus, the lenticular component should be examined for any myopic progression in adults. The severity of myopia is categorized as mild (between 0.5 and 4 D), moderate (between 4 and 8 D), and severe ( 8 D).

• #11 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4

  Studies have found a strong correlation between the rapid reduction in hyperopia and the changes in axial length during early ocular development. […] Together, these studies suggest that axial length is the most influential factor for emmetropization in human eyes. […] The choroid is typically thinner in myopic compared to non-myopic eyes (most pronounced at the fovea) and thins with increasing myopia and axial length in both adults and children. […] Significant choroidal thinning is also observed in high myopia (6.00 D) or eyes with posterior staphyloma, and has been associated with the presence of lacquer cracks, choroidal neovascularization, and reduced visual acuity. […] The choroid also appears to be a biomarker of ocular processes regulating eye growth given that the central macular choroid thins during the initial development and progression of myopia and thickens in response to imposed peripheral myopic retinal image defocus, topical anti-muscarinic agents, and increased light exposure.

• #12 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] The vitamin A derivative, all-trans-retinoic acid (atRA) may be an important component for the control of postnatal ocular growth. […] Evidence is now emerging that nitric oxide (NO) may play a significant role in the postnatal control of ocular growth and myopia development. […] Many studies over the past 50 years have suggested that circadian rhythms may play a role in the control of ocular growth. […] The rate of growth of the chicken eye is largely determined by the rate of synthesis of the extracellular matrix proteoglycan aggrecan by scleral chondrocytes. […] These results strongly support the observation that diurnal rhythms in scleral extracellular matrix synthesis underlie the diurnal rhythms in axial length in chicks. […] The human choroid exhibits a similar rhythm in thickness, with the choroid being significantly thicker at night and thinner in the daytime.

• #13 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4

  Studies have found a strong correlation between the rapid reduction in hyperopia and the changes in axial length during early ocular development. […] Together, these studies suggest that axial length is the most influential factor for emmetropization in human eyes. […] The choroid is typically thinner in myopic compared to non-myopic eyes (most pronounced at the fovea) and thins with increasing myopia and axial length in both adults and children. […] Significant choroidal thinning is also observed in high myopia (6.00 D) or eyes with posterior staphyloma, and has been associated with the presence of lacquer cracks, choroidal neovascularization, and reduced visual acuity. […] The choroid also appears to be a biomarker of ocular processes regulating eye growth given that the central macular choroid thins during the initial development and progression of myopia and thickens in response to imposed peripheral myopic retinal image defocus, topical anti-muscarinic agents, and increased light exposure.

• #14 The Science Behind Myopia – Webvision – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470669/

  The most common form of myopia is school-age myopia; this is the form that will be discussed in this chapter, and it will be called simply myopia from this point on. It progresses slowly, and usually stabilizes by the age of 20. The retina looks normal. Recently, is has been projected that 2.5 billion people (1/3 of the worlds population) will have some degree of myopia by 2030. […] There have been attempts to identify genes that may be important in myopia development. Genome-wide association studies (GWAS), which examine genetic variations between individuals to determine whether certain variants are associated with a specific trait (in this case myopia), have identified correlations between variations in certain genes and an increased risk of myopia. […] It is reasonable to assume that genes play a part in myopia risk, but they alone cannot account for the rapid changes in myopia prevalence that are being observed all over the world, nor for the dramatic differences in myopia prevalence within the same ethnic populations in urban vs. rural environments, for example. Thus, the underlying cause of spontaneous-onset myopia is most likely to be a combination of genes and environmental triggers.

• #15 Myopia in Children: Epidemiology, Genetics, and Emerging Therapies for Treatment and Prevention

  https://www.mdpi.com/2227-9067/11/12/1446

  Refractive errors, particularly myopia, are among the most prevalent visual impairments globally, with rising incidence in children and adolescents. […] We provide an overview of key genetic factors and molecular pathways driving the pathogenesis of myopia and other refractive errors, emphasizing the complex interplay between genetic predisposition and environmental triggers. Understanding the underlying mechanisms is crucial for identifying new strategies for intervention. […] The pathogenesis of these conditions lies in a combination of genetic, epigenetic, and environmental factors. […] Refractive errors are characterized by intricate genetic and molecular mechanisms. […] Progress in genetic studies and molecular research has yielded vital insights into the mechanisms that underlie these disorders.

• #16 Myopia in Children: Epidemiology, Genetics, and Emerging Therapies for Treatment and Prevention

  https://www.mdpi.com/2227-9067/11/12/1446

  The hereditary influence on myopia is extensively documented, with a greater occurrence reported in persons who have a familial background of the disease. […] Genetic investigations have discovered many loci (MYP1-MYP28) linked to myopia, mostly through the inheritance pattern of autosomal dominance. […] Genome-wide association studies (GWASs) have enhanced our comprehension of the genetic makeup of myopia, revealing a considerable number of genomic polymorphic loci linked to the condition in various populations. […] Recent progress in genetic research has discovered more related loci and potential genes that are linked to myopia, enhancing our comprehension of this intricate characteristic. […] The evolution of myopia is governed by intricate biochemical pathways that involve neurotransmitters and growth hormones.

• #17 The Science Behind Myopia by Brittany J. Carr and William K. Stell – Webvision

  https://webvision.med.utah.edu/book/part-xvii-refractive-errors/the-science-behind-myopia-by-brittany-j-carr-and-william-k-stell/

  The most common form of myopia is school-age myopia; this is the form that will be discussed in this chapter, and it will be called simply myopia from this point on. […] Recently, is has been projected that 2.5 billion people (1/3 of the worlds population) will have some degree of myopia by 2030. […] There have been attempts to identify genes that may be important in myopia development. […] The recently published Consortium for Refractive Error And Myopia (CREAM) study is the largest international genome-wide meta-analysis on myopia and refractive error ever conducted. […] Thus, the CREAM study provided significant evidence that the risk of developing myopia may be affected by many unrelated genetic abnormalities, instead of a single underlying cause. […] It is reasonable to assume that genes play a part in myopia risk, but they alone cannot account for the rapid changes in myopia prevalence that are being observed all over the world, nor for the dramatic differences in myopia prevalence within the same ethnic populations in urban vs. rural environments.

• #18 The Science Behind Myopia by Brittany J. Carr and William K. Stell – Webvision

  https://webvision.med.utah.edu/book/part-xvii-refractive-errors/the-science-behind-myopia-by-brittany-j-carr-and-william-k-stell/

  The most common form of myopia is school-age myopia; this is the form that will be discussed in this chapter, and it will be called simply myopia from this point on. […] Recently, is has been projected that 2.5 billion people (1/3 of the worlds population) will have some degree of myopia by 2030. […] There have been attempts to identify genes that may be important in myopia development. […] The recently published Consortium for Refractive Error And Myopia (CREAM) study is the largest international genome-wide meta-analysis on myopia and refractive error ever conducted. […] Thus, the CREAM study provided significant evidence that the risk of developing myopia may be affected by many unrelated genetic abnormalities, instead of a single underlying cause. […] It is reasonable to assume that genes play a part in myopia risk, but they alone cannot account for the rapid changes in myopia prevalence that are being observed all over the world, nor for the dramatic differences in myopia prevalence within the same ethnic populations in urban vs. rural environments.

• #19 The Science Behind Myopia – Webvision – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470669/

  To understand the roles of environmental risk factors for the cause of myopia, scientists have turned to animal models. The results have demonstrated clearly that, while genetics may determine myopia susceptibility, environmental factors are powerful modifiers of eye growth, and they may override genetic predispositions. […] That we can experimentally-induce myopia in young, rapidly growing animals tells us that the visual environment plays an important role in regulation of eye growth. […] Myopia-inducing stimuli require prolonged exposures (days-weeks) for a significant effect. […] The first reported case of myopia in experimental animals was observed serendipitously in non-human primates, during investigations into the cortical effects of monocular visual deprivation in young macaques.

• #20 The Science Behind Myopia by Brittany J. Carr and William K. Stell – Webvision

  https://webvision.med.utah.edu/book/part-xvii-refractive-errors/the-science-behind-myopia-by-brittany-j-carr-and-william-k-stell/

  Thus, the underlying cause of spontaneous-onset myopia is most likely to be a combination of genes and environmental triggers. […] To understand the roles of environmental risk factors for the cause of myopia, scientists have turned to animal models. […] The establishment of this form-deprivation model of myopia in primates led to parallel studies of experimentally-induced myopia in young tree shrews and chickens. […] That we can experimentally-induce myopia in young, rapidly growing animals tells us that the visual environment plays an important role in regulation of eye growth. […] Applying goggles over the eye works even when the optic nerve has been cut, which tells us that the eye alone or more specifically, a specialized sensorineural tissue in the eye called the retina can discriminate whether the image is well focussed or not, and act locally to mediate optically-induced changes in eye growth.

• #21 Myopia (nearsightedness) | AOA

  https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/myopia

  Myopia occurs if the eyeball is too long or the cornea (the clear front cover of the eye) is too curved. As a result, the light entering the eye isn’t focused correctly, and distant objects look blurred. […] While the exact cause of myopia is unknown, there is significant evidence that many people inherit myopia, or at least the tendency to develop myopia. […] Individuals who spend considerable time reading, working at a computer, playing video games or doing other intense close visual work may be more likely to develop myopia. […] Myopia may also occur due to environmental factors or other health problems. […] People who do an excessive amount of near-vision work may experience a false or „pseudo” myopia. Their blurred distance vision is caused by overuse of the eyes’ focusing mechanism.

• #22 Myopia (nearsightedness) | AOA

  https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/myopia

  However, constant visual stress may lead to a permanent reduction in distance vision over time. […] Symptoms of myopia may also be a sign of variations in blood sugar levels in people with diabetes or maybe an early indication of a developing cataract. […] Because the eye continues to grow during childhood, it typically progresses until about age 20. However, myopia may also develop in adults due to visual stress or health conditions such as diabetes. […] Laser procedures such as LASIK (laser in situ keratomileusis) or PRK (photorefractive keratectomy) are also possible treatment options for myopia in adults. […] People who are highly nearsighted or whose corneas are too thin for laser procedures may be able to have their myopia surgically corrected. […] Vision therapy is an option for people whose blurred distance vision is caused by a spasm of the muscles that control eye focusing. […] Children who are at high risk of progressive myopia (family history, early age of onset, and extended periods of near work) may benefit from treatment options that have been shown to reduce the progression of myopia.

• #23 Lesson: Mechanisms of Myopia: What We Know & What We Wonder

  https://www.revieweducationgroup.com/ce/mechanisms-of-myopia-what-we-know-and-what-we-wonder

  It has been thought that there are academic pressures and more intense schooling undertaken by East Asian populations that could contribute to the higher prevalence of myopia among this group. […] While there is a relationship between myopia and near work, it is potentially the intensity rather than the total duration of near work that is the primary driver. […] The primary theory behind high-light intensity is that brighter light triggers increased dopamine release from the retina, which slows axial elongation. […] Ultimately, a recommendation of two hours per day of outdoor time should be made to pre-myopic children. […] A summary of four randomized controlled trials done in East Asia shows that increased outdoor time reduces myopia incidence by 5% to 10% but has little effect on slowing progression. […] Despite several advances in the understanding of myopia development and progression, there are still many unknowns. […] To answer the age-old question of nature vs. nurture, there are aspects of both genetics and environment that play a role in myopia development.

• #24 What Is Myopia | AAOMC

  https://aaomc.org/patients/what-is-myopia/

  Working at near distances can result in the development of myopia. Introduction of school systems in cultures in which they did not previously exist has resulted in greater incidence of myopia. Occupations dealing with intense near point activity lead to further myopic development. Cross sectioned studies have found associations between near work and myopia progression. Children are especially susceptible to near work causing myopia. Young adults ages 20-30 years have developed late onset of myopia that has coincided with beginning intense near work and in many cases, using a computer. […] Esophoria is a risk factor in myopia development in children. Esophoria results in larger accommodative lag, resulting in retinal blur. Esophoria is a condition where the eyes tend to turn inward excessively when doing near tasks. The Orinda Longitudinal Study of Myopia found that parental history of myopia is the predominant factor for myopic development which is not due to myopic parents having an effect on near work activity.

• #25

  https://link.springer.com/article/10.1007/s40123-022-00490-2

  The mechanism of myopia prevention through outdoor activity is most likely related to outdoor light exposure because studies have found that both axial growth and myopia progression are slower during summer months. […] A potential link exists between light luminance and myopia. […] The relationship between light exposure and the control of myopia was subsequently validated in FDM models in monkeys and mice by Smith et al. […] Longitudinal studies and randomized controlled trials have demonstrated that the risk of myopia onset and its progression are decreased in children and adolescents who spend more time outdoors. […] Artificially increases in light exposure may also reduce the progression of myopia, as was demonstrated in an experiment using light therapy glasses for young adults, which revealed that this therapy resulted in a slightly thickened choroid.

• #26 Lesson: Mechanisms of Myopia: What We Know & What We Wonder

  https://www.revieweducationgroup.com/ce/mechanisms-of-myopia-what-we-know-and-what-we-wonder

  It has been thought that there are academic pressures and more intense schooling undertaken by East Asian populations that could contribute to the higher prevalence of myopia among this group. […] While there is a relationship between myopia and near work, it is potentially the intensity rather than the total duration of near work that is the primary driver. […] The primary theory behind high-light intensity is that brighter light triggers increased dopamine release from the retina, which slows axial elongation. […] Ultimately, a recommendation of two hours per day of outdoor time should be made to pre-myopic children. […] A summary of four randomized controlled trials done in East Asia shows that increased outdoor time reduces myopia incidence by 5% to 10% but has little effect on slowing progression. […] Despite several advances in the understanding of myopia development and progression, there are still many unknowns. […] To answer the age-old question of nature vs. nurture, there are aspects of both genetics and environment that play a role in myopia development.

• #27 The influence of the environment and lifestyle on myopia | Journal of Physiological Anthropology | Full Text

  https://jphysiolanthropol.biomedcentral.com/articles/10.1186/s40101-024-00354-7

  Exposure to both long-term and short-term light of moderate levels of illumination induces a significant reduction in axial elongation and an increase in choroidal thickness in young adults. […] DA, a neuromodulator, is the most widely studied neurotransmitter and is proposed to influence eye growth and the emmetropization process. […] DA is released by the amacrine and/or inter-plexiform cells of the retina and has a dose-response relationship with the intensity of light. […] Overall, there is a lack of consistency in the results possibly due to differences in study design and cohort of choice.

• #28 Lesson: Mechanisms of Myopia: What We Know & What We Wonder

  https://www.revieweducationgroup.com/ce/mechanisms-of-myopia-what-we-know-and-what-we-wonder

  It has been thought that there are academic pressures and more intense schooling undertaken by East Asian populations that could contribute to the higher prevalence of myopia among this group. […] While there is a relationship between myopia and near work, it is potentially the intensity rather than the total duration of near work that is the primary driver. […] The primary theory behind high-light intensity is that brighter light triggers increased dopamine release from the retina, which slows axial elongation. […] Ultimately, a recommendation of two hours per day of outdoor time should be made to pre-myopic children. […] A summary of four randomized controlled trials done in East Asia shows that increased outdoor time reduces myopia incidence by 5% to 10% but has little effect on slowing progression. […] Despite several advances in the understanding of myopia development and progression, there are still many unknowns. […] To answer the age-old question of nature vs. nurture, there are aspects of both genetics and environment that play a role in myopia development.

• #29 Lesson: Mechanisms of Myopia: What We Know & What We Wonder

  https://www.revieweducationgroup.com/ce/mechanisms-of-myopia-what-we-know-and-what-we-wonder

  It has been thought that there are academic pressures and more intense schooling undertaken by East Asian populations that could contribute to the higher prevalence of myopia among this group. […] While there is a relationship between myopia and near work, it is potentially the intensity rather than the total duration of near work that is the primary driver. […] The primary theory behind high-light intensity is that brighter light triggers increased dopamine release from the retina, which slows axial elongation. […] Ultimately, a recommendation of two hours per day of outdoor time should be made to pre-myopic children. […] A summary of four randomized controlled trials done in East Asia shows that increased outdoor time reduces myopia incidence by 5% to 10% but has little effect on slowing progression. […] Despite several advances in the understanding of myopia development and progression, there are still many unknowns. […] To answer the age-old question of nature vs. nurture, there are aspects of both genetics and environment that play a role in myopia development.

• #30 Lesson: Mechanisms of Myopia: What We Know & What We Wonder

  https://www.revieweducationgroup.com/ce/mechanisms-of-myopia-what-we-know-and-what-we-wonder

  It has been thought that there are academic pressures and more intense schooling undertaken by East Asian populations that could contribute to the higher prevalence of myopia among this group. […] While there is a relationship between myopia and near work, it is potentially the intensity rather than the total duration of near work that is the primary driver. […] The primary theory behind high-light intensity is that brighter light triggers increased dopamine release from the retina, which slows axial elongation. […] Ultimately, a recommendation of two hours per day of outdoor time should be made to pre-myopic children. […] A summary of four randomized controlled trials done in East Asia shows that increased outdoor time reduces myopia incidence by 5% to 10% but has little effect on slowing progression. […] Despite several advances in the understanding of myopia development and progression, there are still many unknowns. […] To answer the age-old question of nature vs. nurture, there are aspects of both genetics and environment that play a role in myopia development.

• #31 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] The vitamin A derivative, all-trans-retinoic acid (atRA) may be an important component for the control of postnatal ocular growth. […] Evidence is now emerging that nitric oxide (NO) may play a significant role in the postnatal control of ocular growth and myopia development. […] Many studies over the past 50 years have suggested that circadian rhythms may play a role in the control of ocular growth. […] The rate of growth of the chicken eye is largely determined by the rate of synthesis of the extracellular matrix proteoglycan aggrecan by scleral chondrocytes. […] These results strongly support the observation that diurnal rhythms in scleral extracellular matrix synthesis underlie the diurnal rhythms in axial length in chicks. […] The human choroid exhibits a similar rhythm in thickness, with the choroid being significantly thicker at night and thinner in the daytime.

• #32 Myopia: why the retina stops inhibiting eye growth | Scientific Reports

  https://www.nature.com/articles/s41598-022-26323-7

  In myopia, the eye grows too long, and the image projected on the retina is poorly focused when subjects look at a distance. […] A major step in the understanding of myopia was that axial eye growth is controlled almost exclusively by the retina. […] Strikingly, the eyes of young subjects who were already myopic did not respond at all showing that their retina could no longer decode the sign of defocus based on LCA. […] Our results demonstrate for the first time that the human retina uses the difference in focus in the blue and the red to determine the sign of defocus for emmetropization. Strikingly, this function is lost in myopes. […] While we had previously found that the myopic human retina has limited ability to respond to imposed positive defocus, the current results show now that the myopic retina has lost the ability to respond to longitudinal chromatic aberration.

• #33 The Science Behind Myopia by Brittany J. Carr and William K. Stell – Webvision

  https://webvision.med.utah.edu/book/part-xvii-refractive-errors/the-science-behind-myopia-by-brittany-j-carr-and-william-k-stell/

  Thus, the underlying cause of spontaneous-onset myopia is most likely to be a combination of genes and environmental triggers. […] To understand the roles of environmental risk factors for the cause of myopia, scientists have turned to animal models. […] The establishment of this form-deprivation model of myopia in primates led to parallel studies of experimentally-induced myopia in young tree shrews and chickens. […] That we can experimentally-induce myopia in young, rapidly growing animals tells us that the visual environment plays an important role in regulation of eye growth. […] Applying goggles over the eye works even when the optic nerve has been cut, which tells us that the eye alone or more specifically, a specialized sensorineural tissue in the eye called the retina can discriminate whether the image is well focussed or not, and act locally to mediate optically-induced changes in eye growth.

• #34 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  These results suggest a common fundamental pathway that exists across all species that controls refractive eye growth and can be disrupted by similar visual stimuli. […] The signaling pathways that modulate visually driven eye growth have remained elusive. […] The current understanding is that a signaling pathway is initiated with visual stimuli in the retina. […] Each of these structures is covered below to consider how the structure and function of the retina, RPE, choroid, and sclera could align with a role in the signaling cascade for refractive eye growth. […] The retina has been shown to encode critical image features that have been linked to eye-growth regulation (including luminance, wavelength, and spatial contrast). […] Thus, post-retinal processing is not required for retinal images to affect eye growth.

• #35 The Science Behind Myopia by Brittany J. Carr and William K. Stell – Webvision

  https://webvision.med.utah.edu/book/part-xvii-refractive-errors/the-science-behind-myopia-by-brittany-j-carr-and-william-k-stell/

  The complementary effects of positive and negative defocus reveal that the eye most probably the retina itself can discriminate between positive and negative defocus, as well as between unfocussed blur and blur due to negative lens treatment. […] Myopia-inducing stimuli require prolonged exposures for a significant effect. […] The first reported case of myopia in experimental animals was observed serendipitously in non-human primates, during investigations into the cortical effects of monocular visual deprivation in young macaques. […] The establishment of this form-deprivation model of myopia in primates led to parallel studies of experimentally-induced myopia in young tree shrews and chickens. […] The mechanism through which intense light may prevent myopia is unknown, but we can use animal models to investigate the signalling molecules that may be involved.

• #36 Is Nearsightedness Due to the Eyeball Being Too Long?

  https://www.allaboutvision.com/conditions/myopia/length-of-eye/

  Hyperopic defocus has been associated with increased axial length. […] Slowing down the growth of the eyeball is important because high axial myopia (greater than 6.00 D) leads to an increased risk of vision impairment due to complications. […] The lengthening causes the retina and back of the eyeball to stretch. This results in thinning and degenerative changes to the retina, choroid and sclera. These changes can lead to permanent vision impairment and blindness. […] Lifestyle changes and strategies to slow myopia progression may help to slow axial elongation of the eyeball and decrease the risk of complications related to myopia.

• #37 Myopia: why the retina stops inhibiting eye growth | Scientific Reports

  https://www.nature.com/articles/s41598-022-26323-7

  In myopia, the eye grows too long, and the image projected on the retina is poorly focused when subjects look at a distance. […] A major step in the understanding of myopia was that axial eye growth is controlled almost exclusively by the retina. […] Strikingly, the eyes of young subjects who were already myopic did not respond at all showing that their retina could no longer decode the sign of defocus based on LCA. […] Our results demonstrate for the first time that the human retina uses the difference in focus in the blue and the red to determine the sign of defocus for emmetropization. Strikingly, this function is lost in myopes. […] While we had previously found that the myopic human retina has limited ability to respond to imposed positive defocus, the current results show now that the myopic retina has lost the ability to respond to longitudinal chromatic aberration.

• #38 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  Diverse lines of evidence explored in this section reinforce the prevailing view that the retina is essential for encoding retinal image features that affect eye growth. […] A growing body of work indicates that dopamine signaling in the retina is necessary for emmetropization and that the release of dopamine by DACs is protective for myopia development. […] Taken together, these studies suggest that DA receptor activation is needed for normal refractive eye growth under challenging/abnormal visual conditions. […] The RPE has been implicated in refractive eye development, as it is located immediately adjacent to the retina, where it can relay any retina-derived growth regulatory signals to the choroid and sclera. […] The choroid is a complex tissue, consisting of a rich blood supply, lymphatic vessels, stromal cells, intrinsic choroidal neurons, extravascular smooth muscle, and axons of sympathetic, parasympathetic, and sensory neurons.

• #39

  https://link.springer.com/article/10.1007/s40123-022-00490-2

  Among the mechanisms linking myopia and light intensity, the most widely considered hypothesis is that bright light increases the synthesis and release of DA in the retina, and thus potentially affects ocular growth. […] The release of DA is amplified in a linear manner by light stimulation over four log units of intensity, and the DA of the retina may induce choroidal thickening and ocular growth inhibition via the release of NO from the retina or choroid and thus slowing the development of myopia. […] The axial length of eyes and choroidal thickness experience opposite and subtle changes with circadian rhythms and can be disrupted in DIM modes, and this result adds to the evidence indicating that optical defocus could play an important role in defining the axial length and choroidal thickness.

• #40 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  Diverse lines of evidence explored in this section reinforce the prevailing view that the retina is essential for encoding retinal image features that affect eye growth. […] A growing body of work indicates that dopamine signaling in the retina is necessary for emmetropization and that the release of dopamine by DACs is protective for myopia development. […] Taken together, these studies suggest that DA receptor activation is needed for normal refractive eye growth under challenging/abnormal visual conditions. […] The RPE has been implicated in refractive eye development, as it is located immediately adjacent to the retina, where it can relay any retina-derived growth regulatory signals to the choroid and sclera. […] The choroid is a complex tissue, consisting of a rich blood supply, lymphatic vessels, stromal cells, intrinsic choroidal neurons, extravascular smooth muscle, and axons of sympathetic, parasympathetic, and sensory neurons.

• #41 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] The vitamin A derivative, all-trans-retinoic acid (atRA) may be an important component for the control of postnatal ocular growth. […] Evidence is now emerging that nitric oxide (NO) may play a significant role in the postnatal control of ocular growth and myopia development. […] Many studies over the past 50 years have suggested that circadian rhythms may play a role in the control of ocular growth. […] The rate of growth of the chicken eye is largely determined by the rate of synthesis of the extracellular matrix proteoglycan aggrecan by scleral chondrocytes. […] These results strongly support the observation that diurnal rhythms in scleral extracellular matrix synthesis underlie the diurnal rhythms in axial length in chicks. […] The human choroid exhibits a similar rhythm in thickness, with the choroid being significantly thicker at night and thinner in the daytime.

• #42 The Science Behind Myopia – Webvision – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470669/

  The mechanism of NO-mediated prevention of myopia remains to be elucidated. Increased retinal NO acts as a signal for light-adaptation, and retinal NO synthesis is increased under intense illumination. […] The investigation of the role of NO as a regulator of eye growth is still in its early stages, but preliminary results are promising. Non-specific inhibitors of NO synthesis cause transient thinning of the choroid, a change correlated with myopiagenesis.

• #43 The Science Behind Myopia – Webvision – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470669/

  The mechanism of NO-mediated prevention of myopia remains to be elucidated. Increased retinal NO acts as a signal for light-adaptation, and retinal NO synthesis is increased under intense illumination. […] The investigation of the role of NO as a regulator of eye growth is still in its early stages, but preliminary results are promising. Non-specific inhibitors of NO synthesis cause transient thinning of the choroid, a change correlated with myopiagenesis.

• #44 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4

  Studies have found a strong correlation between the rapid reduction in hyperopia and the changes in axial length during early ocular development. […] Together, these studies suggest that axial length is the most influential factor for emmetropization in human eyes. […] The choroid is typically thinner in myopic compared to non-myopic eyes (most pronounced at the fovea) and thins with increasing myopia and axial length in both adults and children. […] Significant choroidal thinning is also observed in high myopia (6.00 D) or eyes with posterior staphyloma, and has been associated with the presence of lacquer cracks, choroidal neovascularization, and reduced visual acuity. […] The choroid also appears to be a biomarker of ocular processes regulating eye growth given that the central macular choroid thins during the initial development and progression of myopia and thickens in response to imposed peripheral myopic retinal image defocus, topical anti-muscarinic agents, and increased light exposure.

• #45 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4

  Studies have found a strong correlation between the rapid reduction in hyperopia and the changes in axial length during early ocular development. […] Together, these studies suggest that axial length is the most influential factor for emmetropization in human eyes. […] The choroid is typically thinner in myopic compared to non-myopic eyes (most pronounced at the fovea) and thins with increasing myopia and axial length in both adults and children. […] Significant choroidal thinning is also observed in high myopia (6.00 D) or eyes with posterior staphyloma, and has been associated with the presence of lacquer cracks, choroidal neovascularization, and reduced visual acuity. […] The choroid also appears to be a biomarker of ocular processes regulating eye growth given that the central macular choroid thins during the initial development and progression of myopia and thickens in response to imposed peripheral myopic retinal image defocus, topical anti-muscarinic agents, and increased light exposure.

• #46

  https://link.springer.com/article/10.1007/s40123-022-00490-2

  Among the mechanisms linking myopia and light intensity, the most widely considered hypothesis is that bright light increases the synthesis and release of DA in the retina, and thus potentially affects ocular growth. […] The release of DA is amplified in a linear manner by light stimulation over four log units of intensity, and the DA of the retina may induce choroidal thickening and ocular growth inhibition via the release of NO from the retina or choroid and thus slowing the development of myopia. […] The axial length of eyes and choroidal thickness experience opposite and subtle changes with circadian rhythms and can be disrupted in DIM modes, and this result adds to the evidence indicating that optical defocus could play an important role in defining the axial length and choroidal thickness.

• #47 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink

  https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4

  Studies have found a strong correlation between the rapid reduction in hyperopia and the changes in axial length during early ocular development. […] Together, these studies suggest that axial length is the most influential factor for emmetropization in human eyes. […] The choroid is typically thinner in myopic compared to non-myopic eyes (most pronounced at the fovea) and thins with increasing myopia and axial length in both adults and children. […] Significant choroidal thinning is also observed in high myopia (6.00 D) or eyes with posterior staphyloma, and has been associated with the presence of lacquer cracks, choroidal neovascularization, and reduced visual acuity. […] The choroid also appears to be a biomarker of ocular processes regulating eye growth given that the central macular choroid thins during the initial development and progression of myopia and thickens in response to imposed peripheral myopic retinal image defocus, topical anti-muscarinic agents, and increased light exposure.

• #48 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] The vitamin A derivative, all-trans-retinoic acid (atRA) may be an important component for the control of postnatal ocular growth. […] Evidence is now emerging that nitric oxide (NO) may play a significant role in the postnatal control of ocular growth and myopia development. […] Many studies over the past 50 years have suggested that circadian rhythms may play a role in the control of ocular growth. […] The rate of growth of the chicken eye is largely determined by the rate of synthesis of the extracellular matrix proteoglycan aggrecan by scleral chondrocytes. […] These results strongly support the observation that diurnal rhythms in scleral extracellular matrix synthesis underlie the diurnal rhythms in axial length in chicks. […] The human choroid exhibits a similar rhythm in thickness, with the choroid being significantly thicker at night and thinner in the daytime.

• #49 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] The vitamin A derivative, all-trans-retinoic acid (atRA) may be an important component for the control of postnatal ocular growth. […] Evidence is now emerging that nitric oxide (NO) may play a significant role in the postnatal control of ocular growth and myopia development. […] Many studies over the past 50 years have suggested that circadian rhythms may play a role in the control of ocular growth. […] The rate of growth of the chicken eye is largely determined by the rate of synthesis of the extracellular matrix proteoglycan aggrecan by scleral chondrocytes. […] These results strongly support the observation that diurnal rhythms in scleral extracellular matrix synthesis underlie the diurnal rhythms in axial length in chicks. […] The human choroid exhibits a similar rhythm in thickness, with the choroid being significantly thicker at night and thinner in the daytime.

• #50 6 Myopia Pathogenesis: From Retinal Image to Scleral Growth | Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease | The National Academies Press

  https://nap.nationalacademies.org/read/27734/chapter/8

  Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] The vitamin A derivative, all-trans-retinoic acid (atRA) may be an important component for the control of postnatal ocular growth. […] Evidence is now emerging that nitric oxide (NO) may play a significant role in the postnatal control of ocular growth and myopia development. […] Many studies over the past 50 years have suggested that circadian rhythms may play a role in the control of ocular growth. […] The rate of growth of the chicken eye is largely determined by the rate of synthesis of the extracellular matrix proteoglycan aggrecan by scleral chondrocytes. […] These results strongly support the observation that diurnal rhythms in scleral extracellular matrix synthesis underlie the diurnal rhythms in axial length in chicks. […] The human choroid exhibits a similar rhythm in thickness, with the choroid being significantly thicker at night and thinner in the daytime.

• #51

  https://link.springer.com/article/10.1007/s40123-022-00490-2

  Among the mechanisms linking myopia and light intensity, the most widely considered hypothesis is that bright light increases the synthesis and release of DA in the retina, and thus potentially affects ocular growth. […] The release of DA is amplified in a linear manner by light stimulation over four log units of intensity, and the DA of the retina may induce choroidal thickening and ocular growth inhibition via the release of NO from the retina or choroid and thus slowing the development of myopia. […] The axial length of eyes and choroidal thickness experience opposite and subtle changes with circadian rhythms and can be disrupted in DIM modes, and this result adds to the evidence indicating that optical defocus could play an important role in defining the axial length and choroidal thickness.

• #52 The Myopia Boom Short-sightedness is reaching epidemic proportions. Some scientists think they have found a reason why. | Waldorf Today – Waldorf Employment, Teaching Jobs, Positions & Vacancies in Waldorf Schools

  https://www.waldorftoday.com/2015/03/the-myopia-boom-short-sightedness-is-reaching-epidemic-proportions-some-scientists-think-they-have-found-a-reason-why/

  What seemed to matter most was the eyes exposure to bright light. […] Yet animal experiments support the idea that light is protective. […] The leading hypothesis is that light stimulates the release of dopamine in the retina, and this neurotransmitter in turn blocks the elongation of the eye during development. […] If our system does not get a strong enough diurnal rhythm, things go out of control, says Ashby, who is now at the University of Canberra. […] Based on epidemiological studies, Ian Morgan, a myopia researcher at the Australian National University in Canberra, estimates that children need to spend around three hours per day under light levels of at least 10,000 lux to be protected against myopia. […] In 2009, Morgan set out to test whether boosting outdoor time would help to protect the eyesight of Chinese children.

• #53 Lesson: Mechanisms of Myopia: What We Know & What We Wonder

  https://www.revieweducationgroup.com/ce/mechanisms-of-myopia-what-we-know-and-what-we-wonder

  Myopia is a result of a mismatch between the refractive power of the eye and its axial length, most commonly from the eye growing too long. […] With an increase in prevalence and severity, the interest in the pathophysiology and mechanisms of myopia follows. […] While there has been an exponential increase in myopia literature over the last few decades, the main focus has been on slowing myopia progression. And so, there are still several unknowns regarding the pathophysiology of this condition and the roles both genetics and the environment play in myopia development and progression. […] Higher-order aberrations (HOAs) can degrade retinal image quality and may interact with lower-order aberrations to change the optics of the eye. These changes may play a role in refractive development and the emmetropization process.

• #54 Are we short-sighted about myopia? | Eye News

  https://www.eyenews.uk.com/features/optometry/post/are-we-short-sighted-about-myopia

  Perhaps the most compelling evidence for the mechanism behind myopia development comes from recent animal work which has shown that the eye grows axially in response to hyperopic blur in the periphery. […] Furthermore, it appears that hyperopia in childhood is a protective factor. […] Conventional single vision spectacle lenses correct central refractive error effectively, but are thought to induce further hyperopic defocus in the periphery as they do not take the axially elongated (prolate) shape of the eye / relative peripheral hyperopia into account. […] In the absence of a single causative factor, several behavioural, optical and pharmaceutical intervention strategies, with the aim of slowing myopia progression, have been proposed. […] Atropine has been known to prevent myopia development / progression since 1874. However, the mechanism by which it does this remains inconclusive. […] Recent research has shown that low dose atropine (0.01%) is also effective at preventing eye growth with significantly fewer side-effects and reduced rebound effects.

• #55 Are we short-sighted about myopia? | Eye News

  https://www.eyenews.uk.com/features/optometry/post/are-we-short-sighted-about-myopia

  Perhaps the most compelling evidence for the mechanism behind myopia development comes from recent animal work which has shown that the eye grows axially in response to hyperopic blur in the periphery. […] Furthermore, it appears that hyperopia in childhood is a protective factor. […] Conventional single vision spectacle lenses correct central refractive error effectively, but are thought to induce further hyperopic defocus in the periphery as they do not take the axially elongated (prolate) shape of the eye / relative peripheral hyperopia into account. […] In the absence of a single causative factor, several behavioural, optical and pharmaceutical intervention strategies, with the aim of slowing myopia progression, have been proposed. […] Atropine has been known to prevent myopia development / progression since 1874. However, the mechanism by which it does this remains inconclusive. […] Recent research has shown that low dose atropine (0.01%) is also effective at preventing eye growth with significantly fewer side-effects and reduced rebound effects.

• #56 All about eye glasses for myopia control | My Kids Vision

  https://www.mykidsvision.org/knowledge-centre/all-about-eye-glasses-for-myopia-control

  Single vision lenses have been shown to focus peripheral light rays behind the eye, which is believed to promote myopia progression. […] Myopia control lens designs adopt different patterns in the peripheral parts of the lens that focus light in front of the retina to act as a stop signal for eye growth, resulting in reduced myopia progression.

• #57 All about eye glasses for myopia control | My Kids Vision

  https://www.mykidsvision.org/knowledge-centre/all-about-eye-glasses-for-myopia-control

  Single vision lenses have been shown to focus peripheral light rays behind the eye, which is believed to promote myopia progression. […] Myopia control lens designs adopt different patterns in the peripheral parts of the lens that focus light in front of the retina to act as a stop signal for eye growth, resulting in reduced myopia progression.

• #58 Myopia (short-sightedness) – Vision Excellence

  https://www.visionexcellence.com.au/common-eye-conditions/myopia-short-sightedness/

  Myopia is a condition that usually begins in childhood and lasts throughout a persons life. It is a condition where the eye has developed a focussing mechanism that is too strong at the front of the eye or if the eyeball itself is too long from front to back for the light to be focussed in the correct position on the retina. Depending on the degree of the myopia, people with this condition may be able to see clearly at varying viewing distances up close but will always have difficulty seeing objects at long distance without blur. […] There has been much recent research into what actually causes myopia. The exact mechanism for an eye becoming more shortsighted is not known but recently a concept called peripheral defocus seems to play some part. This concept is quite complex but a simplified explanation is that traditional spectacles, and to a lesser extent contact lenses, makes a myopic childs vision clear by bringing the rays of light coming from long distance to a sharp focus on the macula. This gives the child good central (straight-ahead) vision but not necessarily good peripheral (at the sides) vision. This peripheral defocus seems to be a factor in causing an eye to become more shortsighted as a child gets older.

• #59 Key role for inflammation-related signaling in the pathogenesis of myopia based on evidence from proteomics analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-67337-7

  The mechanisms underlying myopia pathogenesis are not well understood. […] Cellular immune response and cytokine signaling were frequently found to be affected in both human and animal myopia studies. […] Analysis of two publicly-available proteomic datasets highlighted a potential role of the innate immune system and inflammation in myopia development, detailing specific signaling pathways involved such as Granzyme A (GzmA) and S100 family signaling in the retina, and activation of myofibroblast trans-differentiation in the sclera. […] In particular, the intraocular classical pathway and alternative pathway of the complement system were partially activated; these increases could be, at least in part, the result of structural damage to the excessively enlarged eye. […] Data from animal studies demonstrated that a wider range of biological processes, including those related to inflammation such as the LXR/RXR (function as a critical signaling node linking inflammation and immune cell function) and S100 families (known mediators of inflammation), were increased in myopia.

• #60 Key role for inflammation-related signaling in the pathogenesis of myopia based on evidence from proteomics analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-67337-7

  The mechanisms underlying myopia pathogenesis are not well understood. […] Cellular immune response and cytokine signaling were frequently found to be affected in both human and animal myopia studies. […] Analysis of two publicly-available proteomic datasets highlighted a potential role of the innate immune system and inflammation in myopia development, detailing specific signaling pathways involved such as Granzyme A (GzmA) and S100 family signaling in the retina, and activation of myofibroblast trans-differentiation in the sclera. […] In particular, the intraocular classical pathway and alternative pathway of the complement system were partially activated; these increases could be, at least in part, the result of structural damage to the excessively enlarged eye. […] Data from animal studies demonstrated that a wider range of biological processes, including those related to inflammation such as the LXR/RXR (function as a critical signaling node linking inflammation and immune cell function) and S100 families (known mediators of inflammation), were increased in myopia.

• #61 Key role for inflammation-related signaling in the pathogenesis of myopia based on evidence from proteomics analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-67337-7

  The mechanisms underlying myopia pathogenesis are not well understood. […] Cellular immune response and cytokine signaling were frequently found to be affected in both human and animal myopia studies. […] Analysis of two publicly-available proteomic datasets highlighted a potential role of the innate immune system and inflammation in myopia development, detailing specific signaling pathways involved such as Granzyme A (GzmA) and S100 family signaling in the retina, and activation of myofibroblast trans-differentiation in the sclera. […] In particular, the intraocular classical pathway and alternative pathway of the complement system were partially activated; these increases could be, at least in part, the result of structural damage to the excessively enlarged eye. […] Data from animal studies demonstrated that a wider range of biological processes, including those related to inflammation such as the LXR/RXR (function as a critical signaling node linking inflammation and immune cell function) and S100 families (known mediators of inflammation), were increased in myopia.

• #62 Key role for inflammation-related signaling in the pathogenesis of myopia based on evidence from proteomics analysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-67337-7

  The mechanisms underlying myopia pathogenesis are not well understood. […] Cellular immune response and cytokine signaling were frequently found to be affected in both human and animal myopia studies. […] Analysis of two publicly-available proteomic datasets highlighted a potential role of the innate immune system and inflammation in myopia development, detailing specific signaling pathways involved such as Granzyme A (GzmA) and S100 family signaling in the retina, and activation of myofibroblast trans-differentiation in the sclera. […] In particular, the intraocular classical pathway and alternative pathway of the complement system were partially activated; these increases could be, at least in part, the result of structural damage to the excessively enlarged eye. […] Data from animal studies demonstrated that a wider range of biological processes, including those related to inflammation such as the LXR/RXR (function as a critical signaling node linking inflammation and immune cell function) and S100 families (known mediators of inflammation), were increased in myopia.

• #63

  https://journals.lww.com/ijo/fulltext/2022/08000/current_concepts_in_the_management_of_childhood.6.aspx

  The target tissue and the sensory part are proposed to be integrated via some messenger molecules, such as dopamine, and this is where the role of muscarinic receptors and their antagonists such as atropine and pirenzepine come into play. […] Myopia occurs due to a complex interplay between numerous factors such as genetic predisposition, parental myopia, ethnic differences, and environmental factors. […] Recognition of the modifiable factors involved in myopia pathogenesis is imperative to devise suitable strategies to avert its onset and progression, especially in premyopes. […] Many causal factors have been linked to the evolution of the myopia epidemic in its present stage. […] The available treatment modalities that have been shown to attenuate the progression curve in myopia are pharmacological therapy using topical atropine and optical interventions such as bifocal spectacles, progressive addition spectacles, bifocal and multifocal contact lenses, and orthokeratology (OK).

• #64 Are we short-sighted about myopia? | Eye News

  https://www.eyenews.uk.com/features/optometry/post/are-we-short-sighted-about-myopia

  Perhaps the most compelling evidence for the mechanism behind myopia development comes from recent animal work which has shown that the eye grows axially in response to hyperopic blur in the periphery. […] Furthermore, it appears that hyperopia in childhood is a protective factor. […] Conventional single vision spectacle lenses correct central refractive error effectively, but are thought to induce further hyperopic defocus in the periphery as they do not take the axially elongated (prolate) shape of the eye / relative peripheral hyperopia into account. […] In the absence of a single causative factor, several behavioural, optical and pharmaceutical intervention strategies, with the aim of slowing myopia progression, have been proposed. […] Atropine has been known to prevent myopia development / progression since 1874. However, the mechanism by which it does this remains inconclusive. […] Recent research has shown that low dose atropine (0.01%) is also effective at preventing eye growth with significantly fewer side-effects and reduced rebound effects.

• #65 Myopia Management: Does Atropine Work? – Optometrists.org

  https://www.optometrists.org/general-practice-optometry/guide-to-myopia-management/myopia-management/myopia-management-does-atropine-work/

  Atropine eye drops may slow down the progression of myopia in children. […] Myopia can rapidly progress, leaving a child at a higher risk of developing dangerous eye diseases, such as glaucoma, retinal detachment, pathological myopia or cataracts, later in life. […] Atropine is a non-selective blocker of muscarinic receptors, present in the retina and sclera. Although the specific mechanism of atropine in myopia management is unknown, it is thought that atropine inhibits sclera thinning or stretching, and hence eye growth, by acting directly or indirectly on the retina or sclera. […] Low-doses of atropine drops in 0.01%, 0.02%, and 0.05% concentrations have been found to be effective in slowing down the progression of myopia. […] The study suggests that the 0.01% concentration has minimal side effects while still reducing the rate of myopia progression by 50% to 60%.

• #66

  https://journals.lww.com/ijo/fulltext/2022/08000/current_concepts_in_the_management_of_childhood.6.aspx

  Literature is replete with evidence supporting the use of topical atropine to arrest the progression of myopia. […] The non-accommodative theory is based on the local retinal effect and the biochemical changes brought about by its action on the muscarinic receptors that affect the scleral matrix and decelerate scleral growth. […] Despite ongoing research, the exact mechanism of onset and progression of myopia is yet to be determined.

• #67 Atropine eye drops for myopia control in children | My Kids Vision

  https://www.mykidsvision.org/knowledge-centre/atropine-eye-drops-for-myopia-control-in-children

  Atropine 1% concentration was first shown to work very effectively to slow myopia progression in children aged 6-12 years, who were followed for two years. This concentration (strength or dose) has significant side effects of increased light sensitivity and blurred near (close up) vision. […] Atropine 0.01% to 0.05% has been shown to have minimal side effects in children who were 4 to 12 years of age at the start of treatment. This three year study showed that these low concentrations were safe, well tolerated and had minimal side effects. […] Atropine 0.02% and 0.025% have been shown to slow myopia progression by about one-third, and atropine 0.05% by about one-half, compared to children on placebo treatment. […] The low concentrations of atropine used in myopia management have far less side effects for long term use, and have proven to be safe and effective for slowing myopia progression in children from age 4 to 14 at the start of treatment, and for up to two to three years. Amongst these lower concentrations, atropine 0.05% currently appears to be the most effective, with minimal side effects.

• #68 Bay Eye Care — Myopia Control (Slowing Short-sightedness)

  https://www.bayeyecare.co.nz/myopia-control

  Studies suggest that even a modest reduction in the rate of myopia of 33 % could produce a 73 % reduction in high myopia (above 5.00 D). […] Prescribing standard spectacle lenses or contact lenses for your child will do nothing to slow the progression of short-sightedness. […] The good news is that there is convincing evidence that certain treatments can slow and even halt the progression of myopia. […] It was initially thought that as atropine drops paralysed the focusing muscles of the eye, this was the reason for the myopia control. Our understanding now suggests that the atropine molecule affects a receptor in the tissue of the back of the eye, signalling the eye to stop growing excessively. This mechanism is still being studied around the world. […] Studies suggest that Myproclear Red Light Therapy results in approximately 75% reduction in axial elongation compared to children wearing standard single vision spectacles over a two year period.

• #69

  https://journals.lww.com/ijo/fulltext/2022/08000/current_concepts_in_the_management_of_childhood.6.aspx

  The target tissue and the sensory part are proposed to be integrated via some messenger molecules, such as dopamine, and this is where the role of muscarinic receptors and their antagonists such as atropine and pirenzepine come into play. […] Myopia occurs due to a complex interplay between numerous factors such as genetic predisposition, parental myopia, ethnic differences, and environmental factors. […] Recognition of the modifiable factors involved in myopia pathogenesis is imperative to devise suitable strategies to avert its onset and progression, especially in premyopes. […] Many causal factors have been linked to the evolution of the myopia epidemic in its present stage. […] The available treatment modalities that have been shown to attenuate the progression curve in myopia are pharmacological therapy using topical atropine and optical interventions such as bifocal spectacles, progressive addition spectacles, bifocal and multifocal contact lenses, and orthokeratology (OK).

• #70 What is myopia control and when is it needed? – We Fix Eyes

  http://wefixeyes.co.nz/articles/what-is-myopia-control-and-when-is-it-needed/

  Ortho-K lenses are worn overnight and change the shape of your cornea to correct for myopia. This means you do not need to wear corrective lenses during the day. These special contact lenses worn overnight are effective in the same way as the above treatments. They prevent the peripheral (off-centre) light from being out of focus, so they lead to decreased growth stimulation. […] The mechanism by which atropine works is not yet fully understood. It was believed that atropine paralysed the focusing muscles of the eye. But more recent studies believe it signals a receptor in the back of the eye to stop growing excessively. Current research indicates concentrations of 0.025% and 0.05% work the best. […] The objective of all of these interventions is to slow the rate of short-sightedness progression as soon as possible. This is so that the eye length never gets to or exceeds 26mm.

• #71 Bay Eye Care — Myopia Control (Slowing Short-sightedness)

  https://www.bayeyecare.co.nz/myopia-control

  Studies suggest that even a modest reduction in the rate of myopia of 33 % could produce a 73 % reduction in high myopia (above 5.00 D). […] Prescribing standard spectacle lenses or contact lenses for your child will do nothing to slow the progression of short-sightedness. […] The good news is that there is convincing evidence that certain treatments can slow and even halt the progression of myopia. […] It was initially thought that as atropine drops paralysed the focusing muscles of the eye, this was the reason for the myopia control. Our understanding now suggests that the atropine molecule affects a receptor in the tissue of the back of the eye, signalling the eye to stop growing excessively. This mechanism is still being studied around the world. […] Studies suggest that Myproclear Red Light Therapy results in approximately 75% reduction in axial elongation compared to children wearing standard single vision spectacles over a two year period.

• #72 Myopia (short-sightedness) – barryandsargent.co.nz

  https://barryandsargent.co.nz/eye-health/myopia-short-sightedness/

  Myopia is the most common eye condition worldwide and is associated with increased eye health complications. […] Myopia occurs when the eyeball grows too quickly. […] Myopia can continue throughout adulthood due to increased close work resulting in fatigued eye focusing muscles. Environmental factors and genetics are also a factor. […] Research has resulted in multiple methods of vision correction options specifically designed to slow myopia progression. It is important treatment is initiated as early as possible. […] Specialty soft contact lenses and orthokeratology contact lenses are currently the most effective myopia control treatment. […] Recent evidence has shown that dual-focus (or multifocal) soft contact lenses can show up to a 50 per cent reduction in myopia progression rates and eye growth compared to standard soft contact lenses.

• #73 Lesson: Mechanisms of Myopia: What We Know & What We Wonder

  https://www.revieweducationgroup.com/ce/mechanisms-of-myopia-what-we-know-and-what-we-wonder

  It has been thought that there are academic pressures and more intense schooling undertaken by East Asian populations that could contribute to the higher prevalence of myopia among this group. […] While there is a relationship between myopia and near work, it is potentially the intensity rather than the total duration of near work that is the primary driver. […] The primary theory behind high-light intensity is that brighter light triggers increased dopamine release from the retina, which slows axial elongation. […] Ultimately, a recommendation of two hours per day of outdoor time should be made to pre-myopic children. […] A summary of four randomized controlled trials done in East Asia shows that increased outdoor time reduces myopia incidence by 5% to 10% but has little effect on slowing progression. […] Despite several advances in the understanding of myopia development and progression, there are still many unknowns. […] To answer the age-old question of nature vs. nurture, there are aspects of both genetics and environment that play a role in myopia development.

• #74

  https://journals.lww.com/ijo/fulltext/2022/08000/current_concepts_in_the_management_of_childhood.6.aspx

  Literature is replete with evidence supporting the use of topical atropine to arrest the progression of myopia. […] The non-accommodative theory is based on the local retinal effect and the biochemical changes brought about by its action on the muscarinic receptors that affect the scleral matrix and decelerate scleral growth. […] Despite ongoing research, the exact mechanism of onset and progression of myopia is yet to be determined.

• #75 The Ophthalmologist | Shutting Down Short-Sightedness

  https://theophthalmologist.com/issues/2023/articles/jun/shutting-down-short-sightedness

  Another interesting issue is how long to prolong the therapy. […] We have an increasing number of young adults with myopia progression who inquire about the possible therapy options. […] All evidence-based data on myopia control is based on populations between six and 18 years old, and, because of this, we unfortunately do not know much about the effectiveness and safety of available methods in this older age group. […] We have not yet clarified all of the mechanisms involved in eyeball growth and myopia, so treatment is limited to what we know of hyperopic defocus in the retina midperiphery. […] Low-dose atropine presents a very complex mechanism on sclera and muscarinic receptors. […] The mechanism of action of myopia is not fully understood and there is still more to be done around understanding ortho-k.

• #76 The Ophthalmologist | Shutting Down Short-Sightedness

  https://theophthalmologist.com/issues/2023/articles/jun/shutting-down-short-sightedness

  Thus, increasing awareness of myopia prevention and controlling myopia progression strategies are becoming more important focuses in our routine ophthalmology practice across Europe. […] Fortunately, with increasing knowledge about myopia pathophysiology and risk factors, we have more approaches available to control myopia progression. […] The recent data on new eye-glasses, including DIMS and HAL, are cause for optimism given their considerable efficacy. […] However, these results need to be confirmed; current knowledge is limited in the length of study periods and number of populations studied. […] One of the major problems is the lack of clear predictors of future progression. […] We are aware of several risk factors, but it is still hard to decide how early to start the therapy and how aggressive it should be.

• #77 Focus on Myopia – Pathogenesis and Rising Incidence | National Academies

  https://www.nationalacademies.org/our-work/focus-on-myopia-pathogenesis-and-rising-incidence

  Myopia, or nearsightedness, is a common type of refractive error where close objects appear clearly, but objects farther away appear blurred. […] The goals of the study are to assess the current mechanistic understanding of myopia pathogenesis and causes of its increased prevalence, to identify knowledge gaps and barriers to progress, and to develop a research agenda aimed at better understanding the biological and environmental factors that could explain its increasing incidence. […] Myopia: Causes, Prevention, and Treatment of an Increasingly Common Disease identifies and assesses the current mechanistic understanding of myopia pathogenesis and the causes of its increased prevalence. […] The National Academies of Sciences, Engineering, and Medicine propose to conduct a consensus study that will consider various aspects related to the global increase in myopia. The goals of the study are to assess the current mechanistic understanding of myopia pathogenesis and causes of its increased prevalence, to identify knowledge gaps and barriers to progress, and to develop a research agenda aimed at better understanding the biological and environmental factors that could explain its increasing incidence.

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