Nadwzroczność nie jest odpowiednim tłumaczeniem dla „nearsightedness”. poprawne tłumaczenie to krótkowzroczność

Nadwzroczność nie jest odpowiednim tłumaczeniem dla „nearsightedness”. poprawne tłumaczenie to krótkowzroczność
Patofizjologia i mechanizm

Krótkowzroczność (myopia) jest najczęstszą wadą refrakcji u dzieci i młodych dorosłych, charakteryzującą się niewyraźnym widzeniem obiektów odległych przy zachowanym widzeniu bliskim. Dominującą formą jest krótkowzroczność osiowa, wynikająca z wydłużenia długości osiowej gałki ocznej, gdzie wzrost osiowy o 1 mm koreluje z przesunięciem refrakcyjnym o około 3 dioptrie (D). Klasyfikacja obejmuje krótkowzroczność łagodną (0,5–4 D), umiarkowaną (4–8 D) i ciężką (>8 D). Patogeneza opiera się na lokalnej kaskadzie sygnalizacyjnej inicjowanej w siatkówce, gdzie rozogniskowanie hipermetropowe obwodowej siatkówki wpływa na wzrost gałki ocznej poprzez modulację sygnałów w nabłonku barwnikowym siatkówki, naczyniówce i twardówce. Czynniki genetyczne (m.in. PAX6, TGF-β, COL1A1) oraz środowiskowe, takie jak niedostateczna ekspozycja na światło dzienne, nadmierna praca z bliska i intensywna edukacja, odgrywają kluczową rolę w rozwoju i progresji krótkowzroczności. Badania na modelach zwierzęcych potwierdzają, że siatkówka może lokalnie regulować wzrost oka niezależnie od połączenia nerwowego z mózgiem, a mechanizmy te obejmują m.in. uwalnianie dopaminy i tlenku azotu (NO), które hamują wydłużanie osiowe.

Krótkowzroczność – patogeneza i mechanizm

Krótkowzroczność (łac. myopia) to najczęstsza wada refrakcji u dzieci i młodych dorosłych, charakteryzująca się niewyraźnym widzeniem obiektów oddalonych, przy zachowaniu ostrego widzenia z bliska. Jest najczęściej wynikiem nieprawidłowego wydłużenia gałki ocznej, co powoduje, że obraz tworzony przez rogówkę i soczewkę pada przed fotoreceptorami siatkówki, a nie bezpośrednio na nich.¹² Pomimo wieloletnich badań, dokładne mechanizmy biologiczne powodujące krótkowzroczność pozostają nieznane, a obecnie nie istnieje powszechnie akceptowana metoda jej zapobiegania czy leczenia przyczynowego.³

Klasyfikacja krótkowzroczności

Klasyfikacja krótkowzroczności ma kluczowe znaczenie dla jej odpowiedniego leczenia. Najczęstszym typem obserwowanym w praktyce klinicznej jest krótkowzroczność osiowa, spowodowana zwiększeniem długości osiowej gałki ocznej. Zwiększenie długości osiowej o 1 mm koreluje z przesunięciem krótkowzrocznym o 3 dioptrie.⁴ Ze względu na nasilenie, krótkowzroczność klasyfikuje się jako łagodną (między 0,5 a 4 D), umiarkowaną (między 4 a 8 D) i ciężką (powyżej 8 D).⁵

Możemy również wyróżnić dwa główne typy krótkowzroczności oparte na mechanizmie rozwoju: krótkowzroczność osiową i krótkowzroczność refrakcyjną. Krótkowzroczność osiowa, najczęstsza forma, wynika z wydłużenia długości osiowej oka, co uniemożliwia padanie światła bezpośrednio na siatkówkę. Natomiast krótkowzroczność refrakcyjna charakteryzuje się zwiększoną mocą refrakcyjną elementów optycznych oka bez znaczącego wydłużenia osiowego.⁶ Osoby z krótkowzrocznością refrakcyjną doświadczają problemu z ogniskowaniem, w którym światło zbiega się w punkcie przed siatkówką.⁷

Epidemiologia i czynniki ryzyka

Częstość występowania krótkowzroczności znacznie wzrasta na całym świecie, stanowiąc globalny problem zdrowia publicznego. Według przewidywań WHO, do 2050 roku połowa światowej populacji będzie dotknięta krótkowzrocznością.⁸ Badania amerykańskich dzieci w wieku przedszkolnym wykazały częstość występowania na poziomie 1,2% u białych nie-Latynosów, 3,7% u Latynosów, 3,98% u Azjatów i 6,6% u Afroamerykanów.⁹

Krótkowzroczność jest złożoną cechą, na której rozwój wpływają czynniki genetyczne, środowiskowe i behawioralne.¹⁰ Wykazano, że zarówno czynniki genetyczne, jak i środowiskowe kontrolują wzrost oka i wpływają na rozwój krótkowzroczności.¹¹ Ryzyko wystąpienia krótkowzroczności może być dziedziczone po rodzicach, jednak same geny nie mogą tłumaczyć gwałtownych zmian w częstości występowania krótkowzroczności na całym świecie, ani dramatycznych różnic w częstości występowania tej wady w tych samych populacjach etnicznych w środowiskach miejskich i wiejskich.¹²

Czynniki środowiskowe zwiększające ryzyko krótkowzroczności obejmują niedostateczną ekspozycję na światło, niską aktywność fizyczną, pracę z bliska oraz zwiększoną liczbę lat edukacji.¹³ Jedną z hipotez jest to, że brak normalnych bodźców wizualnych powoduje nieprawidłowy rozwój gałki ocznej.¹⁴ Osoby, które spędzają dużo czasu czytając, pracując przy komputerze, grając w gry wideo lub wykonując inne intensywne prace wymagające bliskiego widzenia, mogą być bardziej narażone na rozwój krótkowzroczności.¹⁵

Molekularne i genetyczne podstawy krótkowzroczności

Badania genetyczne ujawniły, że genetyka odgrywa znaczącą rolę w rozwoju krótkowzroczności. Badania asocjacyjne całego genomu (GWAS) zidentyfikowały korelacje między wariantami określonych genów a zwiększonym ryzykiem krótkowzroczności.¹⁶ Badania epigenetyczne wskazują, że metylacja DNA może być jednym z mechanizmów, za pomocą których czynniki środowiskowe wpływają na rozwój krótkowzroczności.¹⁷

Zidentyfikowano różnice w metylacji w genach, które były wcześniej sugerowane jako związane z krótkowzrocznością, takich jak PAX6, ZNRF3, PSEN1, SOCS1, GRB2, ADCY3, RGS5, SRF i AP1B1.¹⁸ Gen PAX6, który odgrywa kluczową rolę w rozwoju oczu, został powiązany zarówno z wysoką, jak i ekstremalną krótkowzrocznością, podkreślając jego znaczenie w rozwoju wad refrakcji.¹⁹

Badania GWAS ujawniły znaczną liczbę polimorficznych loci genomowych związanych z krótkowzrocznością w różnych populacjach. Badania konsorcjum CREAM i 23andMe odegrały kluczową rolę w znalezieniu genów związanych z neurotransmisją, funkcją kanałów jonowych, metabolizmem kwasu retinowego i przebudową macierzy pozakomórkowej. Wśród godnych uwagi genów są GRIA4, KCNQ5, RDH5, LAMA2 i BMP2.²⁰

Wykazano, że gen kodujący transformujący czynnik wzrostu-β (TGF-β) odgrywa kluczową rolę w procesie przebudowy twardówki, a znaczne obniżenie poziomu tego produktu zostało zaobserwowane w oczach krótkowzrocznych.²¹ Innym genem kandydującym jest gen kolagenu typu 1 alfa-1 (COL1A1), który jest genem macierzy pozakomórkowej i ulega ekspresji w ścianie twardówki u pacjentów z wysoką krótkowzrocznością (ale także w eksperymentalnej krótkowzroczności).²²

Badania na modelach zwierzęcych

Badania na modelach zwierzęcych dostarczyły istotnych informacji na temat mechanizmów leżących u podstaw krótkowzroczności. Naukowcy zwrócili się do modeli zwierzęcych, aby zrozumieć rolę czynników ryzyka środowiskowego w powstawaniu krótkowzroczności.²³ Wykazały one, że można eksperymentalnie indukować krótkowzroczność u młodych, szybko rosnących zwierząt, co wskazuje, że środowisko wizualne odgrywa ważną rolę w regulacji wzrostu oka.²⁴

Badania na zwierzętach (takich jak kurczaki, świnki morskie i małpy) były pomocne w zrozumieniu wzrostu oka kierowanego bodźcami wizualnymi oraz potencjalnych mechanizmów prowadzących do krótkowzroczności.²⁵ W modelach zwierzęcych noszenie gogli powodujących deprywację formy lub soczewek indukujących rozogniskowanie prowadzi do nieprawidłowego wzrostu oka i rozwoju wad refrakcji.²⁶

Zwierzęcy model deprywacji formy krótkowzroczności doprowadził do równoległych badań eksperymentalnie indukowanej krótkowzroczności u młodych tupajów i kurcząt.²⁷ Bodźce wywołujące krótkowzroczność wymagają długotrwałej ekspozycji (dni-tygodnie) dla znaczącego efektu.²⁸ Co ważne, zastosowanie gogli na oku działa nawet po przecięciu nerwu wzrokowego, co wskazuje, że samo oko, a dokładniej wyspecjalizowana tkanka sensoryczno-nerwowa w oku zwana siatkówką, może odróżnić, czy obraz jest dobrze zogniskowany, czy nie, i działać lokalnie, aby pośredniczyć w zmianach wzrostu oka indukowanych optycznie.²⁹

Mechanizmy patofizjologiczne krótkowzroczności

Rola siatkówki w patogenezie

Obecne zrozumienie patogenezy krótkowzroczności wskazuje, że ścieżka sygnalizacyjna jest inicjowana przez bodźce wizualne w siatkówce.³⁰ Siatkówka koduje kluczowe cechy obrazu, które zostały powiązane z regulacją wzrostu oka.³¹ Rozmazane lub nieostre obrazy wciąż wpływają na wzrost oka, nawet gdy nerw wzrokowy jest zmiażdżony, przerywając połączenie między okiem a mózgiem.³²

Różne linie dowodowe potwierdzają dominujący pogląd, że siatkówka jest niezbędna do kodowania cech obrazu siatkówkowego, które wpływają na wzrost oka.³³ Emmetropizacja jest lokalnym, wizualnie regulowanym procesem, co sugeruje, że rozwój krótkowzroczności jest również modulowany przez sygnały wizualne odbierane przez siatkówkę.³⁴

Ponadto badania wykazały, że rozogniskowanie hipermetryczne na obwodowej siatkówce może odgrywać rolę w rozwoju i progresji krótkowzroczności. Wykazano, że u osób z krótkowzrocznością występuje względne hipermetropowe rozogniskowanie obwodowe (obrazy w obwodowej siatkówce spadały za płaszczyzną siatkówki u osób z krótkowzrocznością po korekcji optycznej), stąd postulowano, że obwodowy błąd refrakcji może napędzać mechanizmy emmetropizacji prowadzące do zmian w modelach wzrostu oka.³⁵

Rola nabłonka barwnikowego siatkówki (RPE)

Nabłonek barwnikowy siatkówki (RPE) został wskazany jako istotny w rozwoju refrakcyjnym oka, ponieważ znajduje się bezpośrednio obok siatkówki, gdzie może przekazywać sygnały regulujące wzrost pochodzące z siatkówki do naczyniówki i twardówki.³⁶ Receptory muskarynowe znajdują się również w nabłonku barwnikowym siatkówki, warstwie, która uczestniczy w przenoszeniu kaskady sygnalizacyjnej w kierunku tkanki docelowej, tj. naczyniówki i/lub twardówki.³⁷

Rola naczyniówki

Naczyniówka wydaje się być biomarkerem procesów ocznych regulujących wzrost oka, biorąc pod uwagę, że centralna plamkowa naczyniówka ścieńcza się podczas początkowego rozwoju i progresji krótkowzroczności.³⁸ Zmiany oczne w odpowiedzi na deprywację formy i rozogniskowanie indukowane soczewkami są głównie związane ze zmianami długości osiowej (głównie z powodu zmian głębokości komory ciała szklistego) i grubości naczyniówki.³⁹

Atropina powodowała szybkie i przejściowe pogrubienie naczyniówki i hamowała wzrost oka, sugerując, że te dwie odpowiedzi, tj. pogrubienie naczyniówki i wzrost oka, mogą być powiązane.⁴⁰ Grubość naczyniówki jest również sugerowana jako biomarker przewidujący przyszłe wydłużenie osiowe (a tym samym progresję krótkowzroczności), przy czym zmniejszone wydłużenie osiowe jest związane z grubszą naczyniówką, szczególnie skroniowo.⁴¹

Rola twardówki

Ścieńczenie twardówki związane z krótkowzrocznością osiową jest przede wszystkim ograniczone do bieguna tylnego, ze względu na redystrybucję tkanki twardówki.⁴² Istnieje również pogląd, że twardówka jest miejscem docelowym zahamowania krótkowzroczności przez atropinę. Synteza glikozaminoglikanu z macierzy pozakomórkowej twardówki została zahamowana przez atropinę w badaniach z udziałem tkanki twardówki kurcząt.⁴³

Przekonujące dowody z ostatnich 40 lat wskazują, że postnatalny wzrost oka jest w dużej mierze kontrolowany przez wewnątrzgałkową kaskadę chemiczną od siatkówki do twardówki.⁴⁴ Ta kaskada jest inicjowana przez jakość obrazów wizualnych na siatkówce, prowadząc do zmian molekularnych w siatkówce, RPE i naczyniówce, ostatecznie powodując zmiany w twardówce poprzez syntezę macierzy pozakomórkowej twardówki i biomechanikę twardówki, co ostatecznie wpływa na kształt oka.⁴⁵

Rola neuroprzekaźników i cząsteczek sygnałowych

Pochodna witaminy A, kwas all-trans-retinowy (atRA) może być ważnym składnikiem kontroli postnatalnego wzrostu oka.⁴⁶ Pojawiają się również dowody, że tlenek azotu (NO) może odgrywać znaczącą rolę w postnatalnej kontroli wzrostu oka i rozwoju krótkowzroczności.⁴⁷

Dominującą teorią wyjaśniającą wpływ wysokiej intensywności światła jest to, że jaśniejsze światło wyzwala zwiększone uwalnianie dopaminy z siatkówki, co spowalnia wydłużenie osiowe.⁴⁸ Uwalnianie dopaminy jest wzmacniane w sposób liniowy przez stymulację świetlną ponad cztery jednostki natężenia, a dopamina siatkówki może indukować pogrubienie naczyniówki i hamowanie wzrostu oka poprzez uwalnianie NO z siatkówki lub naczyniówki, spowalniając tym samym rozwój krótkowzroczności.⁴⁹

Badania sugerują, że dopamina wpływa również na rozwój krótkowzroczności. W szczególności dopamina prawdopodobnie wpływa na krótkowzroczność poprzez interakcję z określonymi receptorami w siatkówce. Ta interakcja może przyczyniać się do wydłużenia oka, które jest kluczowym czynnikiem w krótkowzroczności.⁵⁰ Hipoteza niedoboru dopaminy sugeruje, że niska sygnalizacja dopaminergiczna może powodować krótkowzroczność. W szczególności, gdy aktywność dopaminy jest zmniejszona, na przykład przy przedłużonej pracy z bliska (czytanie, czas przed ekranem itp.), równowaga między ogniskowaniem oka a regulacją wzrostu może zostać zakłócona. W rezultacie ta nierównowaga może prowadzić do nadmiernego wydłużenia oka i krótkowzroczności.⁵¹

Rola rytmów dobowych

Wiele badań w ciągu ostatnich 50 lat sugerowało, że rytmy dobowe mogą odgrywać rolę w kontroli wzrostu oka.⁵² Te eksperymentalne i kliniczne obserwacje stanowią przekonujące dowody na rolę rytmów dobowych w postnatalnej regulacji wzrostu oka i patogenezie krótkowzroczności.⁵³

Liczne badania laboratoryjne i kliniczne niedawno wskazały na zaburzenia dobowe w rozwoju krótkowzroczności.⁵⁴ Poziomy ekspresji wielu genów podczas ustalonej i postępującej krótkowzroczności zależą od pory dnia zarówno w siatkówce, jak i naczyniówce.⁵⁵ Większość różnicowo wyrażonych genów siatkówki została zidentyfikowana podczas fazy świetlnej (ZT00-ZT12), a największa liczba różnic w ekspresji genów między okiem zasłoniętym a okiem otwartym podczas progresji krótkowzroczności wystąpiła o ZT04.⁵⁶

Zdecydowana większość różnicowo wyrażonych genów w naczyniówce wystąpiła o ZT12, a większość różnicowo wyrażonych genów w siatkówce wystąpiła we wcześniejszych godzinach, co jest zgodne z koncepcją opóźnienia czasowego między przynajmniej niektórymi sygnałami siatkówkowymi a ich działaniami w naczyniówce.⁵⁷

Czynniki środowiskowe w patogenezie krótkowzroczności

Rola czasu spędzanego na świeżym powietrzu

Jednym z najbardziej ustalonych czynników środowiskowych chroniących przed krótkowzrocznością jest zwiększony czas spędzany na zewnątrz. Zwiększenie czasu spędzanego przez dziecko na zewnątrz pomaga zapobiec lub opóźnić wystąpienie krótkowzroczności.⁵⁸ Badania wykazały, że niedobór ekspozycji na naturalne światło słoneczne może przyczyniać się do niedawnego wzrostu częstości krótkowzroczności.⁵⁹

Zwiększony czas spędzany na zewnątrz może spowolnić progresję krótkowzroczności i może zmniejszyć ryzyko wystąpienia nowej krótkowzroczności o 50%.⁶⁰ Mechanizm nie jest w pełni zrozumiany, ale istnieje kilka wiarygodnych teorii. Zwiększona ekspozycja na światło podczas przebywania na zewnątrz prowadzi do zwężenia źrenicy (i zwiększenia głębi ostrości), zmniejszenia rozmycia lub zwiększenia dopaminy siatkówki, co może hamować wydłużenie osiowe.⁶¹

Brak dziennej ekspozycji na światło jest silnie związany z nadmiernym wydłużeniem gałki ocznej.⁶² Spędzanie więcej czasu na zewnątrz wydaje się mieć efekt ochronny przed zbyt długim wzrostem gałki ocznej, co prowadzi do krótkowzroczności osiowej.⁶³

Rola pracy z bliska

Nadmierna praca z bliska od dawna jest uważana za czynnik przyczyniający się do rozwoju krótkowzroczności. Zaproponowano, że opóźnienie akomodacji podczas pracy z bliska indukuje rozogniskowanie hipermetropowe, które jest silnym bodźcem dla wzrostu oka.⁶⁴ Czytanie na bardzo bliskich odległościach roboczych (30 cm) i przez dłuższe ciągłe okresy czasu (30 minut) jest związane z większym prawdopodobieństwem wystąpienia krótkowzroczności.⁶⁵

Progresja krótkowzroczności ma coś wspólnego z długotrwałym, utrzymującym się skupieniem, jak to robią zapaleni czytelnicy i poważni studenci.⁶⁶ Osoby z krótkowzrocznością mogą również doświadczać tzw. fałszywej lub „pseudo” krótkowzroczności. Ich niewyraźne widzenie na odległość jest spowodowane nadmiernym wykorzystaniem mechanizmu ogniskującego oczu. Jednak stały stres wizualny może z czasem prowadzić do trwałego pogorszenia widzenia na odległość.⁶⁷⁶⁸

Zakres wzrokowości może wpływać jako surogat dla zwiększonego zaangażowania w pracę z bliska. Istnieją spójne dowody epidemiologiczne sugerujące, że edukacja ma przyczynową rolę w odniesieniu do krótkowzroczności, poprzez różne miary, takie jak czas trwania edukacji, osiągnięcia edukacyjne i presja edukacyjna.⁶⁹

Rola ekranów elektronicznych

Częstość występowania krótkowzroczności gwałtownie wzrosła w ostatnich dziesięcioleciach. Jest to szczególnie prawdziwe we wschodniej Azji – występuje 96% przypadków krótkowzroczności u koreańskich nastolatków. W USA częstość występowania krótkowzroczności podwoiła się w dekadzie przełomu lat 80. Jest to problem zdrowia publicznego!⁷⁰

Wielu badaczy uważa, że wzrost ten można przypisać większej ilości czasu spędzanego na wpatrywaniu się w ekrany i mniejszej ilości czasu spędzanego na zewnątrz.⁷¹ Około 68% dzieci przed 3 rokiem życia korzysta z urządzeń ekranowych codziennie, a te dzieci, które to robią, są bardziej narażone na rozwój krótkowzroczności do wieku przedszkolnego.⁷²

Patofizjologia zmian ocznych w krótkowzroczności

Krótkowzroczność występuje, gdy gałka oczna jest zbyt długa lub rogówka (przezroczysta przednia pokrywa oka) jest zbyt zakrzywiona. W rezultacie światło wpadające do oka nie jest prawidłowo ogniskowane, a odległe przedmioty wydają się niewyraźne.⁷³ Sprzężenie optyki w przedniej części oka z jego długością osiową określa refrakcję oka. W krótkowzroczności (krótkowzroczności) oko jest stosunkowo długie w stosunku do mocy optycznej rogówki i soczewki; odległe obrazy są niewyraźne, ponieważ ich ostrość znajduje się przed fotoreceptorami siatkówki.⁷⁴

Podczas normalnego procesu emmetropizacji oko rozszerza się we wszystkich kierunkach (osiowo i równikowe) i jest związane z mechanicznym rozciąganiem i ścieńczaniem soczewki wzdłuż płaszczyzny równikowej, co prowadzi do zmniejszenia mocy soczewki. Rozprzężenie między tym procesem wydłużenia osiowego a spłaszczeniem krzywizny rogówki i soczewki powoduje eskalację wzrostu osiowego i zatrzymanie ścieńczania soczewki poprzez zakłócenie ekspansji równikowej, prowadząc do krótkowzroczności.⁷⁵

Wydłużenie powoduje rozciągnięcie siatkówki i tylnej części gałki ocznej. Prowadzi to do ścieńczenia i zmian degeneracyjnych w siatkówce, naczyniówce i twardówce. Zmiany te mogą prowadzić do trwałego upośledzenia widzenia i ślepoty.⁷⁶

Zmiany w długości osiowej

Większość form krótkowzroczności występuje, ponieważ długość osiowa jest zbyt duża w stosunku do mocy refrakcyjnej oka, inaczej znana jako krótkowzroczność osiowa.⁷⁷ Krótkowzroczność osiowa jest przypisywana zwiększeniu długości osiowej oka.⁷⁸ Badania wykazały silną korelację między szybką redukcją nadwzroczności a zmianami długości osiowej podczas wczesnego rozwoju oka. Badania te sugerują, że długość osiowa jest najważniejszym czynnikiem dla emmetropizacji w ludzkim oku.⁷⁹

Osiowa krótkowzroczność spowodowana ponad 5D wiąże się z wyższym ryzykiem powikłań takich jak degeneracja plamki, odwarstwienie siatkówki, zaćma i jaskra.⁸⁰ Mechanizm prowadzący do zmian w wydłużeniu oka obejmuje lokalne przetwarzanie obrazu siatkówkowego, które wysyła wiadomość stop lub idź do twardówki, regulując właściwości macierzy twardówki i jej tempo wydłużenia.⁸¹

Rola rozogniskowania hipermetropowego

Rola rozogniskowania siatkówkowego i obwodowej nadwzroczności jako prekursora w pojawieniu się i progresji krótkowzroczności była szeroko badana.⁸² Rozogniskowanie hipermetropowe odnosi się do celowego wprowadzenia nieostrego obrazu na obwodowej siatkówce przy jednoczesnym utrzymaniu wyraźnego widzenia na centralnej siatkówce. Jest ono stosowane jako technika w zarządzaniu krótkowzrocznością, aby spowolnić wydłużanie się oka, znane również jako długość osiowa.⁸³

Mechanizm działania rozogniskowania hipermetropowego nie jest jeszcze w pełni zrozumiały, ale istnieje kilka proponowanych teorii. Jedna z potwierdzonych dowodami teorii sugeruje, że gdy obwodowa siatkówka doświadcza rozogniskowanych lub niewyraźnych obrazów, wysyła sygnały do oka, aby spowolnić jego wzrost w próbie osiągnięcia wyraźnego widzenia. Ten mechanizm sprzężenia zwrotnego pomaga regulować wydłużenie gałki ocznej, co jest charakterystyczne dla krótkowzroczności.⁸⁴

Zostało zaobserwowane, że u osób krótkowzrocznych oko jest prolate, co skutkuje większym stopniem obwodowego rozogniskowania hipermetropowego. Aby to rozwiązać, Ortho-K zaprojektowano tak, aby tworzyć obwodowe rozogniskowanie krótkowzroczne, co z kolei zmniejsza lub odwraca bodziec do wydłużenia osiowego.⁸⁵

Rola zapaleń i sygnalizacji immunologicznej

Analiza dwóch publicznie dostępnych zestawów danych proteomicznych podkreśliła potencjalną rolę wrodzonego układu odpornościowego i stanu zapalnego w rozwoju krótkowzroczności, szczegółowo opisując konkretne ścieżki sygnalizacyjne zaangażowane, takie jak sygnalizacja Granzyme A (GzmA) i rodziny S100 w siatkówce oraz aktywacja trans-różnicowania miofibroblastów w twardówce.⁸⁶

Za pomocą nowatorskich analiz połączonych, publicznie dostępnych baz danych, stwierdzono, że odpowiedź komórkowa układu odpornościowego i ścieżki sygnalizacji cytokin są powszechnie dotknięte zarówno w ludzkiej krótkowzroczności, jak i w eksperymentalnej krótkowzroczności zwierząt.⁸⁷ W szczególności, wewnątrzgałkowy szlak klasyczny i alternatywny szlak układu dopełniacza były częściowo aktywowane; te wzrosty mogły być, przynajmniej częściowo, wynikiem uszkodzeń strukturalnych nadmiernie powiększonego oka.⁸⁸

Dane z badań na zwierzętach wykazały, że szerszy zakres procesów biologicznych, w tym tych związanych ze stanem zapalnym, takich jak rodziny LXR/RXR (funkcjonują jako krytyczny węzeł sygnalizacyjny łączący stan zapalny i funkcję komórek odpornościowych) i S100 (znane mediatory stanu zapalnego), były zwiększone w krótkowzroczności, oraz że atropina i normalne widzenie mogły odwrócić te wzrosty w dotkniętych ścieżkach sygnalizacyjnych.⁸⁹

Implikacje kliniczne i powikłania

Krótkowzroczność, jeśli nie jest leczona, jest jedną z głównych przyczyn upośledzenia widzenia na całym świecie. Im większy stopień krótkowzroczności, tym większe ryzyko powikłań, takich jak zwyrodnienie plamki, odwarstwienie siatkówki, zaćma i jaskra; ryzyko jest szczególnie duże, gdy ujemny błąd refrakcji jest bardziej ujemny niż -6,00 D, stan nazywany wysoką krótkowzrocznością.⁹⁰

Patologia oczna związana z wysoką krótkowzrocznością nie jest generalnie obserwowana przy izolowanej krótkowzroczności fizjologicznej.⁹¹ Jednak patologiczna krótkowzroczność może również powodować utratę wzroku, której nie można skorygować okularami lub soczewkami kontaktowymi. Oznacza to, że poziom krótkowzroczności jest tak zaawansowany, że doszło do degradacji tylnej części oka.⁹²

Zmniejszenie progresji krótkowzroczności zmniejsza prawdopodobieństwo rozwoju degeneracji plamki krótkowzrocznej, która może spowodować utratę wzroku. Nawet niewielka redukcja, o zaledwie jedną dioptrię, może zmniejszyć to prawdopodobieństwo o 40%. Zmniejszenie krótkowzroczności może obniżyć ryzyko rozwoju jaskry, zaćmy i odwarstwienia siatkówki.⁹³

Związek między wysoką krótkowzrocznością a jaskrą, szczególnie jaskrą pierwotną otwartego kąta, jest dobrze udokumentowany, a zwiększająca się ciężkość krótkowzroczności koreluje nieliniowo z podwyższonym ryzykiem jaskry. Ścieńczenie warstwy włókien nerwowych siatkówki, wykrywane za pomocą OCT, często poprzedza utratę funkcji, co sugeruje, że zmiany strukturalne u osób z wysoką krótkowzrocznością wymagają wczesnego wykrycia i strategii interwencyjnych w celu zachowania funkcji widzenia.⁹⁴

Podsumowanie

Krótkowzroczność jest złożonym zaburzeniem o wieloczynnikowej etiologii, z rosnącą częstością występowania na całym świecie. Chociaż dokładna przyczyna patologiczna pozostaje nieznana, znaczące postępy zostały poczynione w zrozumieniu mechanizmów biologicznych leżących u jej podstaw. Zarówno czynniki genetyczne, jak i środowiskowe odgrywają ważną rolę w jej rozwoju i progresji.

Krótkowzroczność osiowa, najczęstsza forma, jest wynikiem nadmiernego wydłużenia gałki ocznej, co powoduje, że obraz tworzony przez optykę oka pada przed siatkówką. Kaskada sygnalizacyjna rozpoczyna się w siatkówce, gdzie jakość obrazu wpływa na regulację wzrostu oka poprzez złożoną sieć sygnałów molekularnych, które ostatecznie wpływają na strukturę twardówki i długość osiową oka.

Zrozumienie patogenezy krótkowzroczności ma kluczowe znaczenie dla opracowania skutecznych strategii profilaktycznych i terapeutycznych. Wczesna interwencja i skuteczne strategie zarządzania mogą pomóc spowolnić progresję krótkowzroczności i zmniejszyć ryzyko związanych z nią powikłań ocznych, poprawiając długoterminowe zdrowie oczu i jakość życia pacjentów.

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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 Controlling Nearsightedness in Children – Colorado Eye Center
https://www.coloradoeyecenter.com/childrens-vision/controlling-nearsightedness-children/
Myopia (nearsightedness) is a common vision problem affecting children who can see well up close, while distant objects are blurred. […] Recent research suggests ortho-k may also reduce the lengthening of the eye itself, indicating that wearing ortho-k lenses during childhood may actually cause a permanent reduction in myopia, even if the lenses are discontinued in adulthood. […] Because research has suggested nearsightedness in children may be linked to focusing fatigue, investigators have looked into using atropine to disable the eyes focusing mechanism to control myopia. […] Some evidence suggests wearing eyeglasses with bifocal or progressive multifocal lenses may slow the progression of nearsightedness in some children. […] A recent study by researchers at Ohio State University found that wearing multifocal contact lenses reduces the rate of progression of myopia in children by 50%. […] One potential reason why multifocal contact lenses may limit progression is that these lenses appear to reduce the lengthening of the eye, which leads to increasing myopia over time.
#3 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.
#4 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).
#5 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).
#6 Myopia: Pathogenesis and Intervention – Nature Cell and Science
https://cellnatsci.com/2958-695X/article/10-61474-ncs-2024-00049
Myopia can be classified into two types based on its underlying mechanism: axial myopia and refractive myopia. The more common form, axial myopia, results from elongation of the eyes axial length, preventing incoming light from focusing directly on the retina. In contrast, refractive myopia is characterized by an increased refractive power of the eyes optical components without significant axial elongation. This form of myopia is primarily attributed to alterations in the refractive index or curvature of the cornea or lens. Individuals with refractive myopia experience a focusing issue in which light converges at a point anterior to the retina, resulting in blurred vision for distant objects. Such refractive anomalies may arise due to developmental factors, genetic predisposition, or secondary conditions affecting the lens, such as nuclear sclerosis or other lenticular changes. […]
#7 Myopia – Wikipedia
https://en.wikipedia.org/wiki/Myopia
Because myopia is a refractive error, the physical cause of myopia is comparable to any optical system that is out of focus. […] 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. […] Curvature myopia is attributed to excessive, or increased, curvature of one or more of the refractive surfaces of the eye, especially the cornea. […] Index myopia is attributed to variation in the index of refraction of one or more of the ocular media.
#8 Childhood-onset myopia management: Evidence review – College of Optometrists
https://www.college-optometrists.org/category-landing-pages/clinical-topics/myopia/childhood-onset-myopia-management-evidence-review
Myopia is increasing in prevalence, causing a global public health problem. By 2050, it is predicted that half the worlds population will have myopia, a known risk factor for sight threatening ocular pathology. Higher levels of myopia (5D) are associated with a higher risk of these complications. […] Research has shown that myopia has a link to ocular health complications, even at lower levels of myopia (5D). The aim of myopia management (myopia control) is to delay the onset and slow the progression of myopia, thereby reducing the final level of myopia, which, in turn, is likely to help to maintain good ocular health later in life by reducing the associated risks. […] There is evidence that delaying the onset of myopia helps limit the final level of myopia. Preventing or delaying onset is only currently possible through environmental adaptations to increase time spent outdoors and limiting indoor near vision activities.
#9 The Science Behind Myopia – Webvision – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470669/
Myopia prevalence varies greatly in different ethnic and geographical populations. Recent studies of American preschool children revealed a prevalence of 1.2% in non-Hispanic whites, 3.7% in Hispanics, 3.98% in Asians, and 6.6% in African Americans. […] 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. Thus, the underlying cause of spontaneous-onset myopia is most likely to be a combination of genes and environmental triggers.
#10 Myopia: Pathogenesis and Intervention – Nature Cell and Science
https://cellnatsci.com/2958-695X/article/10-61474-ncs-2024-00049
Myopia, commonly referred to as nearsightedness, represents a significant refractive error of the eye, in which distant objects appear blurred while near objects remain clear. This condition primarily develops during childhood and early adulthood and results from excessive elongation of the eyeball, causing images to focus in front of the retina rather than directly on it. Although this optical aberration may seem straightforward, myopia is a complex trait influenced by genetic predisposition, environmental factors, and individual behaviors, all of which contribute to its onset and progression. […] […] The rapid increase in myopia prevalence has prompted further investigation into its underlying causes and potential interventions. Compelling evidence from numerous studies underscores the role of both genetic and environmental factors in the development and progression of myopia. While genetic factors confer susceptibility, contemporary lifestyle elements, including extensive educational demands and other near-work activities, are also suspected to be critical contributors. […]
#11 Azthena logo with the word Azthena
https://www.news-medical.net/health/Myopia-Research.aspx
Myopia (shortsightedness) is the most common ocular abnormality with growing prevalence worldwide and in a progressive nature in children, which have both contributed to a recent surge in interest. […] Various environmental and genetic factors have been shown to control eye growth and influence myopia development. […] The pathways implicated in eye growth control and myopia development in avian animal models have been partially characterized, but at this stage, it is not clear that these pathways can be transferred to eye growth control in humans. […] Gene encoding for transforming growth factor- (TGF- ) plays a crucial role in the process of scleral remodeling, and significant reductions of this product have been found in myopic eyes. Furthermore, both PAX 6 and SOX2, two so-called master control genes that play a major role in eye development and growth, have been implicated in myopia pathogenesis possibly due to genetic variation in an upstream promoter or regulator.
#12 The Science Behind Myopia – Webvision – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470669/
Myopia prevalence varies greatly in different ethnic and geographical populations. Recent studies of American preschool children revealed a prevalence of 1.2% in non-Hispanic whites, 3.7% in Hispanics, 3.98% in Asians, and 6.6% in African Americans. […] 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. Thus, the underlying cause of spontaneous-onset myopia is most likely to be a combination of genes and environmental triggers.
#13 Myopia – Wikipedia
https://en.wikipedia.org/wiki/Myopia
Myopia results from the length of the eyeball growing too long or less commonly the lens being too strong. […] The underlying cause of myopia is believed to be a combination of genetic and environmental factors. […] A risk for myopia may be inherited from one’s parents. […] Genetic linkage studies have identified 18 possible loci on 15 different chromosomes that are associated with myopia, but none of these loci is part of the candidate genes that cause myopia. […] Environmental factors that increase the risk of myopia include insufficient light exposure, low physical activity, near work, and increased years of education. […] One hypothesis is that a lack of normal visual stimuli causes improper development of the eyeball. […] Myopia can be induced with minus spherical lenses, and overminus in prescription lenses can induce myopia progression.
#14 Myopia – Wikipedia
https://en.wikipedia.org/wiki/Myopia
Myopia results from the length of the eyeball growing too long or less commonly the lens being too strong. […] The underlying cause of myopia is believed to be a combination of genetic and environmental factors. […] A risk for myopia may be inherited from one’s parents. […] Genetic linkage studies have identified 18 possible loci on 15 different chromosomes that are associated with myopia, but none of these loci is part of the candidate genes that cause myopia. […] Environmental factors that increase the risk of myopia include insufficient light exposure, low physical activity, near work, and increased years of education. […] One hypothesis is that a lack of normal visual stimuli causes improper development of the eyeball. […] Myopia can be induced with minus spherical lenses, and overminus in prescription lenses can induce myopia progression.
#15 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.
#16 The Science Behind Myopia – Webvision – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470669/
Myopia prevalence varies greatly in different ethnic and geographical populations. Recent studies of American preschool children revealed a prevalence of 1.2% in non-Hispanic whites, 3.7% in Hispanics, 3.98% in Asians, and 6.6% in African Americans. […] 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. Thus, the underlying cause of spontaneous-onset myopia is most likely to be a combination of genes and environmental triggers.
#17 Epigenetically dysregulated genes and pathways implicated in the pathogenesis of non-syndromic high myopia | Scientific Reports
https://www.nature.com/articles/s41598-019-40299-x
Myopia, commonly referred to as nearsightedness, is one of the most common causes of visual disability throughout the world. […] Both genetics and environment play a role in development of myopia. […] An epigenetic event such as DNA methylation could be one of the mechanisms through which these environmental factors influence the development of myopia. […] The current study identifies the global DNA methylation hotspots in the genome of high myopia patients under the age of 12 years. […] We have identified differential methylation in genes those were previously suggested to be associated with myopia such as, PAX6, ZNRF3, PSEN1, SOCS1, GRB2, ADCY3, RGS5, SRF and AP1B1. […] The methylation identified in our study in the promoter and first exon of TGFBR3 may influence the expression of this gene, causing the myopic phenotype that may lead to POAG.
#18 Epigenetically dysregulated genes and pathways implicated in the pathogenesis of non-syndromic high myopia | Scientific Reports
https://www.nature.com/articles/s41598-019-40299-x
Myopia, commonly referred to as nearsightedness, is one of the most common causes of visual disability throughout the world. […] Both genetics and environment play a role in development of myopia. […] An epigenetic event such as DNA methylation could be one of the mechanisms through which these environmental factors influence the development of myopia. […] The current study identifies the global DNA methylation hotspots in the genome of high myopia patients under the age of 12 years. […] We have identified differential methylation in genes those were previously suggested to be associated with myopia such as, PAX6, ZNRF3, PSEN1, SOCS1, GRB2, ADCY3, RGS5, SRF and AP1B1. […] The methylation identified in our study in the promoter and first exon of TGFBR3 may influence the expression of this gene, causing the myopic phenotype that may lead to POAG.
#19 Myopia in Children: Epidemiology, Genetics, and Emerging Therapies for Treatment and Prevention
https://www.mdpi.com/2227-9067/11/12/1446
Myopia is a common disease in which distant things appear blurry because the images are focused in front of the retina. The degree of visual impairment determines whether this refractive error is classified as mild, moderate, or high myopia. The hereditary influence on myopia is extensively documented, with a greater occurrence reported in persons who have a familial background of the disease. Studies on twins, especially those involving monozygotic twins, have provided additional evidence for the significant role of genetics in the development of myopia. […] Genetic investigations have discovered many loci (MYP1-MYP28) linked to myopia, mostly through the inheritance pattern of autosomal dominance. Nevertheless, these discoveries frequently lack reliable duplication, underscoring the intricacy of myopia genetics. Research on candidate genes has investigated the genes associated with the growth of the eye and the composition of the extracellular matrix. The PAX6 gene, which plays a vital role in the development of the eyes, has been associated with both high and extreme myopia, highlighting its significance in the development of refractive errors.
#20 Myopia in Children: Epidemiology, Genetics, and Emerging Therapies for Treatment and Prevention
https://www.mdpi.com/2227-9067/11/12/1446
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. The CREAM consortium and 23andMe studies have played a crucial role in finding genes associated with neurotransmission, ion channel function, retinoic acid metabolism, and extracellular matrix remodeling. Some of the noteworthy genes are GRIA4, KCNQ5, RDH5, LAMA2, and BMP2, among others. Although ongoing research is constantly providing valuable information, the precise mechanisms via which these genes contribute to the development of myopia have yet to be completely understood. […] 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. In addition to the initial discovery of 28 loci, further genome-wide association studies (GWASs) have uncovered more than 160 genetic loci that are linked to refractive error. These loci include PAX6, RBFOX1, and KCNMA1. RBFOX1, for instance, has a role in the development of the nervous system and has been associated with high myopia in multiple research investigations. Furthermore, the KCNMA1 gene, responsible for producing a large calcium-activated potassium channel, has been linked to the regulation of ocular growth.
#21 Azthena logo with the word Azthena
https://www.news-medical.net/health/Myopia-Research.aspx
Myopia (shortsightedness) is the most common ocular abnormality with growing prevalence worldwide and in a progressive nature in children, which have both contributed to a recent surge in interest. […] Various environmental and genetic factors have been shown to control eye growth and influence myopia development. […] The pathways implicated in eye growth control and myopia development in avian animal models have been partially characterized, but at this stage, it is not clear that these pathways can be transferred to eye growth control in humans. […] Gene encoding for transforming growth factor- (TGF- ) plays a crucial role in the process of scleral remodeling, and significant reductions of this product have been found in myopic eyes. Furthermore, both PAX 6 and SOX2, two so-called master control genes that play a major role in eye development and growth, have been implicated in myopia pathogenesis possibly due to genetic variation in an upstream promoter or regulator.
#22 Azthena logo with the word Azthena
https://www.news-medical.net/health/Myopia-Research.aspx
An association between common myopia and polymorphisms in three genes coding for matrix metalloproteinases (enzymes that degrade matrix proteins and modulate scleral extensibility) has recently been reported. […] Another candidate gene is the collagen type-1 alpha-1 gene (COL1A1), which is an extracellular matrix gene expressed in the scleral wall in patients with high myopia (but also in experimental myopia). […] Several new loci on different chromosomes have recently been identified and linked to myopia. […] As our understanding of the molecular mechanisms underlying the susceptibility and progression of this condition is still limited, novel and crucial genes are yet to be discovered.
#23 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 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.
#24 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/
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. […] 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.
#25 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.
#26 Understanding myopia: Pathogenesis and mechanisms | QUT ePrints
https://eprints.qut.edu.au/133580/
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. These studies have shown that experimentally degrading the quality of the image formed on the retina by introducing translucent diffusers (i.e., form-deprivation), or altering the focal point of the image with respect to the retinal plane by imposing plus or minus lenses to the eyes (i.e., lens induced defocus) results in abnormal eye growth and development of reflective errors. 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.
#27 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/
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. […] 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.
#28 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 (form-deprivation) and blur due to negative lens treatment. […] 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. […] 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. […] 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.
#29 The Science Behind Myopia – Webvision – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470669/
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. […] The complementary effects of positive and negative defocus reveal that the eye can discriminate between positive and negative defocus, as well as between unfocussed blur and blur due to negative lens treatment. […] We do not know whether eye growth is controlled by two different signals, one start and one stop, operating in push-pull fashion or by a single signal that increases elongation or decreases it. […] Myopia is a centuries-old problem, and although we have made great progress in scientific investigation of its underlying cause, we have been unsuccessful in preventing it from becoming named by the World Health Organization as an ever-increasing global health concern.
#30 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. […] Blurred or defocused images continue to affect eye growth even when the optic nerve is crushed, severing the link between eye and brain.
#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
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. […] Blurred or defocused images continue to affect eye growth even when the optic nerve is crushed, severing the link between eye and brain.
#32 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. […] Blurred or defocused images continue to affect eye growth even when the optic nerve is crushed, severing the link between eye and brain.
#33 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
Thus, post-retinal processing is not required for retinal images to affect eye growth. […] 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. […] 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. […] Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] This cascade is initiated by the quality of visual images on the retina, leading to molecular changes in the retina, the RPE and choroid, ultimately effecting changes in the sclera through scleral extracellular matrix synthesis and scleral biomechanics, resulting finally in eye shape.
#34 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
Emmetropization is a local, visually regulated process, thereby suggesting that myopia development is also modulated by visual signals perceived by the retina. […] The two prevailing environmental factors are near work and outdoor time, which are discussed in more detail later. […] It is clear there is a dose-dependent response between increased time outdoors and the risk of myopia onset. […] The primary theory behind high-light intensity is that brighter light triggers increased dopamine release from the retina, which slows axial elongation. […] It is imperative that practitioners continue to stay on top of education in this area so they can practice evidence-based optometry. […] By delaying onset, we can reduce the severity of an individual’s myopia and decrease the prevalence of high myopia and the risk of ocular consequences that follow.
#35 Myopia – EyeWiki
https://eyewiki.org/Myopia
More recent experimental data showed that children or adults with myopia had relative peripheral hyperopic defocus (images in the peripheral retina fell behind the retinal plane in optically corrected myopic subjects) so it was postulated that the peripheral refractive error could drive the emmetropization mechanisms leading to changes in ocular growth patterns. […] More research is needed in this area before this technology is available.
#36 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
Thus, post-retinal processing is not required for retinal images to affect eye growth. […] 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. […] 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. […] Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] This cascade is initiated by the quality of visual images on the retina, leading to molecular changes in the retina, the RPE and choroid, ultimately effecting changes in the sclera through scleral extracellular matrix synthesis and scleral biomechanics, resulting finally in eye shape.
#37 Mechanism of Action of Atropine in Controlling Myopia Progression – Review of Myopia Management
https://reviewofmm.com/mechanism-of-action-of-atropine-in-controlling-myopia-progression/
It was considered that atropine might be exerting its effect by altering retinal neurotransmission. […] Muscarinic receptors are also found in the retinal pigment epithelium, a layer that is involved in transferring the signaling cascade toward the target tissue i.e., the choroid and/or the sclera. Atropine was found to increase the release of dopamine but reduced the electroretinogram (ERG) b and d waves and dampened oscillations of retinal pigment epithelium (RPE) potentials. […] Additionally, a study in chicks found strong support for muscarinic antagonists exerting myopia inhibition via M4 receptors that are likely located in the retina. […] Atropine resulted in rapid and transient choroidal thickening and inhibited eye growth, and it was suggested that the two responses, i.e., choroidal thickening and eye growth, may be linked.
#38 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink
https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4
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. […] Scleral thinning associated with axial myopia is primarily restricted to the posterior pole, due to scleral tissue redistribution. […] The myopic response to FD varies among different animals. […] In all species, axial myopia is predominantly caused by a significant elongation of the vitreous chamber, along with thinning of the choroid and the sclera. […] The ocular response to lens induced defocus depends on the frequency and duration of lens wear, and not simply the total duration per day. […] These findings argue for a nonlinear processing of myopic and hyperopic defocus signals across the retina. […] In conclusion, over the last 40 years, remarkable progress has been made in understanding the possible mechanisms and pathogenesis of myopia, with a large contribution to this knowledge coming from an extensive body of work in animal models.
#39 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.
#40 Mechanism of Action of Atropine in Controlling Myopia Progression – Review of Myopia Management
https://reviewofmm.com/mechanism-of-action-of-atropine-in-controlling-myopia-progression/
It was considered that atropine might be exerting its effect by altering retinal neurotransmission. […] Muscarinic receptors are also found in the retinal pigment epithelium, a layer that is involved in transferring the signaling cascade toward the target tissue i.e., the choroid and/or the sclera. Atropine was found to increase the release of dopamine but reduced the electroretinogram (ERG) b and d waves and dampened oscillations of retinal pigment epithelium (RPE) potentials. […] Additionally, a study in chicks found strong support for muscarinic antagonists exerting myopia inhibition via M4 receptors that are likely located in the retina. […] Atropine resulted in rapid and transient choroidal thickening and inhibited eye growth, and it was suggested that the two responses, i.e., choroidal thickening and eye growth, may be linked.
#41 Effect of virtual reality-based visual training for myopia control in children: a randomized controlled trial | BMC Ophthalmology | Full Text
https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-024-03580-w
Myopia, one of the most common refractive errors, has raised significant international concern in recent decades, which may lead to blindness due to complications of high myopia. Myopia is mainly manifested as the decline of distance vision, lengthening of the axial length, and thinning of the choroid. The choroid plays an important role in regulating eye growth and refractive development. Previous study reported that the thinner choroid was associated with higher amounts of myopia. Choroidal thickness has also been suggested to be a biomarker for predicting future axial elongation (and thus myopia progression), with reduced axial elongation being tied to a thicker choroid, especially temporally. […] The study explored and verified a new method of applying virtual reality technology with visual training to myopia control. Among low-myopic children (aged 8 to 13 years), the VRVT intervention represented the reduction in axial elongation compared with the control group (0.0630.060 vs. 0.1290.060) in this 3-month randomized controlled trial.
#42 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink
https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4
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. […] Scleral thinning associated with axial myopia is primarily restricted to the posterior pole, due to scleral tissue redistribution. […] The myopic response to FD varies among different animals. […] In all species, axial myopia is predominantly caused by a significant elongation of the vitreous chamber, along with thinning of the choroid and the sclera. […] The ocular response to lens induced defocus depends on the frequency and duration of lens wear, and not simply the total duration per day. […] These findings argue for a nonlinear processing of myopic and hyperopic defocus signals across the retina. […] In conclusion, over the last 40 years, remarkable progress has been made in understanding the possible mechanisms and pathogenesis of myopia, with a large contribution to this knowledge coming from an extensive body of work in animal models.
#43 Mechanism of Action of Atropine in Controlling Myopia Progression – Review of Myopia Management
https://reviewofmm.com/mechanism-of-action-of-atropine-in-controlling-myopia-progression/
There is also a view that sclera is the target site for myopia inhibition with atropine. The synthesis of glycosaminoglycan, of the scleral extracellular matrix, was inhibited by atropine in studies involving scleral tissue from chicks. […] An improved understanding of the mechanism and target pathways will provide better ways to administer the compound. Furthermore, knowledge of the mechanism will help identify the individuals who are likely to get better treatment and improve the understanding of potential side effects.
#44 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
Thus, post-retinal processing is not required for retinal images to affect eye growth. […] 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. […] 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. […] Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] This cascade is initiated by the quality of visual images on the retina, leading to molecular changes in the retina, the RPE and choroid, ultimately effecting changes in the sclera through scleral extracellular matrix synthesis and scleral biomechanics, resulting finally in eye shape.
#45 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
Thus, post-retinal processing is not required for retinal images to affect eye growth. […] 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. […] 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. […] Convincing evidence over the past 40 years indicates that postnatal eye growth is largely controlled by an intraocular retina-to-sclera chemical cascade. […] This cascade is initiated by the quality of visual images on the retina, leading to molecular changes in the retina, the RPE and choroid, ultimately effecting changes in the sclera through scleral extracellular matrix synthesis and scleral biomechanics, resulting finally in eye shape.
#46 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
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. […] Taken together, these experimental and clinical observations provide compelling evidence for the role of circadian rhythms in postnatal ocular growth regulation and myopia pathogenesis.
#47 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
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. […] Taken together, these experimental and clinical observations provide compelling evidence for the role of circadian rhythms in postnatal ocular growth regulation and myopia pathogenesis.
#48 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
Emmetropization is a local, visually regulated process, thereby suggesting that myopia development is also modulated by visual signals perceived by the retina. […] The two prevailing environmental factors are near work and outdoor time, which are discussed in more detail later. […] It is clear there is a dose-dependent response between increased time outdoors and the risk of myopia onset. […] The primary theory behind high-light intensity is that brighter light triggers increased dopamine release from the retina, which slows axial elongation. […] It is imperative that practitioners continue to stay on top of education in this area so they can practice evidence-based optometry. […] By delaying onset, we can reduce the severity of an individual’s myopia and decrease the prevalence of high myopia and the risk of ocular consequences that follow.
#49
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. […] This phenomenon provides a theoretical basis for the hypothesis that light exposure affects the occurrence and development of myopia; indeed, some investigators who performed a series of experiments on the association of light environment with myopia in the early years found a correlation. […] 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.
#50 Dopamine in Myopia: Understanding Vision Changes
https://precisioneyemd.com/2023/08/30/dopamine-in-myopia/
Myopia, or nearsightedness, is a common vision condition. People with myopia have difficulty seeing distant objects clearly. […] Recently, research has shown a connection between dopamine and myopia, which could have significant implications for visual health. […] Studies suggest that dopamine also influences myopia development. Specifically, dopamine likely affects myopia by interacting with certain receptors in the retina. This interaction may contribute to eye elongation, which is a key factor in myopia. […] The dopamine deficiency hypothesis suggests that low dopamine signaling could cause myopia. In particular, when dopamine activity is reduced such as with prolonged near work (reading, screen time, etc.) the balance between the eyes focusing and growth regulation may be disrupted. As a result, this imbalance could lead to excessive eye elongation and myopia.
#51 Dopamine in Myopia: Understanding Vision Changes
https://precisioneyemd.com/2023/08/30/dopamine-in-myopia/
Myopia, or nearsightedness, is a common vision condition. People with myopia have difficulty seeing distant objects clearly. […] Recently, research has shown a connection between dopamine and myopia, which could have significant implications for visual health. […] Studies suggest that dopamine also influences myopia development. Specifically, dopamine likely affects myopia by interacting with certain receptors in the retina. This interaction may contribute to eye elongation, which is a key factor in myopia. […] The dopamine deficiency hypothesis suggests that low dopamine signaling could cause myopia. In particular, when dopamine activity is reduced such as with prolonged near work (reading, screen time, etc.) the balance between the eyes focusing and growth regulation may be disrupted. As a result, this imbalance could lead to excessive eye elongation and myopia.
#52 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
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. […] Taken together, these experimental and clinical observations provide compelling evidence for the role of circadian rhythms in postnatal ocular growth regulation and myopia pathogenesis.
#53 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
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. […] Taken together, these experimental and clinical observations provide compelling evidence for the role of circadian rhythms in postnatal ocular growth regulation and myopia pathogenesis.
#54 Diurnal gene expression patterns in retina and choroid distinguish myopia progression from myopia onset | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0307091
The world-wide prevalence of myopia (nearsightedness) is increasing, but its pathogenesis is incompletely understood. […] Among many putative mechanisms, laboratory and clinical findings have implicated circadian biology in the etiology of myopia. […] Considering other laboratory findings and human genetics and epidemiology, these results further link circadian biology to the pathogenesis of myopia; but they also point to important mechanistic differences between the onset of myopia and the progression of established myopia. […] Numerous laboratory and clinical findings have recently implicated circadian disruption in the development of myopia. […] The coupling of the optics in the front of the eye with its axial length determines ocular refraction. […] In myopia (nearsightedness), the most common refractive error, the eye is relatively long for the optical power of the cornea and lens; distant images are blurred because their focus lies in front of the retinal photoreceptors.
#55 Diurnal gene expression patterns in retina and choroid distinguish myopia progression from myopia onset | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0307091
Notwithstanding many decades of clinical and basic research, many hypotheses and much speculation, the etiologic mechanism(s) for the altered eye development underlying myopia or for its increasing prevalence are unclear. […] A vast number of signaling molecules, transcription factors, enzymes and biological pathways have been associated with myopia, but no coherent framework has yet emerged that clearly provides an explanation for the pathogenesis of clinical myopia. […] The expression levels of many genes during established and progressing myopia depend on the time of day in both retina and choroid. […] Most differentially expressed retinal genes were identified during the light phase (ZT00-ZT12), and the largest number of gene expression differences between occluded and open eyes during myopia progression occurred at ZT04.
#56 Diurnal gene expression patterns in retina and choroid distinguish myopia progression from myopia onset | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0307091
Notwithstanding many decades of clinical and basic research, many hypotheses and much speculation, the etiologic mechanism(s) for the altered eye development underlying myopia or for its increasing prevalence are unclear. […] A vast number of signaling molecules, transcription factors, enzymes and biological pathways have been associated with myopia, but no coherent framework has yet emerged that clearly provides an explanation for the pathogenesis of clinical myopia. […] The expression levels of many genes during established and progressing myopia depend on the time of day in both retina and choroid. […] Most differentially expressed retinal genes were identified during the light phase (ZT00-ZT12), and the largest number of gene expression differences between occluded and open eyes during myopia progression occurred at ZT04.
#57 Diurnal gene expression patterns in retina and choroid distinguish myopia progression from myopia onset | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0307091
The overwhelming majority of differentially expressed genes in choroid occurred at ZT12 and most differentially expressed genes in retina occurred at earlier times, consistent with the notion of a time delay between at least some retinal signals and their actions at the choroid. […] The limited overlap in the overall gene categories suggest that these genes and the processes they regulate may be active throughout the day, and that only a few genes underlie time-independent signaling common to myopia onset and progression.
#58 The visual environment in myopia | Myopia Profile
https://www.myopiaprofile.com/articles/the-visual-environment-in-myopia
Spending more time outside is the simplest lifestyle intervention we can advise for both at-risk pre-myopes and progressing myopes. It is well established now that increasing a child’s time outdoors helps to prevent or delay the onset of myopia. […] The mechanism is not fully understood, but there are several plausible theories. Increased light exposure while outdoors leads to pupil constriction (and an increase in depth of field), a decrease in blur, or increase in retinal dopamine which may inhibit axial elongation. […] Excessive near work has long been implicated in myopia development. It has been proposed that accommodative lag during near work induces hyperopic defocus a powerful stimulus for eye growth. […] Reading at very close working distances (30 cm) and for longer continuous periods of time (30 minutes) is associated with greater odds of having myopia.
#59 Myopia (Nearsightedness) | John A. Moran Eye Center | University of Utah Health
https://healthcare.utah.edu/moran/optometry/myopia
Myopia, also known as nearsightedness, causes poor long-distance vision. Nearsighted people have longer eyeballs or a higher curvature of their cornea. This can occur due to genetics or lifestyle components, such as overusing the eyes focusing mechanism with close work. The prevalence of myopia is increasing globally, which significantly increases the risk of vision impairment. […] Reducing the progression of myopia reduces your likelihood of developing myopic macular degeneration, which can cause vision loss. Even a small reduction by as little as one diopter can reduce your likelihood by 40%.Reducing myopia can lower the risk of developing glaucoma, cataracts, and retinal detachment. […] Studies show a deficiency in natural sunlight exposure could contribute to the recent increase in myopia. […] Increased time spent outdoors can slow myopia progression and may decrease the risk of new myopia onset by 50%. […] Studies show a deficiency in natural sunlight exposure could contribute to an increase in myopia.
#60 Myopia (Nearsightedness) | John A. Moran Eye Center | University of Utah Health
https://healthcare.utah.edu/moran/optometry/myopia
Myopia, also known as nearsightedness, causes poor long-distance vision. Nearsighted people have longer eyeballs or a higher curvature of their cornea. This can occur due to genetics or lifestyle components, such as overusing the eyes focusing mechanism with close work. The prevalence of myopia is increasing globally, which significantly increases the risk of vision impairment. […] Reducing the progression of myopia reduces your likelihood of developing myopic macular degeneration, which can cause vision loss. Even a small reduction by as little as one diopter can reduce your likelihood by 40%.Reducing myopia can lower the risk of developing glaucoma, cataracts, and retinal detachment. […] Studies show a deficiency in natural sunlight exposure could contribute to the recent increase in myopia. […] Increased time spent outdoors can slow myopia progression and may decrease the risk of new myopia onset by 50%. […] Studies show a deficiency in natural sunlight exposure could contribute to an increase in myopia.
#61 The visual environment in myopia | Myopia Profile
https://www.myopiaprofile.com/articles/the-visual-environment-in-myopia
Spending more time outside is the simplest lifestyle intervention we can advise for both at-risk pre-myopes and progressing myopes. It is well established now that increasing a child’s time outdoors helps to prevent or delay the onset of myopia. […] The mechanism is not fully understood, but there are several plausible theories. Increased light exposure while outdoors leads to pupil constriction (and an increase in depth of field), a decrease in blur, or increase in retinal dopamine which may inhibit axial elongation. […] Excessive near work has long been implicated in myopia development. It has been proposed that accommodative lag during near work induces hyperopic defocus a powerful stimulus for eye growth. […] Reading at very close working distances (30 cm) and for longer continuous periods of time (30 minutes) is associated with greater odds of having myopia.
#62 Is Nearsightedness Due to the Eyeball Being Too Long?
https://www.allaboutvision.com/conditions/myopia/length-of-eye/
The most common form of nearsightedness is called axial myopia. It occurs when the distance from the cornea to the back of the eye (the axial length) is too long relative to the focusing power of the cornea and lens. As a result, light focuses in front of the retina rather than on the retina. […] Axial myopia is the result of excessive elongation of the eye. In other words, it is due to the eyeball being too long. […] If this process does not occur properly, the eye can elongate too much resulting in axial myopia. […] A lack of daylight exposure is strongly associated with excessive elongation of the eyeball. […] Spending more time outdoors seems to have a protective effect against the eyeball growing too long, which results in axial myopia. […] Some studies have shown that lack of a clear retinal image can induce changes in the length of an eyeball.
#63 Is Nearsightedness Due to the Eyeball Being Too Long?
https://www.allaboutvision.com/conditions/myopia/length-of-eye/
The most common form of nearsightedness is called axial myopia. It occurs when the distance from the cornea to the back of the eye (the axial length) is too long relative to the focusing power of the cornea and lens. As a result, light focuses in front of the retina rather than on the retina. […] Axial myopia is the result of excessive elongation of the eye. In other words, it is due to the eyeball being too long. […] If this process does not occur properly, the eye can elongate too much resulting in axial myopia. […] A lack of daylight exposure is strongly associated with excessive elongation of the eyeball. […] Spending more time outdoors seems to have a protective effect against the eyeball growing too long, which results in axial myopia. […] Some studies have shown that lack of a clear retinal image can induce changes in the length of an eyeball.
#64 The visual environment in myopia | Myopia Profile
https://www.myopiaprofile.com/articles/the-visual-environment-in-myopia
Spending more time outside is the simplest lifestyle intervention we can advise for both at-risk pre-myopes and progressing myopes. It is well established now that increasing a child’s time outdoors helps to prevent or delay the onset of myopia. […] The mechanism is not fully understood, but there are several plausible theories. Increased light exposure while outdoors leads to pupil constriction (and an increase in depth of field), a decrease in blur, or increase in retinal dopamine which may inhibit axial elongation. […] Excessive near work has long been implicated in myopia development. It has been proposed that accommodative lag during near work induces hyperopic defocus a powerful stimulus for eye growth. […] Reading at very close working distances (30 cm) and for longer continuous periods of time (30 minutes) is associated with greater odds of having myopia.
#65 The visual environment in myopia | Myopia Profile
https://www.myopiaprofile.com/articles/the-visual-environment-in-myopia
Spending more time outside is the simplest lifestyle intervention we can advise for both at-risk pre-myopes and progressing myopes. It is well established now that increasing a child’s time outdoors helps to prevent or delay the onset of myopia. […] The mechanism is not fully understood, but there are several plausible theories. Increased light exposure while outdoors leads to pupil constriction (and an increase in depth of field), a decrease in blur, or increase in retinal dopamine which may inhibit axial elongation. […] Excessive near work has long been implicated in myopia development. It has been proposed that accommodative lag during near work induces hyperopic defocus a powerful stimulus for eye growth. […] Reading at very close working distances (30 cm) and for longer continuous periods of time (30 minutes) is associated with greater odds of having myopia.
#66 Contact Lenses Gettysburg | Myopia Nearsightedness York, PA
https://www.lheyecenter.com/vision-disorders-york/myopia-nearsightedness/
Progression of myopia has something to do with prolonged, sustained focusing, as avid readers and serious students do. […] The incidence of myopia has absolutely exploded in recent decades. This is especially true in eastern Asia there is a 96% incidence of myopia in Korean teens. In the US the rate of myopia doubled in the decade straddling 1980. This is a public health problem! Myopia causes a lot of eye diseases, as stated above.
#67 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.
#68 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. […] Myopia may also develop in adults due to visual stress or health conditions such as diabetes. […] Because persons with high myopia are at a greater risk of developing cataracts, glaucoma and myopic macular degeneration, myopia management may help preserve eye health.
#69 The visual environment in myopia | Myopia Profile
https://www.myopiaprofile.com/articles/the-visual-environment-in-myopia
Approximately 68% of children before age 3 use screen-based devices on a daily basis, and those children who do are more likely to have developed myopia by pre-school age. […] Level of education may act as a surrogate for increased involvement in near work. There is consistent epidemiological evidence suggesting that education has a causal role in relation to myopia, through various measures such as duration of education, educational achievement, and educational pressure.
#70 Contact Lenses Gettysburg | Myopia Nearsightedness York, PA
https://www.lheyecenter.com/vision-disorders-york/myopia-nearsightedness/
Progression of myopia has something to do with prolonged, sustained focusing, as avid readers and serious students do. […] The incidence of myopia has absolutely exploded in recent decades. This is especially true in eastern Asia there is a 96% incidence of myopia in Korean teens. In the US the rate of myopia doubled in the decade straddling 1980. This is a public health problem! Myopia causes a lot of eye diseases, as stated above.
#71 Myopia Control in Arcadia, CA – Book Your Appointment Online
https://southpasadenaeyecare.com/vision-care-products/myopia-control/
Myopia (nearsightedness) typically starts to develop in childhood and often progresses until about age 20. […] Slowing the progression is important because it may reduce the risk of developing serious eye conditions later in life such as cataracts, glaucoma, retinal detachment, and blindness. […] Many researchers believe the rise can be attributed to more time spent staring at screens and less time outdoors. […] Evidence suggests that nearsighted children who undergo several years of orthokeratology may end up with less myopia as adults. […] Several studies show that low-dose atropine helps to reduce the progression of myopia in children, especially when combined with Ortho-K lenses.
#72 The visual environment in myopia | Myopia Profile
https://www.myopiaprofile.com/articles/the-visual-environment-in-myopia
Approximately 68% of children before age 3 use screen-based devices on a daily basis, and those children who do are more likely to have developed myopia by pre-school age. […] Level of education may act as a surrogate for increased involvement in near work. There is consistent epidemiological evidence suggesting that education has a causal role in relation to myopia, through various measures such as duration of education, educational achievement, and educational pressure.
#73 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.
#74 Diurnal gene expression patterns in retina and choroid distinguish myopia progression from myopia onset | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0307091
The world-wide prevalence of myopia (nearsightedness) is increasing, but its pathogenesis is incompletely understood. […] Among many putative mechanisms, laboratory and clinical findings have implicated circadian biology in the etiology of myopia. […] Considering other laboratory findings and human genetics and epidemiology, these results further link circadian biology to the pathogenesis of myopia; but they also point to important mechanistic differences between the onset of myopia and the progression of established myopia. […] Numerous laboratory and clinical findings have recently implicated circadian disruption in the development of myopia. […] The coupling of the optics in the front of the eye with its axial length determines ocular refraction. […] In myopia (nearsightedness), the most common refractive error, the eye is relatively long for the optical power of the cornea and lens; distant images are blurred because their focus lies in front of the retinal photoreceptors.
#75
https://journals.lww.com/ijo/fulltext/2022/08000/current_concepts_in_the_management_of_childhood.6.aspx
Myopia or short-sightedness is an emerging pandemic affecting more than 50% population in South-Asian countries. […] The pathophysiology of myopia involves a complex interplay of numerous environmental and genetic factors leading to progressive axial elongation. […] Though several factors such as genetic predisposition and environmental causes are instrumental in the pathogenesis, the discrete role of each of these to target the onset and delay the progression of myopia remains ambiguous. […] During the normal process of emmetropisation, the eye expands in all directions (axial and equatorial) and is associated with mechanical stretching and thinning of the crystalline lens along the equatorial plane, which results in a decrease in the power of the lens. A decoupling between this process of axial elongation and flattening of the corneal and lens curvature causes escalated axial growth and arrest of lens thinning by disruption of the equatorial expansion, leading to myopia.
#76 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. […] 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.
#77 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
These changes may play a role in refractive development and the emmetropization process. […] There is strong evidence to support the notion that current optical treatments for myopia management also induce more HOAs. […] Most forms of myopia occur because the axial length is too long relative to the refractive power of the eye, otherwise known as axial myopia. […] The most common form of myopiaâschool-age myopiaâis impacted by both the environment and gene expression. […] However, adult-onset myopia may have a different pathophysiology given that it develops later in life. […] While it is clear that there is a genetic component to myopia development, genetics cannot single-handedly be responsible for the dramatic rise in the condition. […] Myopia is a multifactorial disease that also has an environmental component.
#78 Myopia – Wikipedia
https://en.wikipedia.org/wiki/Myopia
Because myopia is a refractive error, the physical cause of myopia is comparable to any optical system that is out of focus. […] 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. […] Curvature myopia is attributed to excessive, or increased, curvature of one or more of the refractive surfaces of the eye, especially the cornea. […] Index myopia is attributed to variation in the index of refraction of one or more of the ocular media.
#79 Understanding Myopia: Pathogenesis and Mechanisms | SpringerLink
https://link.springer.com/chapter/10.1007/978-981-13-8491-2_4
In fact, several optical interventions alter ocular aberrations, peripheral refraction, and the accommodative response of the eye in an attempt to arrest myopia development. […] Based on decades of work on the effects of ambient lighting on refractive development in laboratory animals, recent clinical studies have revealed protective effects of greater outdoor exposures on development and progression of myopia in children. […] This chapter focuses on the pathogenesis and potential underlying mechanisms of myopia, and the following section discusses the changes in different ocular parameters during myopic eye growth. […] 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.
#80 Childhood-onset myopia management: Evidence review – College of Optometrists
https://www.college-optometrists.org/category-landing-pages/clinical-topics/myopia/childhood-onset-myopia-management-evidence-review
Myopia is increasing in prevalence, causing a global public health problem. By 2050, it is predicted that half the worlds population will have myopia, a known risk factor for sight threatening ocular pathology. Higher levels of myopia (5D) are associated with a higher risk of these complications. […] Research has shown that myopia has a link to ocular health complications, even at lower levels of myopia (5D). The aim of myopia management (myopia control) is to delay the onset and slow the progression of myopia, thereby reducing the final level of myopia, which, in turn, is likely to help to maintain good ocular health later in life by reducing the associated risks. […] There is evidence that delaying the onset of myopia helps limit the final level of myopia. Preventing or delaying onset is only currently possible through environmental adaptations to increase time spent outdoors and limiting indoor near vision activities.
#81 Myopia – EyeWiki
https://eyewiki.org/Myopia
Myopia (nearsightedness) is an ocular disorder in which the optical power of the eye is too strong for the corresponding axial length. Light rays from an object at infinity entering a non-accommodating myopic eye are converged too strongly and focus in front of the retina. […] Myopia is a complex disease with a multi-factorial etiology. It is well documented that pathological non-syndromic high myopia and associated syndromic high myopia show evidence of familial inheritance. […] The ocular pathology that is associated with high myopia is not generally observed with isolated physiologic myopia. […] The signalling cascade from the retina to the sclera is still under study. […] The mechanism leading to changes in ocular elongation involves local retinal image processing which sends a stop or go message to the sclera, regulating scleral matrix properties and its rate of elongation.
#82
https://journals.lww.com/ijo/fulltext/2022/08000/current_concepts_in_the_management_of_childhood.6.aspx
The role of retinal defocus and peripheral hyperopia as a precursor in the onset and progression of myopia has also been widely explored. […] 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. However, the role of each in lowering the incidence and progression of myopia is not specifically defined. […] Recognition of the modifiable factors involved in myopia pathogenesis is imperative to devise suitable strategies to avert its onset and progression, especially in premyopes.
#83 Hyperopic Defocus Blur
https://www.myopiafocus.org/hyperopic-defocus-blur
Hyperopic defocus refers to deliberately introducing out-of-focus images on the peripheral retina while maintaining clear vision on the central retina. It is used as a technique in myopia management to slow down the lengthening of the eye which is also known as axial length. […] The mechanism behind how hyperopic defocus works is not yet fully understood, but there are a few proposed theories. One evidenced theory suggests that when the peripheral retina experiences defocused or blurred images, it sends signals to the eye to slow down its growth in an attempt to achieve clear vision. This feedback mechanism helps regulate the elongation of the eyeball, which is a characteristic of myopia. […] The purpose of creating this intentional blur is to stimulate specific optical signals in the peripheral retina. It is believed that these signals trigger a feedback mechanism that influences the growth and elongation of the eyeball. By providing the peripheral retina with defocused images, it may help slow down the elongation of the eye and the progression of myopia.
#84 Hyperopic Defocus Blur
https://www.myopiafocus.org/hyperopic-defocus-blur
Hyperopic defocus refers to deliberately introducing out-of-focus images on the peripheral retina while maintaining clear vision on the central retina. It is used as a technique in myopia management to slow down the lengthening of the eye which is also known as axial length. […] The mechanism behind how hyperopic defocus works is not yet fully understood, but there are a few proposed theories. One evidenced theory suggests that when the peripheral retina experiences defocused or blurred images, it sends signals to the eye to slow down its growth in an attempt to achieve clear vision. This feedback mechanism helps regulate the elongation of the eyeball, which is a characteristic of myopia. […] The purpose of creating this intentional blur is to stimulate specific optical signals in the peripheral retina. It is believed that these signals trigger a feedback mechanism that influences the growth and elongation of the eyeball. By providing the peripheral retina with defocused images, it may help slow down the elongation of the eye and the progression of myopia.
#85 Prevention of myopia progression using orthokeratology
https://www.kosinmedj.org/journal/view.php?number=1265
Peripheral retinal defocus occurs when the central focal point is on the retina while the peripheral focal points are not. […] It is worth noting that in myopes, the eye is prolate resulting to a greater degree of peripheral hyperopic defocus. […] To address this, Ortho-K is designed to create peripheral myopic defocus, in turn decreasing or reversing the stimulus for axial elongation. […] Ortho-K treatment effectively alters the corneal shape and profile and in turn, increases total HOA that, based on this theory, is desirable in the treatment of myopia progression. […] However, studies have inconclusive results. […] Although Ortho-K shows a significant slowing effect in myopic progression, the results vary with each report and across individuals. […] The Discontinuation of Orthokeratology on Eyeball Elongation (DOEE) study reported that discontinuation of Ortho-K use before age 14 years led to an increased rate of axial length elongation. […] Ortho-K is a treatment modality for the correction of myopia and the slowing of its progression.
#86 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. […] Novel approaches toward prevention of myopia development and/or progression require a better understanding of fundamental changes that occur in the initial stages of myopia formation in order to identify causal factors, elucidate novel therapeutic targets, and allow for early intervention.
#87 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
By means of novel analyses of merged, publicly-available databases, cellular immune response and cytokine signaling pathways were found to be commonly affected in both human myopia and experimental animal myopia. […] 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, and that atropine and normal vision could reverse these increases in the affected signaling pathways.
#88 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
By means of novel analyses of merged, publicly-available databases, cellular immune response and cytokine signaling pathways were found to be commonly affected in both human myopia and experimental animal myopia. […] 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, and that atropine and normal vision could reverse these increases in the affected signaling pathways.
#89 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
By means of novel analyses of merged, publicly-available databases, cellular immune response and cytokine signaling pathways were found to be commonly affected in both human myopia and experimental animal myopia. […] 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, and that atropine and normal vision could reverse these increases in the affected signaling pathways.
#90 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.
#91 Myopia – EyeWiki
https://eyewiki.org/Myopia
Myopia (nearsightedness) is an ocular disorder in which the optical power of the eye is too strong for the corresponding axial length. Light rays from an object at infinity entering a non-accommodating myopic eye are converged too strongly and focus in front of the retina. […] Myopia is a complex disease with a multi-factorial etiology. It is well documented that pathological non-syndromic high myopia and associated syndromic high myopia show evidence of familial inheritance. […] The ocular pathology that is associated with high myopia is not generally observed with isolated physiologic myopia. […] The signalling cascade from the retina to the sclera is still under study. […] The mechanism leading to changes in ocular elongation involves local retinal image processing which sends a stop or go message to the sclera, regulating scleral matrix properties and its rate of elongation.
#92 Myopia (nearsightedness): Definition, causes, and treatment
https://www.medicalnewstoday.com/articles/myopia
#93 Myopia (Nearsightedness) | John A. Moran Eye Center | University of Utah Health
https://healthcare.utah.edu/moran/optometry/myopia
Myopia, also known as nearsightedness, causes poor long-distance vision. Nearsighted people have longer eyeballs or a higher curvature of their cornea. This can occur due to genetics or lifestyle components, such as overusing the eyes focusing mechanism with close work. The prevalence of myopia is increasing globally, which significantly increases the risk of vision impairment. […] Reducing the progression of myopia reduces your likelihood of developing myopic macular degeneration, which can cause vision loss. Even a small reduction by as little as one diopter can reduce your likelihood by 40%.Reducing myopia can lower the risk of developing glaucoma, cataracts, and retinal detachment. […] Studies show a deficiency in natural sunlight exposure could contribute to the recent increase in myopia. […] Increased time spent outdoors can slow myopia progression and may decrease the risk of new myopia onset by 50%. […] Studies show a deficiency in natural sunlight exposure could contribute to an increase in myopia.
#94 Myopia: Pathogenesis and Intervention – Nature Cell and Science
https://cellnatsci.com/2958-695X/article/10-61474-ncs-2024-00049
The relationship between high myopia and glaucoma, especially primary open-angle glaucoma, is well-documented, with increasing myopia severity correlating non-linearly with elevated glaucoma risk. The thinning of the retinal nerve fiber layer, detected via OCT, often precedes functional loss, suggesting that structural changes in highly myopic individuals warrant early detection and intervention strategies to preserve visual function. […]