Myopia risk factors. Update 2023

The aetiology of myopia has been extensively studied in the past decades. It is estimated that almost 30% of uncorrectable vision impairment could be attributable to myopic related disease. The latest research confirms that several environmental risks factors are important myopia determinants. More evidence was published on the effect of COVID‐19 lockdown on myopia. Increased near work and digital screen time and decreased outdoor time remained after the lockdowns and changes in myopia prevalence and progression were reported. Behaviours that contribute to a higher risk of myopia persisted post lockdowns leading to children with higher myopic risk profiles. Outdoor programmes remain as an important strategy to reduce myopia incidence. Recent evidence does not support the role of near work breaks such as 20‐20‐20 rule as a treatment option to reduce digital eye strain. Nevertheless, there is insufficient evidence to determine if this can be an effective treatment to reduce myopia incidence or myopia progression. Research into the influence of diet on myopia development has been mixed. New factors have emerged from genetic studies showing that increased adiponectin levels are protective against myopia. High haemoglobin A1c (HbA1c) levels may be associated with increased risk of myopia. Thus, the role of regular exercise and healthy diet should be further explored as potential strategies to prevent myopia onset or delay the age of myopia onset in future research studies. There is a growing body of evidence on the role of sleep and body mass index as risks factors for myopia, although further research is still necessary to confirm those factors and its association with myopia. Ongoing research should continue to identify risk factors for myopia development. Better‐designed studies are necessary to identify more efficient ways to prevent myopia and decrease myopia progression.