Ophthalmologists should consider the causes of myopia and not simply treat its consequences.

Ophthalmologists should consider the causes of myopia and not simply treat its consequences Myopia has been undergoing a major re-evaluation in recent years both by ophthalmologists and basic scientists, though for diVerent reasons. For ophthalmologists the rise of refractive surgery in the past decade has seen myopia changing from a condition requiring optical correction to one that can be managed surgically with the aid of the excimer laser and other techniques. For basic scientists interested in the control of eye growth, the past decade has been equally revolutionary with a huge increase in the understanding of mechanisms by which eye growth is regulated by the quality of the retinal image. This research oVers insights into why myopia develops in humans and oVers clinicians a novel perspective from which to approach the management of myopia. Rather than attempting to alter corneal curvature to " treat " myopia, it may be possible to prevent or " cure " myopia by directly manipulating the growth mechanisms of the eye. Epidemiological studies indicate that myopia represents a growing public health problem, particularly in the Far East. Singapore, for example, has seen an increase in the prevalence of myopia in young adults from 26% to 43% over a decade, reaching 65% in university graduates. 1 This increase largely reflects the increasing levels of youth onset myopia and adult onset myopia. There is a wide variety of epidemiological evidence that suggests that environmental eVects can influence the development of these forms of myopia. Within the Singaporean population, both the prevalence and degree of myopia correlate with the time spent in full time education. 2 In populations with little genetic heterogeneity, such as Inuit populations, studies have revealed that within a generation, the incidence of myopia has risen dramatically in line with the onset of formal education and literacy. 3 4 In addition to this evidence for an environmental contribution to the aetiology of myo-pia, there is also abundant evidence for a genetic influence. These contrasting lines of evidence have stimulated the long running " nature versus nurture " debate, although it is now clear that myopia results from the interaction of environmental and genetic factors. 5 However, the observed increases in myopia over a generation indicate that the modern myopic epidemic is being fuelled by environmental changes. Furthermore, environmental influences are more easily altered than our genetic make up. Understanding how the visual environment can influence …