Table 1 Summary of environmental and lifestyle factors influencing myopia
From: The influence of the environment and lifestyle on myopia
Factor | Evidence | Relationship with myopia |
|---|---|---|
Time spent outdoors | Strong | • Increasing time outdoors is associated with less risk of myopia onset. • Dose-dependent effect. |
Light intensity or light levels | Strong | • Higher levels of light are associated with less myopia. • Potentially a dose-dependent effect. |
Spectral composition of light | Possible | • Interventions using red, blue, or violet lights have shown promising results. • These findings require further evaluation with a longer study duration, better side-effect evaluation, and possible rebound effect investigation. |
Timing, duration, pattern of light exposure | Possible | • Protective, duration-dependent effect of high illuminance light. • The impacts of timing and patterns of light exposure are understudied in humans and limited to animal studies. |
Spatial frequency of the visual environment | Possible | • Lower spatial frequency is associated with an increased risk of myopia development. • Findings are limited to animal studies and mathematical modeling in humans. |
Physical activity | Weak | • Not an independent factor but rather linked to time spent outdoors. |
Near work | Strong | • Intensity, continuity, and closer working distance are consistently associated with a higher risk of myopia. |
Accommodation | Possible | • Inconsistent evidence on accommodation lag and amplitude. • Impacts are not fully understood. |
Relative peripheral refraction | Possible | • Peripheral retinal hyperopic defocus is associated with myopia development. • These findings lack consistency. |
Urbanization and housing | Weak | • Inconsistent and related to increased near work and reduced time spent outdoors. |
Socioeconomic status | Weak | • Inconsistent and related to increased near work. |
Education level | Possible | • Predominantly related to increased near work. |
Pollution | Weak | • Related to urbanization and housing type and increased near work. |
Second-hand smoking | Weak | • Inconsistent and weak association between smoking and myopia. • Confounded by education and subjective measurements. |
Seasons | Weak | • Children born in summer have a lower incidence of myopia. • Less myopia progression was observed during summer. • Unclear link, confounded by multiple factors. |
Sleep and circadian rhythms | Possible | • Potential link between delayed circadian phase and myopia. • Inconsistent and conflicting evidence which needs objective quantification of sleep and light exposure. |
Diet and nutrition | Weak | • Inconsistent and needs more structured investigations. |