From the Guidelines
Factors Influencing Pediatric Ocular Growth and Development
The most significant factors influencing pediatric ocular growth and development are genetic predisposition, time spent outdoors, and near work activities.
- Genetic factors: Hereditary factors play a crucial role in the development of myopia, with studies suggesting a higher concordance of myopia between monozygotic twins and between children and parents 1.
- Time spent outdoors: Increased outdoor time has been shown to be protective against myopia in children, with a meta-analysis indicating that outdoor time as an intervention was correlated with a reduced myopia shift over a 3-year follow-up period 1.
- Near work activities: While previously thought to be a significant risk factor, recent evidence suggests that near work activities, such as reading and screen time, are less of a risk factor than previously believed 1.
Interventions for Myopia Control
Effective interventions for slowing the progression of myopia include:
- Topical antimuscarinic agents: Such as atropine, which have been shown to be the most effective in reducing myopia progression 1.
- Multifocal contact lenses and spectacles: Which have been found to be effective in slowing progression, but to a lesser degree than antimuscarinic agents 1.
- Orthokeratology: Which has been shown to be effective in reducing peripheral hyperopic defocus, a likely mechanism for myopia control 1.
Additional Considerations
- Low-concentration atropine: Has been shown to reduce the likelihood of myopia onset, and is a potential treatment option for children at risk of myopia progression 1.
- Contact lens wear: While contact lenses can be an effective treatment option for myopia control, they also carry a risk of complications, such as microbial keratitis, and should be used with caution 1.
From the Research
Factors Influencing Pediatric Ocular Growth and Development
The development of the eye in children is a complex process influenced by various factors. Some of the key factors include:
- Hereditary and environmental factors, which play a crucial role in the interactive growth of ocular tissues responsible for determining the refractive state of the eye 2
- Nearwork environment, which has been reported to be associated with myopia progression 3
- Peripheral refraction and accommodation, which are intrinsic factors that may contribute to juvenile myopia progression 3
- Physical development, such as body height, which is concomitant to axial length growth and myopic shift in children 4
- Visual stimulation and deprivation, which can lead to abnormalities in visual development, including abnormal eyeball growth and neurological changes 5
- Nutrition, which plays a key role in visual development, with essential nutrients such as omega-3 fatty acid docosahexaenoic acid and omega-6 fatty acid arachidonic acid protecting against visual development abnormalities 5
Interaction Between Extrinsic and Intrinsic Factors
The interaction between extrinsic (environment) and intrinsic (peripheral refraction and accommodation) factors is speculated to contribute to juvenile myopia progression 3. The relationship between intrinsic factors and myopia progression is stronger when the extrinsic risk is low, whereas the relationship is abolished when extrinsic risk is high 3.
Role of Physical Development
Physical development, such as body height, is concomitant to axial length growth and myopic shift in children, suggesting that axial length growth is driven by physical development until around 12 years old 4. However, excessive growth is dominated by myopia development.
Importance of Early Screening and Nutrition
Early screening and optimized nutrition are crucial in reducing the risk of abnormal visual development and preventing long-term or permanent visual deficits 5. Abnormal visual input can lead to abnormalities in visual development, which can become permanent visual impairment if left untreated.