Modifiable Environmental Risk Factors Affecting Myopia

Purpose: The global rise in the prevalence of myopia calls for evidence-based strategies to be devised to reduce the incidence and delay the progression of Myopia. The aim of this study is to review the current literature on modifiable environmental risk factors that control the development and progression of Myopia, specifically in paediatric population. Method: A comprehensive literature review was conducted using PubMed, ScienceDirect, Elsevier, and Google Scholar databases, including keywords such as "environmental risk factors"; "myopia"; “outdoor activity”; “near work”; “high body mass index”; “LED lamps usage”; “watching television”; “digital devices”; “sleep”; “melatonin”; “low vitamin D levels”; “sports”; “socioeconomic status”; “COVID-19 and online education”. English language full-text articles published between Jan 2010 and Oct 2020 were included in the study. Studies were critically reviewed for study methodology and robustness of data. Thirty six studies are included in this literature review. Conclusion: Prevention of onset of myopia and delay in progression of myopia can be altered by modifying the contributing environmental risk factors. Increase in outdoor time with adequate sunlight exposure, rural environment, less duration of near work, use of incandescent lamp, normal circadian rhythms with adequate regular sleeping hours can prevent the onset and progression of myopia. Myopia association with high BMI, watching television, playing digital devices, serum vitamin D levels, participation in sports yet to be established. High socioeconomic status associated with more indoor activity, increased academic pressure, sedentary life style contributes to prevalence of myopia. COVID-19 pandemic control measures with consequent online education resulted in increased digital screen time, near work, and limited outdoor activities, causing rise of myopia pandemic.