Risk Factors for Myopia: A Review

Due to the myopia prevalence increase worldwide, this study aims to establish the most relevant risk factors associated with its development and progression. A review search was carried out using PubMed, Web of Science, and Scopus databases to identify the main myopia risk factors. The inclusion criteria for the articles were those related to the topic, carried out in subjects from 5 to 30 years, published between January 2000 and May 2023, in English, and with the full text available. Myopia etiology has proven to be associated with both genetic and environmental factors as well as with gene–environment interaction. The risk of developing myopia increases in children with myopic parents (one parent ×2 times, two parents ×5 times). Regarding environmental factors, education is the main risk factor correlated with myopia prevalence increase. Further, several studies found that shorter distance (<30 cm) and longer time spent (>30 min) for near work increase the risk of myopia. Meanwhile, increased outdoor activity (>40 min/day) has been shown to be a key factor in reducing myopia incidence. In conclusion, the interventional strategy suggested so far to reduce myopia incidence is an increase in time outdoors and a reduction in the time spent performing near-work tasks.

[1]  N. Davies,et al.  Effect of Education on Myopia: Evidence from the United Kingdom ROSLA 1972 Reform , 2020, Investigative ophthalmology & visual science.

[2]  C. K. Hsiao,et al.  Evolution of the Prevalence of Myopia among Taiwanese Schoolchildren: A Review of Survey Data from 1983 to 2017. , 2020, Ophthalmology.

[3]  P. Lee,et al.  The diversified defocus profile of the near‐work environment and myopia development , 2020, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[4]  I. C. Munch,et al.  Low physical activity and higher use of screen devices are associated with myopia at the age of 16‐17 years in the CCC2000 Eye Study , 2020, Acta ophthalmologica.

[5]  M. A. Sanchez-Tena,et al.  Prevalence and Risk Factors of Myopia in Spain , 2019, Journal of ophthalmology.

[6]  A. Barak,et al.  Association Between Type of Educational System and Prevalence and Severity of Myopia Among Male Adolescents in Israel. , 2019, JAMA ophthalmology.

[7]  Xin Zhang,et al.  Electronic devices and myopic refraction among children aged 6‐14 years in urban areas of Tianjin, China , 2019, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[8]  Rishikesh Kumar,et al.  Prevalence of Myopia and Associated Risk Factors in Schoolchildren in North India. , 2019, Optometry and vision science : official publication of the American Academy of Optometry.

[9]  J. Stack,et al.  Risk factors associated with myopia in schoolchildren in Ireland , 2019, British Journal of Ophthalmology.

[10]  A. Steptoe,et al.  The Associations between Near Visual Activity and Incident Myopia in Children: A Nationwide 4-Year Follow-up Study. , 2019, Ophthalmology.

[11]  M. Kauppinen,et al.  Risk factors for high myopia: a 22‐year follow‐up study from childhood to adulthood , 2018, Acta ophthalmologica.

[12]  T. Wong,et al.  From reading books to increased smart device screen time , 2018, British Journal of Ophthalmology.

[13]  Scott A. Read,et al.  Patterns of Daily Outdoor Light Exposure in Australian and Singaporean Children , 2018, Translational vision science & technology.

[14]  Jonathan H. Morgan,et al.  Genome-wide association meta-analysis highlights light-induced signaling as a driver for refractive error , 2018, Nature Genetics.

[15]  J. Loughman,et al.  Parental attitudes to myopia: a key agent of change for myopia control? , 2018, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[16]  S. Chiou,et al.  Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. , 2018, Ophthalmology.

[17]  R. Pandey,et al.  Incidence and progression of myopia and associated factors in urban school children in Delhi: The North India Myopia Study (NIM Study) , 2017, PloS one.

[18]  Amanda N. French,et al.  The epidemics of myopia: Aetiology and prevention , 2017, Progress in Retinal and Eye Research.

[19]  P. Lee,et al.  Childhood exposure to constricted living space: a possible environmental threat for myopia development , 2017, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[20]  T. Yamashita,et al.  Association of lifestyle and body structure to ocular axial length in Japanese elementary school children , 2017, BMC Ophthalmology.

[21]  S. Chiou,et al.  Risk factors for myopia progression in second-grade primary school children in Taipei: a population-based cohort study , 2017, British Journal of Ophthalmology.

[22]  Xun Xu,et al.  Time spent in outdoor activities in relation to myopia prevention and control: a meta‐analysis and systematic review , 2017, Acta ophthalmologica.

[23]  J. Guggenheim,et al.  Time Outdoors at Specific Ages During Early Childhood and the Risk of Incident Myopia , 2017, Investigative ophthalmology & visual science.

[24]  N. Congdon,et al.  Age-Specific Prevalence of Visual Impairment and Refractive Error in Children Aged 3-10 Years in Shanghai, China. , 2016, Investigative ophthalmology & visual science.

[25]  K. Ciuffreda,et al.  The influence of near work on myopic refractive change in urban students in Beijing: a three-year follow-up report , 2016, Graefe's Archive for Clinical and Experimental Ophthalmology.

[26]  C. Sabanayagam,et al.  Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children , 2016, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[27]  K. Bonsu,et al.  Relationship between Reduced Accommodative Lag and Myopia Progression , 2016, Optometry and vision science : official publication of the American Academy of Optometry.

[28]  K. Naidoo,et al.  Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. , 2016, Ophthalmology.

[29]  Peter K. Joshi,et al.  Meta-analysis of gene–environment-wide association scans accounting for education level identifies additional loci for refractive error , 2016, Nature Communications.

[30]  J. Mai,et al.  Prevalence and associated factors of myopia among primary and middle school-aged students: a school-based study in Guangzhou , 2016, Eye.

[31]  O. Franco,et al.  Low serum vitamin D is associated with axial length and risk of myopia in young children , 2016, European Journal of Epidemiology.

[32]  V. Öner,et al.  Influence of indoor and outdoor activities on progression of myopia during puberty , 2016, International Ophthalmology.

[33]  K. Saunders,et al.  Six Year Refractive Change among White Children and Young Adults: Evidence for Significant Increase in Myopia among White UK Children , 2016, PloS one.

[34]  Pei-Chang Wu,et al.  The Association between Near Work Activities and Myopia in Children—A Systematic Review and Meta-Analysis , 2015, PloS one.

[35]  Scott A Read,et al.  Light Exposure and Eye Growth in Childhood. , 2015, Investigative ophthalmology & visual science.

[36]  M. He,et al.  Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial. , 2015, JAMA.

[37]  P. Mitchell,et al.  Near Work Related Parameters and Myopia in Chinese Children: the Anyang Childhood Eye Study , 2015, PloS one.

[38]  Xiao-yan Wu,et al.  Effect of outdoor activity on myopia onset and progression in school-aged children in northeast china: the sujiatun eye care study , 2015, BMC Ophthalmology.

[39]  Shan C. Lin,et al.  Myopia and glaucoma: sorting out the difference , 2015, Current opinion in ophthalmology.

[40]  R. Pandey,et al.  Prevalence of Myopia and Its Risk Factors in Urban School Children in Delhi: The North India Myopia Study (NIM Study) , 2015, PloS one.

[41]  A. Viljanen,et al.  The progression of myopia from its onset at age 8–12 to adulthood and the influence of heredity and external factors on myopic progression. A 23‐year follow‐up study , 2014, Acta ophthalmologica.

[42]  M. Beutel,et al.  Myopia and level of education: results from the Gutenberg Health Study. , 2014, Ophthalmology.

[43]  Y. Chan,et al.  Differences in Prevalence of Refractive Errors in Young Asian Males in Singapore between 1996–1997 and 2009–2010 , 2014, Ophthalmic epidemiology.

[44]  Elise Harb,et al.  Visual activity and its association with myopia stabilisation , 2014, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[45]  J. Jonas,et al.  Refractive Error, Visual Acuity and Causes of Vision Loss in Children in Shandong, China. The Shandong Children Eye Study , 2013, PloS one.

[46]  Gretchen A. Stevens,et al.  Causes of vision loss worldwide, 1990-2010: a systematic analysis. , 2013, The Lancet. Global health.

[47]  Gabriëlle H S Buitendijk,et al.  Education influences the role of genetics in myopia , 2013, European Journal of Epidemiology.

[48]  Amanda N. French,et al.  Risk factors for incident myopia in Australian schoolchildren: the Sydney adolescent vascular and eye study. , 2013, Ophthalmology.

[49]  Amanda N. French,et al.  Time outdoors and the prevention of myopia. , 2013, Experimental eye research.

[50]  F. Schaeffel,et al.  An updated view on the role of dopamine in myopia. , 2013, Experimental eye research.

[51]  I. Morgan,et al.  Myopia and international educational performance , 2013, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[52]  Pei-Chang Wu,et al.  Outdoor activity during class recess reduces myopia onset and progression in school children. , 2013, Ophthalmology.

[53]  Gabriëlle H S Buitendijk,et al.  Genome-wide meta-analyses of multiancestry cohorts identify multiple new susceptibility loci for refractive error and myopia , 2013, Nature Genetics.

[54]  Claire L. Simpson,et al.  Matrix metalloproteinases and educational attainment in refractive error: evidence of gene-environment interactions in the Age-Related Eye Disease Study. , 2013, Ophthalmology.

[55]  J. Jonas,et al.  Outdoor activity and myopia among primary students in rural and urban regions of Beijing. , 2013, Ophthalmology.

[56]  D. Flitcroft The complex interactions of retinal, optical and environmental factors in myopia aetiology , 2012, Progress in Retinal and Eye Research.

[57]  D. Mutti,et al.  Time outdoors, visual activity, and myopia progression in juvenile-onset myopes. , 2012, Investigative ophthalmology & visual science.

[58]  K. Naidoo,et al.  Global cost of correcting vision impairment from uncorrected refractive error. , 2012, Bulletin of the World Health Organization.

[59]  Chuong B. Do,et al.  Genome-Wide Analysis Points to Roles for Extracellular Matrix Remodeling, the Visual Cycle, and Neuronal Development in Myopia , 2012, PLoS genetics.

[60]  O. Pärssinen The increased prevalence of myopia in Finland , 2012, Acta ophthalmologica.

[61]  George Mcmahon,et al.  Time outdoors and physical activity as predictors of incident myopia in childhood: a prospective cohort study. , 2012, Investigative ophthalmology & visual science.

[62]  R. Casson,et al.  Refractive Error in School Children in an Urban and Rural Setting in Cambodia , 2012, Ophthalmic epidemiology.

[63]  D. Fan,et al.  Change in vision disorders among Hong Kong preschoolers in 10 years , 2011, Clinical & experimental ophthalmology.

[64]  David A. Berntsen,et al.  Accommodative lag and juvenile-onset myopia progression in children wearing refractive correction , 2011, Vision Research.

[65]  D. Mutti,et al.  Visual activity before and after the onset of juvenile myopia. , 2011, Investigative ophthalmology & visual science.

[66]  D. Mutti,et al.  Blood Levels of Vitamin D in Teens and Young Adults with Myopia , 2011, Optometry and vision science : official publication of the American Academy of Optometry.

[67]  Chien-Jen Chen,et al.  Comparing myopic progression of urban and rural Taiwanese schoolchildren , 2010, Japanese Journal of Ophthalmology.

[68]  N. Congdon,et al.  Population density and refractive error among Chinese children. , 2010, Investigative ophthalmology & visual science.

[69]  Pei-Chang Wu,et al.  Effects of Outdoor Activities on Myopia Among Rural School Children in Taiwan , 2010, Ophthalmic epidemiology.

[70]  P. Mitchell,et al.  Family history, near work, outdoor activity, and myopia in Singapore Chinese preschool children , 2010, British Journal of Ophthalmology.

[71]  N. Congdon,et al.  Associations between near work, outdoor activity, and myopia among adolescent students in rural China: the Xichang Pediatric Refractive Error Study report no. 2. , 2009, Archives of ophthalmology.

[72]  B. S. Kumar,et al.  A comparative clinical survey of the prevalence of refractive errors and eye diseases in urban and rural school children. , 2009, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[73]  R. Klein,et al.  Heritability analysis of spherical equivalent, axial length, corneal curvature, and anterior chamber depth in the Beaver Dam Eye Study. , 2009, Archives of ophthalmology.

[74]  R. Iribarren,et al.  Age of First Distance Prescription and Final Myopic Refractive Error , 2009, Ophthalmic epidemiology.

[75]  Yingfeng Zheng,et al.  Prevalence of Myopia in Urban and Rural Children in Mainland China , 2009, Optometry and vision science : official publication of the American Academy of Optometry.

[76]  P. Mitchell,et al.  Myopia and the urban environment: findings in a sample of 12-year-old Australian school children. , 2008, Investigative ophthalmology & visual science.

[77]  Paul Mitchell,et al.  Outdoor activity reduces the prevalence of myopia in children. , 2008, Ophthalmology.

[78]  Paul Mitchell,et al.  Role of near work in myopia: findings in a sample of Australian school children. , 2008, Investigative ophthalmology & visual science.

[79]  S. Saw,et al.  A comparison of measures of reading and intelligence as risk factors for the development of myopia in a UK cohort of children , 2008, British Journal of Ophthalmology.

[80]  N. Martin,et al.  Genetic dissection of myopia: evidence for linkage of ocular axial length to chromosome 5q. , 2008, Ophthalmology.

[81]  P. Mitchell,et al.  Myopia, Lifestyle, and Schooling in Students of Chinese Ethnicity in Singapore and Sydney Study Population , 2022 .

[82]  Weizhong Lan,et al.  A longitudinal study on the relationship between myopia development and near accommodation lag in myopic children , 2008, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[83]  P. Riddell,et al.  Variability of the Accommodation Response in Early Onset Myopia , 2008, Optometry and vision science : official publication of the American Academy of Optometry.

[84]  D. Mutti,et al.  Parental history of myopia, sports and outdoor activities, and future myopia. , 2007, Investigative ophthalmology & visual science.

[85]  P. Mitchell,et al.  Ethnic differences in the impact of parental myopia: findings from a population-based study of 12-year-old Australian children. , 2007, Investigative ophthalmology & visual science.

[86]  D. Troilo,et al.  Accommodation and induced myopia in marmosets , 2007, Vision Research.

[87]  D. Tan,et al.  School grades and myopia , 2007, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[88]  Yingfeng Zheng,et al.  Refractive error and visual impairment in school children in rural southern China. , 2007, Ophthalmology.

[89]  D. Czepita,et al.  Prevalence of myopia and hyperopia in a population of Polish schoolchildren , 2006, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[90]  R. Guymer,et al.  Heritability of refractive error and ocular biometrics: the Genes in Myopia (GEM) twin study. , 2006, Investigative ophthalmology & visual science.

[91]  Elise Harb,et al.  Characteristics of accommodative behavior during sustained reading in emmetropes and myopes , 2006, Vision Research.

[92]  Richard A Stone,et al.  A cohort study of incident myopia in Singaporean children. , 2006, Investigative ophthalmology & visual science.

[93]  D. Mutti,et al.  Accommodative lag before and after the onset of myopia. , 2006, Investigative ophthalmology & visual science.

[94]  C. Wildsoet,et al.  Effects of interchanging hyperopic defocus and form deprivation stimuli in normal and optic nerve-sectioned chicks , 2006, Vision Research.

[95]  R. Held,et al.  Accommodation, Accommodative Convergence, and Response AC/A Ratios Before and at the Onset of Myopia in Children , 2005, Optometry and vision science : official publication of the American Academy of Optometry.

[96]  D. Fung,et al.  IQ and the association with myopia in children. , 2004, Investigative ophthalmology & visual science.

[97]  Jonathan Winawer,et al.  Homeostasis of Eye Growth and the Question of Myopia , 2004, Neuron.

[98]  S. Saw,et al.  Prevalence of refractive errors in teenage high school students in Singapore , 2004, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[99]  A. Reymond,et al.  Knobloch syndrome: Novel mutations in COL18A1, evidence for genetic heterogeneity, and a functionally impaired polymorphism in endostatin , 2004, Human Mutation.

[100]  Bruce Bennetts,et al.  Detection of thirty novel FBN1 mutations in patients with Marfan syndrome or a related fibrillinopathy , 2004, Human mutation.

[101]  Hiroshi Ohtsuki,et al.  Accommodative lag under habitual seeing conditions: comparison between adult myopes and emmetropes. , 2003, Japanese journal of ophthalmology.

[102]  O. Mäkitie,et al.  New locus for autosomal dominant high myopia maps to the long arm of chromosome 17. , 2003, Investigative ophthalmology & visual science.

[103]  Y. Leung,et al.  TGFβ-Induced Factor: A Candidate Gene for High Myopia , 2003 .

[104]  C. Wildsoet Neural pathways subserving negative lens-induced emmetropization in chicks – Insights from selective lesions of the optic nerve and ciliary nerve , 2003, Current eye research.

[105]  D. Mutti,et al.  Parental myopia, near work, school achievement, and children's refractive error. , 2002, Investigative ophthalmology & visual science.

[106]  M. Rosenfield,et al.  Do Progressing Myopes Show Reduced Accommodative Responses? , 2002, Optometry and vision science : official publication of the American Academy of Optometry.

[107]  Richard A Stone,et al.  Nearwork in early-onset myopia. , 2002, Investigative ophthalmology & visual science.

[108]  L. Dandona,et al.  Population‐based assessment of refractive error in India: the Andhra Pradesh eye disease study , 2002, Clinical & experimental ophthalmology.

[109]  O. Rascol,et al.  A genome wide scan for familial high myopia suggests a novel locus on chromosome 7q36 , 2002, Journal of medical genetics.

[110]  A. Sjølie,et al.  The importance of genes and environment for ocular refraction and its determiners: a population based study among 20–45 year old twins , 2001, The British journal of ophthalmology.

[111]  T. Wong,et al.  Academic achievement, close up work parameters, and myopia in Singapore military conscripts , 2001, British Journal of Ophthalmology.

[112]  S. Saw,et al.  Near-work activity and myopia in rural and urban schoolchildren in China. , 2001, Journal of pediatric ophthalmology and strabismus.

[113]  J. Katz,et al.  Familial clustering and myopia progression in Singapore school children , 2001, Ophthalmic epidemiology.

[114]  C. Scharfe,et al.  The complete form of X-linked congenital stationary night blindness is caused by mutations in a gene encoding a leucine-rich repeat protein , 2000, Nature Genetics.

[115]  F. Nieto,et al.  Factors Related to the Progression of Myopia in Singaporean Children , 2000, Optometry and vision science : official publication of the American Academy of Optometry.

[116]  Earl L. Smith,et al.  Spectacle lenses alter eye growth and the refractive status of young monkeys , 1995, Nature Medicine.

[117]  J. Wallman,et al.  Developing eyes that lack accommodation grow to compensate for imposed defocus , 1990, Visual Neuroscience.

[118]  R D Sperduto,et al.  Prevalence of myopia in the United States. , 1983, Archives of ophthalmology.

[119]  Gabriëlle H S Buitendijk,et al.  University of Southern Denmark Increasing Prevalence of Myopia in Europe and the Impact of Education , 2015 .

[120]  L. Nelson Myopia, Lifestyle and Schooling in Students of Chinese Ethnicity in Singapore and Sydney , 2009 .

[121]  Catherine A McCarty,et al.  Development of cataract and associated risk factors: the Visual Impairment Project. , 2006, Archives of ophthalmology.

[122]  N. Shimizu,et al.  Refractive errors and factors associated with myopia in an adult Japanese population. , 2003, Japanese journal of ophthalmology.