Preface

In 2023, I noticed that I wasn't able to see as clearly as I could before, It was hard for me to see the board and read signs off in the distance. After an eye exam, I was diagnosed with myopia (nearsightedness). I started noticing that so many other people had glasses. While reading the topic choices for science fair, the topic for vision/ophthalmology sparked my interest as I wanted to learn more about this condition and wanted to help everyone with it.

Problem

Did you know that it is estimated by the BHVI (Brien Holden Vision Institution) and WHO (World Health Organization) that currently one-third of the world's population is myopic (nearsighted - far away objects look blurry but close up objects are in focus)? Furthermore, it is expected that by the year 2050, half of the population will become myopic. [90] Many environmental factors are increasing myopia rates. Myopia is a serious issue. It can progress quickly and potentially lead to sight-threatening diseases such as retinal tears and detachments, myopic maculopathy (issues in the macula due to severe cases of myopia - pathological myopia) [89], macular degeneration (loss of central part of vision) [44], [49] glaucoma (high pressure of the fluid inside the eye that can damage the optic nerve) [87], cataracts (when the lens inside the eye becomes foggy) [88], etc. In a world full of screens and need for near work, our eyes are changing more than ever. The purpose of my research is to learn about myopia in depth, factors affecting its progression and onset - particularly near work - and practical steps that we can take collectively for the prevention and slower progression of myopia. From my project, I aim to spread awareness about myopia, educate others about it, and encourage healthy practices to decrease chances of developing myopia and any further complications.

 

 

For my background research, I studied the following topics:

• Eye Anatomy and Function
• What is Myopia
• How does an Image Formed in the Eye
• How do Corrective Lenses Work

In addition to the topics mentioned above, I also researched on the topics below as later the part of background research:

• Axial length vs. Spherical equivalent
• Age and Myopia
• Types of Myopia

While doing my main research I came across these topics that I didn't know about before, and I went back and learned them. These additional topics were not originally part of my background research but I included them in my report because they were essential for a deep understanding of my main research.

For each topic I verified the sources that I referred to by following the steps below:

• Cross verifying the information
• Using recent sources (not more than 5 years older) as much as possible, if I did refer to some sources that were older than 5 years, I did on topics that are less likely to change over time (e.g.- eye anatomy, how do traditional corrective lenses work to help myopic people see clearly, etc.)
• Before referring to the article I looked at the author(s) - if that information was available - and the publication to get a better idea about the authenticity of the source

For my main research, I studied the following topics:

• Factors affecting myopia other than genetics
• Deeper research on effect of near work on myopia
• Whether or not digital screen time is worse for myopia then let's say a book
• Myopia control (strategies, technologies, therapy, and treatment)

For my main research I did a couple of extra things than I did in my background research:

• I made sure I was covering various perspectives, and was being really careful with the details. I focused on gathering facts and how they come together into a bigger picture.
• I researched a lot more thoroughly than my background research
• I used a variety of resources (articles, books, professionals, youtube videos, news, podcasts, studies).
• I went backwards in a topic I did not know to get a deeper understanding (like axial length, cycloplegic refraction, etc).
• I gathered factual information precisely (making sure I kept in mind any inconsistencies in the information - if one source says one thing and another source says another)
• Kept in mind:  fact, opinion, and bias
• I prefered if the site included citations, or was written or reviewed by a professional

I ensured my understanding is accurate and thorough by reading, listening, watching the source a few times and asking my parents or teachers if I have questions about it or doing further research.

For reviewing studies, I focused greatly on the results and the main idea of the studies to examine the aspect of experimental data.

To form my conclusion, I focused on these aspects:

• Self-reflection (what I did well and how, what I can improve on, and what steps I can take to improve in that area).
• Real-world Applications: what changes can we make in our daily lives?
• Technological advancements: what are the treatments and technologies we can advance in and how can we make them possible.
• Overall thesis: information collected, organised in a comprehensive and concluding manner. For example, clouclips track behaviours associated with vision, and orthokeratology helps eliminate the need for corrective lenses during the day time and creates peripheral defocus which helps slow down axial elongation. Thus, cloup clips are better for preventing myopia and fixing behaviours that might be the cause, whereas orthokeratology is better for more genetic myopia, or myopia that does not have direct apparent cause. 
• Future experiment:  If I were to design and execute an experiment related to my project, how would I do it?

All of these things would help me take my understanding to the next level, apply my knowledge effectively, and provide ways to take my research further.

 

 

Eye Anatomy & Function

• Sclera- the white part of the eye; the outermost layer providing the eye protection and shape.
• Iris - the colored ring of the eye; controls the size of the pupil to manage the amount of light getting in.
• Pupil - the black opening in the iris from which the light enters inside the eye.
• Lens -  the convex lens in the eye that helps the light rays converge to a focal point.
• Cornea- the clear layer on top of the iris from which light enters first; contributes to the total refractive power of the eye.
• Retina- the light sensitive layer in the back of the eye that contains many nerves. The retina takes the image formed by the lens and converts them into electrical signals. 
• Optic nerve - sends these electrical signals to the brain. It contains two typs of nerve cells: cone cells, which are color receptors of the eye (the three types are red, blue and green in a typical eye) and help with seeing details. And rod cells which are activated in places of low light and help with depth perception.
• Aqueous humour - water-like fluid between the cornea and the iris 
• Vitreous humour - the fluid inside the eye between the lens and retina which helps the eye keep its shape; also referred to as 'the vitreous'
• Conjunctiva - a thin transparent lining outside the sclera and the inside of the eyelids
• Ciliary muscles - muscles inside the that hold the lens and makes it thicker when focusing on close-up objects
• External muscles - help with eye movement and alignment, includes the medial rectus, lateral rectus, inferior rectus, superior rectus, and oblique rectus.
• Macula - the central part of the cornea which is highly light sensitive and is responsible for our central vision
• Fovea centralis - it is a small pit present in the macula which is packed with cone cells which help greatly with seeing details and distinguishing colours.
• Choroid - the connective tissue between the sclera and the retina which contains tiny blood vessels.
• Suspensory ligament -  are the tiny tissues that join or connect the ciliary muscles to the lens.
• Optic disc -  where the optic nerve and retina connect.

​

Image from: "Admin. (2023, March 23). Human Eye - definition, structure, function, parts, diagram. BYJUS. https://byjus.com/physics/structure-human-eye-functioning"

[1], [3], [4], [5], [6], [7], [8], [9], [10], [22], [25], [26], [86]

How does an image form in the eye?

• Light travels in straight lines.
• The light enters through the cornea, the pupil, and then the lens.
• When the light passes through the lens in the eye (the lens in our eyes is convex), it makes the light beams converge and form a focal point on the retina (in an emmetropic eye - normal eye without any refractive error). [31]
• Due to the light converging to a focal point, the image that is formed on the retina is upside-down, when the electrical impulses travel from the retina, through the optic nerve, and reaches the brain, it is inverted and becomes right-side-up again.

What is myopia?

Myopia is a refractive error in the eyes where the light entering the eyes focuses in front of the retina, rather than on the retina (a light- sensitive layer in the back of the eye) due to either a genetically or naturally higher power cornea or lens (as it makes the light rays converge more and come to a focal point quicker), or more commonly an elongated eyeball causing objects close-up to look clear, but far away objects look blurry. When the power of the cornea or the lens in the eye is higher, myopia does not progress, whereas when myopia is caused by the abnormal growth of the eyeball, myopia can progress, meaning get worse. Other symptoms of myopia include headaches, eye strain, squinting, etc.

​

Image from: "Carr, B. J., & Stell, W. K. (2017, November 7). The science behind myopia. Webvision - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470669/"

[11], [12], [13], [14], [15], [18], [19], [20], [26], [28], [90]

How do Corrective Lenses help Myopic People See Clearly?

 Corrective lenses are curved lenses that correct the refractive error of the eye by using laws of refraction. Biconcave lenses (a type of corrective lens) bend the light rays outwards (diverge) so that by the time the light rays come together to a focal point, the light is focused on the retina. Note that corrective lenses just help form a clear image on the retina and are not a treatment for myopia itself. [21], [31] Corrective lenses' power is measured in diopters (D). Concave lenses are measured in negative diopters. The higher the absolute value, the higher power it has.

 

What is the Difference between Axial Length and Spherical Equivalent?

Axial length is the anteroposterior (front to back) length of the eye. Having a longer than normal axial length causes myopia as the light rays form a focal point in front of the retina. Whereas spherical equivalent is the total power of the lens that is needed to correct the refractive error. It includes the spherical and cylindrical lens correction. The spherical power is to see distant objects (mimics a normal axial length) and the cylindrical power is for astigmatism (when the curvature of the lens or cornea is uneven) .   [55], [73], [94]

 

Age and Myopia

Babies are born farsighted (hyperopic), through childhood their eyes grow and develop into an emmetropic one (normal eye without a refractive error). From 0 - 3 years old eye growth occurs quickly, and reaches almost to emmetropia and is referred to as the infantile period. The eyes of children are almost fully developed and emmetropic at the age of six, but further refinement and development occurs till the age of 13. The period between age 3 - 13 is called the juvenile period.

This process could occur quicker and potentially lead to myopia in children.

It is recommended that kids below three years of age are kept away from screens, near work time is kept to a minimum, and toddlers go outside in the sunlight as much as possible. Kids who have spent more time on near work early on in their life have a significantly higher risk of developing myopia. [30] [32], [91]

Accommodation 

Our eyes have to accommodate to focus on objects up close (the ciliary muscles have to contract and make the lens bulge out in the middle to be able to focus light on the retina), because our eyes are made to look far away.

Types of Myopia

There are two ways we can classify myopia.

1. By severity:

    1. Mild/simple/low myopia - Spherical equivalent of less than -3.00 D and normally does not lead to any sight threatening diseases.

     2. Moderate myopia - Spherical equivalent between -3.00 D and -6.00 D

     3. High myopia - Spherical equivalent greater than -6.00 D and poses significant risk to sight threatening diseases.

     4. Pathological/degenerative myopia - Similar to high myopia but the risk of vision loss and sight threatening diseases are extremely high.

Also, the severity is determined by taking into account the age of the patient. For example, a 7 year old has a spherical equivalent of -1.00 D is more severe than a 50 year old who has a spherical equivalent of -4.00 D.

​

Image from: MYOPIA - a GROWING EPIDEMIC — Toronto’s Orthokeratology & Myopia Control Clinic. (n.d.). Toronto’s Orthokeratology & Myopia Control Clinic. https://www.orthoktoronto.com/myopia-a-growing-epidemic

2. By the specific factors affecting the eye causing nearsightedness:

       1. Axial myopia - Most common and due to the increase in anteroposterior (front to back) length of the eye

       2. Curvature myopia - Due to the increased curve of the lens, cornea, or both

       3. Index myopia - Increased power of the lens, associated with old age and cataracts

       4. Pseudo-myopia - Caused by a ciliary muscle spasm (when the ciliary muscles are strained due to a lot of near work and are unable to relax even                 when looking into the distance). This can be temporary and is reversible.

[34], [35], [36], [37]

Cycloplegic Refraction in Myopia Diagnosis

Cycloplegic refraction is a process where atropine of 1% concentration or other chemical compound eye drops are put in the eyes to dilate the pupils and  fully relax and freeze the accommodative system. This is done to accurately measure one's spherical equivalent, as it eliminates the chances of blurry vision or the ability to read the chart properly from pseudo-myopia or over focusing.  [85]

 

  What are the factors affecting myopia other than genetics?

• Time spent outdoors: Spending at least 1-2 hours outside everyday is known to slow down the progression of myopia and its onset especially in children. The sunlight gives the retina dopamine which tells the eyes when to stop growing, without it the eyes have no idea when to stop growing. Also, our eyes have to accommodate for focusing on things closer than 15 feet. This strains the ciliary muscles which results in the eyeball elongating. Spending time outdoors help relax the ciliary muscles. The bright light outside activates the cone cells in the retina which are responsible for color and details. In a low light environment, the rod cells work more which are responsible for depth perception. For this reason, spending time outdoors in the sunlight enhances our ability to see details over time.  [2], [23], [28], [29], [30],

       

 

• Time spent on near work: Our eyes have to accommodate to focus on objects up close (the ciliary muscles have to contract and make the lens bulge out in the middle to be able to focus light on the retina), because our eyes are made to look far away. The ciliary muscles get tired and strained which results in the eyeball to elongate. Prolonged and extensive near work could lead to a ciliary muscle spasm (when the ciliary muscles are unable to relax even when not doing near work) which could cause temporary blurry vision known as pseudo-myopia. If not treated on time and properly, it could lead to axial elongation. There are many theories of the link between the tiring of the ciliary muscles and axial elongation. The main theory is that our eyes are actually too short for having the ability to adequately focus on close-up objects and that is why our eyes accommodate to make the convex  lens in our eyes of a higher power so that the light rays converge more so it comes to a focal point on the retina rather than behind it. Due to excessive near work the axial length (antero-posterior length of the eye) increases as a coping mechanism to reduce the need to contract the ciliary muscles. Another theory is that when the cilliary muscles contract, it pulls on the choroid causing the eye to elongate.   [2], [16], [17], [30], [32], [40], [52], [76], [79], [80], [82], [83],

         

 

•  An eye alignment disorder known as convergence excess esophoria is when the eyes over converge when focusing on close-up objects. Normally the eyes have to converge, meaning turn inwards to some level to be able to form a clear image of near objects. It is when the eyes converge more than they need to, that it can result in headaches, even double vision, or eye strain more than someone who does not have this condition. This disorder can be a significant risk factor for myopic onset and progression by inducing more discomfort while near work. Causes include the following: genetics, weakness of the muscles responsible for eye movement, excessive near work and poor habits associated with it, head injury, neurological factors, other eye conditions, etc. Treatments available to help with this condition include the following: vision therapy exercises for eye coordination and strengthening of the eye muscles responsible for movement, prism lenses to help with the symptoms and reducing the need to over converge, syntonics (lenses with filters for specific wavelengths of light) helps relax eye muscles and activates other processes  in the brain crucial for visual perception, comfort, and coordination. [60], [61], [62], [63], [70]

          

 

Does Digital Screen Time Affect our Eyes More than Let's Say a Book?

There isn't a proper yes or no answer but what we do know is that the blue light from the digital screens could cause eye strain (known as digital eye strain or computer vision syndrome). Digital eye strain happens mainly because of blinking infrequently while on a screen or the eyelids closing partially - only covering till the pupil which leads to dry eyes as blinking is integral to the lubrication of the eyes. The blue light in electronic devices scatter in our eyes and cause a lot of glare which makes it harder for our eyes to focus. In this case artificial tear drops can help reduce eye fatigue and dryness. Also, the digital eye strain is caused by the tiring of the ciliary muscles, like in any other form of near work. Proper posture is also very important, making sure the screen is at a comfortable distance and at eye level to reduce shoulder and neck pain. Many studies which have been conducted that claim that blue light damages our eyes were performed on mice and rats who were exposed to very high levels of blue light that we don't encounter in our daily lives, and on retinal cells on petri dishes which function differently than living retinal cells in our eyes working with other mechanisms. Plus, our retina has pigments called Lutein and Zeaxanthin, which we can get from our regular diet, that block and absorb some levels of blue light. Additionally, the sun is the biggest source of blue light, which is actually beneficial for overall health. When the retina detects blue light it communicates with the pineal gland (produces melatonin; a hormone essential for sleep) in our brain telling it that it is day time. Some sites state that blue light exposure from digital screens increase the risk of macular degeneration (when the central part of the retina gets damaged which results in the full or partial loss of the central vision - typically age related), but for that to happen you'll need a lot of blue light, like staring at the sun which can also cause solar retinopathy. 

Using devices or being in a lot of artificial lighting (L.E.D - high in blue light) at night could disturb the circadian rhythm by not letting the body produce melatonin (hormone essential for sleep) as the body still thinks it's daytime. Not getting enough sleep or poor quality sleep can affect eye health in the long term. 

Strategies for Near Work

• Taking break every 20-30 minutes and looking at least 20 feet away as looking beyond 15-20 feet is when our ciliary muscles fully relax and stop accommodating. Or, 20-20-20 rule which states that every 20 minutes look 20 feet away for 20 seconds, however, recent studies have shown that it is more beneficial to take a brake for 2 minutes every 30 minutes.
• Keep the object(s) at  least 30 cm away, or at Harmon's distance (if you keep your fist on your chin, the object should not be closer than where your elbow would be).
• Doing near work in a well-lit area and wearing blue light glasses or putting digital devices on night mode if screen time at night time is required.
• Having proper posture (having the screen at eye level, or reading a book keeping it on an elevated surface.

All of these help reduce the effect of near work or myopia. Furthermore, limiting leisure screen time in general to 1-2 hours helps. 

[2], [30], [33], [34], [38], [39], [41], [43], [44], [45], [47], [48], [49], [50], [51], [52], [53],

What are the new Technologies & Treatments for Myopia?

1. Atropine 0.05% or 0.01% eye drops

• Initially atropine was used as dilation drops (Atropine 1%) to freeze the accommodative system so that one's cycloplegic refraction can be done.
• Doctors and scientists found in some studies that atropine slows down axial elongation by making the sclera and choroid thicker and stiffer which makes it difficult for them to expand and the eyeball elongating.
• 0.05% or 0.01% was the best as it did slow down axial elongation and also reduced the side effects such as light sensitive eyes because of dilated pupils and blurry vision up-close
• Atropine 0.05% is usually the best concentration as it is the most effective for slowing down axial elongation.
• Atropine drops can slow down myopia up to -0.98 D over the span of two years. 
• Typically, you have to put one drop in each eye every night before bed.
• The chemical formula for atropine is: C17H23NO3.

2. Orthokeratology hard contact lenses:

• These are hard contact lenses that are worn at night while sleeping and shape the cornea by flattening the central part of the cornea so that the way the light enters the eye, the light rays in the central part of the retina comes to a focal point directly on it, while also creating peripheral defocus (explanation under 'Peripheral defocus glasses and soft contact lenses')
• The cornea holds its shape for 24-48 hours.
• Wearing these hard contact lenses at night eliminates the need for corrective lenses during the day. 

Image from: "H. (2021, February 8). ORTHOKERATOLOGY. Eyecing on the Cake. https://eyecingonthecake.com/2019/11/29/orthokeratology/"

3. Peripheral defocus glasses and soft contact lenses.

• Has the actual power of the patient’s eye in the centre and has completely different powers on the sides.
• Light focuses directly on the retina for the central part of the vision but light rays in the periphery focus slightly in front of the retina, this creates what is known as 'peripheral defocus.' 
• Whereas in single vision lenses (traditional corrective lenses) the light rays in the periphery focus slightly behind the retina, which sends a signal to the brain to make the eyeball longer. 
• Though peripheral defocus glasses and soft contact lenses work in the same way, typically soft contact lenses are better as they move with eyes and so they stay in the proper place (the actual power for the patient's refractive error right in the middle).
• Every Brand has their own specific design following the same idea.
• Popular brands are MiYOSMART and MyoCare. 
• Bifocal and trifocal lenses (lenses with two or three different prescriptions in the same lens respectively) do have some level of peripheral blur, but do not work as well as the peripheral defocus lenses.

 

Image from: "Hale, M. (2024, May 24). Lens File: Making the Miyosmart move. Optician Online. https://www.opticianonline.net/content/features/lens-file-making-the-miyosmart-move"

4. Lasik eye surgery.

• Shapes the cornea by taking some tissues out, which changes how the light enters the eye, and improves vision.
• Does not slow down myopic progression, just lowers the refractive error.

5. Vision therapy

• Helps train the eyes to work together, visual perception, memory, coordination, depth perception, etc.
• Helps strengthen the eye muscles responsible for movement especially for esophoria.
• Helps the eyes to focus properly and help relax the ciliary muscles especially in cases of pseudo-myopia.
• Syntonics (lenses with filters for specific wavelengths of light) helps relax eye muscles and activates other processes in the brain crucial for visual perception, comfort, and coordination.

6. Red light therapy

• The exposure to specific wavelengths of red light help thicken the blood vessels in the choroid which over time, slows down axial elongation.
• There is still a lot of research is going on to further develop and study this form of myopia control. 

6. Quality of Sleep

• Getting good quantity and quality of sleep is essential for our overall health and helps the eyes relax and helps with their lubrication, eye development and much more. [86], [92]

7. Diet and Nutrition

• The retina thrives form nutrition 
• Vitatmin A is essential for dry eyes and seeing in places with low light.
• Lutein and Zeaxanthin, mainly found in leafy greens, help the retina block and absorb excess blue light.
• Aqueous humor has a high concentration of vitamin C in it.
• Vitamin C provides protection for the eyes form sight-threatening diseases.
• Omega-3 fatty acids help with eye development.
• ZInc is responsible for converting vitamin A into melanin in the back of the eye which helps the eye protect itself form sun damage.
• Vitamin E is beneficial for the overall health of the eye. [93]

8. Clouclips

• These are small devices that when clipped to one's glasses, track and assess visual behaviors and habits throughout the day such as near work distance and prolonged near work.
• These can also give reminders for visual behavior adjustments.
• This can provide valuable information and data to the user and people conducting studies as well.

Image from: "Wen, L., Cheng, Q., Cao, Y., Li, X., Pan, L., Li, L., Zhu, H., Mogran, I., Lan, W., & Yang, Z. (2021). The Clouclip, a wearable device for measuring near‐work and outdoor time: validation and comparison of objective measures with questionnaire estimates. Acta Ophthalmologica, 99(7). https://doi.org/10.1111/aos.14785"

[2], [16] [27], [28], [54], [56], [58], [59], [65], [66], [67], [68], [69], [70], [71], [77], [78], [84], 

Overall thesis

Near work does in fact increase the chances of the onset of myopia, and could speed up axial elongation. If frequent breaks are taken, proper distance between self and the screen and posture is maintained, outdoor time is prioritized, near work in general is limited, another underlying condition is not present, this should not be a huge problem. Proper diet, exercise, sleep should also be taken care of for our overall health and wellbeing.

Screen time overall tends to be noticeably worse than for example a book. Using blue light glasses or night mode on electronic devices especially at night time helps the eyes to focus more easily and does not disturb the circadian rhythm, taking time to blink, and/or using artificial tear drops, wearing computer glasses if needed, taking breaks, and limiting leisure screen time all significantly decrease the negative effects of screen time on our eyes.

Orthokeratology or Ortho-K usually works better than peripheral defocus lenses. Some people might find wearing hard contact lenses while sleeping a little harsh, then the second best option are the soft contact lenses, then peripheral defocus lenses are still a lot better than traditional corrective lenses or leaving myopia uncorrected.

Atropine is highly beneficial in slowing down axial elongation, (best in cases of axial myopia).

Red light therapy works similarly to atropine as it strengthens the choroid.

Clouclips are the best for when specific habits and/or behaviours could be causing myopia.

Vision therapy is optimal if there is an underlying condition causing myopia such as esophoria.

Self-reflection 

I believe that the things that I did well in this project is doing extensive research, examining multiple perspectives, and verifying the sources I referred to. I used many resources, and had clear logical steps that I took to verify the information. By using a lot of resources, I came across new concepts that further built and solidified my understanding, and also sparked interest in me to learn more about certain concepts or topics. I took into account various approaches on the same topic that I came across to be able to form a well-rounded conclusion. I kept a consistent logbook, in which I made regular and detailed entries each time I worked on my project, and showed the development of my project and my thought process. Before beginning my project, I read through the science fair booklet, read the rubric, watched videos on how to do a science fair project all of which enhanced my understanding on what I need to do for my project as well. 

Things I could improve on are: being more organized, and understanding & interpreting statistical data. As this was my first time doing a large scale research/study project, I needed better organizational skills to keep myself on track and sorted, and avoid having to do extra work like going back and checking which site I got this information from. I did have some organizational strategies, like taking notes sometimes or writting the some of sources I went through on a day in my logbook, or collected all the links for my sources in a google doc, but weren't consistent. One reason for this is that I started this project late as I was doing background research on another topic before and made the decision to switch my topic as I couldn't find as many resources for it. Some other strategies I would have used were writing all my sources I used in that day and under each one take notes of what I found (this will help me later on in writing my actual report and bibliography) more consistently and start writing my research earlier. I would also try to set time-bound goals to keep me on track and to give myself an exact idea on what I should be doing and what I should have done.

For statistical data,  the data of the studies I had found were difficult to understand and interpret, but I know that if I take time, breaking it down in small chunks and learning them. For example, what does the x-axis of this graph represent and what do the values of the y-axis represent? Focusing on the main idea of the whole article, understanding the method being used (might take some extra research on different types of study methods), and really spending more time on it, all would combine to help me in giving me a better chance of doing well in statistical data. 

Real-world Applications

• Children under the age of 3, should be kept away from screens as much as possible and try to limit time spent on near work. Kids should be encouraged and raised in an environment that encourages playing outside, using their imagination, bigger bulkier toys that can be played with at a comfortable distance.
• Children between 3-6 should be taught numbers and the alphabet with bigger letters that are arranged to form words that are further away.  Playing and even learning should be encouraged to be outside when the weather is pleasant.
• There should be parents' education programs at school or work to educate parents about myopia and their children's eye health in general at least once a year to raise awareness about this condition.
• Elementary, middle, and high schools should encourage students to go old school and use paper and pencil as much as possible, only if the need for electronic devices is necessary and highly beneficial for a specific task.
• Scheduled breaks during near work activities in school should be implemented. 
• Routine eye exams are essential for early detection of myopia and can reduce the risk of it getting worse in the future. Different age groups have different recommended times to get an eye exam, the standard is once a year for adolescents. 
• Breaking up a ton of reading into reading some of it and listening to the rest in an audio format, could lift a lot of the load off our eyes and maintain a healthy balance of the skills required to read and take care of our eyes.
• Larger windows that allow more light to enter in a room should become a preferred interior design choice for houses, schools, and workplaces as looking out the window relaxes the accommodative system and the increase in sunlight exposure can help the eyes to produce dopamine. 

Technological advancements

• We can find more ways to stiffen the sclera and choroid to reduce axial elongation or give a form of artificial dopamine to the eyes to tell them when to stop growing early in life especially when the person has a family history of high myopia.
• We can also advance the technology in screen and how they can be made more comfortable to look at (using a lower frequency light, more paper-like similar to a kindle, and making screens larger). 
• A form of eye surgery could be developed and performed where the cornea is fixed into the shape of how it becomes after using orthokeratology hard contact lenses. The cornea shape could also be readjusted if changes in spherical equivalent occur.

Future experiment

If I were to do an experiment related to my research, my controlled variables would be the amount of time participants spend outdoors in sufficient sunlight, direct family history of myopia, their near work distance, how often they take breaks and for how long, their posture, age, ethnicity, their current refractive error, without any other underlying eye conditions, their near work time and behaviours previous to the experiment, and use of myopia treatment.

My manipulated variable would be the time the participants spend doing near work. 

The responding variables would be the change in the axial length, spherical equivalent, and accommodative fatigue over the span of the experiment.

 1. Admin. (2023, March 23). Human Eye - definition, structure, function, parts, diagram. BYJUS. https://byjus.com/physics/structure-human-eye-functioning

2. Interview with Dr. Jessica Yang (optometrist) at Eyedeology Optometery (2025, Feb 28), Contact: info@eyedeology.ca, Eyedeology Optometry, Rockyview Health Centre, Calgary.

3. Choroid. (n.d.). Mount Sinai Health System. https://www.mountsinai.org/health-library/special-topic/choroid#:~:text=The%20choroid%20is%20the%20layer,the%20choroid%20is%20called%20choroiditis.

4. Eye anatomy: parts of the eye and how we see. (2023, April 29). American Academy of Ophthalmology. https://www.aao.org/eye-health/anatomy/parts-of-eye

5. What is the optic disc? - medical definition. (n.d.). https://www.allaboutvision.com/eye-care/eye-anatomy/eye-structure/optic-disc/ (talks about glaucoma)

6. Fovea Centralis - all about vision. (n.d.). https://www.allaboutvision.com/eye-care/eye-anatomy/eye-structure/fovea/

7. Professional, C. C. M. (2025, January 13). Cornea. Cleveland Clinic. https://my.clevelandclinic.org/health/body/21562-cornea

8. Professional, C. C. M. (2024, November 25). Eyes. Cleveland Clinic. https://my.clevelandclinic.org/health/body/21823-eyes

9. Ayaga, V. (2024, October 23). Eye Anatomy: Parts of the Eye & How Vision Works. Vision Center. https://www.visioncenter.org/eye-anatomy/

Medically Reviewed by  Dr. Melody Huang, O.D.

Page Updated on  October 23, 2024.

10. Human eye diagram:
https://th.bing.com/th/id/OIP.sHZi9a9XP4PGjpobWglHrgHaHo?rs=1&pid=ImgDetMain

11. Nearsightedness - Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/nearsightedness/symptoms-causes/syc-20375556. Published: Apr 19, 2024.

12. Cao. (n.d.). Myopia (Nearsightedness) | Canadian Association of Optometrists. https://opto.ca/eye-health-library/myopia-nearsightedness. 

Last updated:September 16, 2024

13. Nearsightedness: What is myopia? (2024, November 7). American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/myopia-nearsightedness.  Author: Turbert D, Reviewed by: Cesar A Briceno, MD, Edited by: Porter D.

14. Myopia. (n.d.). https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/myopia?sso=yv

15. Myopia (Nearsightedness). (2024, December 6). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/8579-myopia-nearsightedness

16. Doctor Eye Health. (2019, February 11). Stop Myopia | What Causes Nearsightedness and How to Stop Myopia from Getting Worse [Video]. YouTube. https://www.youtube.com/watch?v=9yRk_zzH9ys

17. Doctor Eye Health. (2024, August 13). What REALLY causes nearsightedness and how it gets worse [Video]. YouTube. https://www.youtube.com/watch?v=QWsuckyXp1gx

18. Medical Centric. (2021, May 14). Myopia, Signs and symptoms, causes, diagnosis and treatment. [Video]. YouTube. https://www.youtube.com/watch?v=PEk-d_dSBIM

19. International Myopia Institute. (2024b, February 19). Myopia - Myopia Institute. Myopia Institute -. https://myopiainstitute.org/myopia/

20. AniMed. (2016, April 3). How the Eye Works Animation - How Do We See Video - Nearsighted & Farsighted Human Eye Anatomy [Video]. YouTube. https://www.youtube.com/watch?v=YcedXDN6a88

21. BYJU’S. (2019b, March 8). Defects of vision and their correction - How do spectacles work? [Video]. YouTube. https://www.youtube.com/watch?v=F2KHaUjNHos

22. Peekaboo Kidz. (2018b, May 4). Human Eye - The Dr. Binocs Show | Best Learning Videos for Kids | Peekaboo Kidz [Video]. YouTube. https://www.youtube.com/watch?v=axpCN6Vj9p0

23. Vox. (2023b, March 7). Why so many people need glasses now [Video]. YouTube. https://www.youtube.com/watch?v=LAkFtka3UFw

24. BCDoctorsofOptometry. (2017b, March 31). Can myopia be cured? [Video]. YouTube. https://www.youtube.com/watch?v=AZdXeqz-9Pg

25. Bill Nye. (2009b, April 8). Bill Nye the science guy on the eyeball [Video]. YouTube. https://www.youtube.com/watch?v=cFVbLnXWn6A

26. FreeMedEducation. (2018c, May 3). What is Myopia (Short sightedness)? [Video]. YouTube. https://www.youtube.com/watch?v=dWqrnsDtmpU

27. TEDx Talks. (2019, July 19). Myopia: a Global Epidemic | Dr. Kevin Chan | TEDxBethesda [Video]. YouTube. https://www.youtube.com/watch?v=IeCDXLdKPyU

28. ABC Science. (2016, April 27). MYOPIA [Video]. YouTube. https://www.youtube.com/watch?v=DjdkbcOx05A

29. Health411-The Myopia epidemic and you. (2022, April 24). Apple Podcasts. https://podcasts.apple.com/in/podcast/health411/id1493848609?i=1000558491728

30. #18 Dr. Eef van der Worp: Preventing Myopia Before it Starts. (2022, January 26). Apple Podcasts. https://podcasts.apple.com/in/podcast/18-dr-eef-van-der-worp-preventing-myopia-before-it-starts/id1606064102?i=1000549014767

31. Science Focus 8, Authors: Lois Edwards, Jacqueline Martin, Richard S. Published: April 6, 2001 by McGraw-Hill Ryerson. Unit- Light and Optics, Topic 4 Lenses and Vision, starting from Pg-209. 

32. The Myopia myth. (n.d.). http://www.myopia.org/ebook/

Author: Donald S. Rehm. Published by: International Myopia Prevention Assn.
Ligonier, PA 15658

33. Is myopia more genetic or environmental? (n.d.). https://www.allaboutvision.com/conditions/myopia/genetic-or-environmental/  . 

Author: Sonia Kelly, OD, MS, Revied by: Maria Liu, OD, PhD, MPH, MBA, FAAO

Published on: Mar 8, 2022, Medically reviewed on: Feb 8, 2022

34. Carr, B. J., & Stell, W. K. (2017, November 7). The science behind myopia. Webvision - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470669/

35. Types of myopia | Myopia Focus. (n.d.). Myopia Focus. https://www.myopiafocus.org/types-of-childhood-myopia 

 Author: Jason Higginbotham, BSc (Hons) MCOptom Prof Cert Glau Prof Cert Med Ret Prof Cert LV FBDO MBCLA

36. Chaurasia, S. (2022, May 31). Types of myopia. Optography. https://optography.org/types-of-myopia/

37. What are the different types of myopia? (n.d.). https://www.allaboutvision.com/conditions/myopia/types/

 Author: Sonia Kelley, OD, MS

 Page updated on Monday, March 6, 2023 - Page published on Tuesday, February 28, 2023

38.  Brend, Y. (2023, June 23). Excessive screen time is changing our eyes faster than we can blink. CBC. https://www.cbc.ca/news/canada/excessive-screen-use-eyes-myopia-1.6815857. Accessed: Jan 29, 2025

39. ABC15 Arizona. (2023, June 5). Screen time increasing risk of myopia [Video]. YouTube. https://www.youtube.com/watch?v=JZXk70S83sw. Accessed: Jan 29, 2025

40. The Connection Between Near Work And Myopia  Visual Symptoms Treatment Center 

https://www.visualsymptomstreatmentcenter.com/eye-care-services/myopia-management-optometrist/the-connection-between-near-work-and-myopia/

41. All about screen time and close work | My Kids Vision. (n.d.). https://www.mykidsvision.org/knowledge-centre/all-about-screen-time-and-close-work

42. Does near-work cause nearsightedness? (2019, July 30). American Academy of Ophthalmology. https://www.aao.org/eye-health/ask-ophthalmologist-q/does-near-work-cause-nearsightedness.  Author: Wayne F. Bizer, DO

43. SEE-THROUGH. (2023b, January 14). Does excessive screen time cause myopia? [Video]. YouTube. https://www.youtube.com/watch?v=JB3gjFNKO-g

44. Doctor Eye Health. (2023, July 11). Debunking Myths: Can Screens (really) Damage Your Eyes? [Video]. YouTube. https://www.youtube.com/watch?v=4DQFonidUMg

45. Mommy Dear. (2020, March 31). Are screens causing your child to need glasses??! | Facts and Myths Explained [Video]. YouTube. https://www.youtube.com/watch?v=GhvmWWp760w

46. Jake Steiner. (2021, June 1). How glasses make your eyesight worse | Endmyopia | Jake Steiner [Video]. YouTube. https://www.youtube.com/watch?v=zJJQdue_mzc

47. Michael Chua, MD. (2022, May 31). Blue light glasses -- a waste of money? Explained by an MD [Video]. YouTube. https://www.youtube.com/watch?v=h8feWf7X750

48. Doctor Mike. (2020b, September 13). Here’s what blue light actually does to your body [Video]. YouTube. https://www.youtube.com/watch?v=wGnRcX53XBQ

49. Myopic macular degeneration: What you should know. (n.d.). WebMD. https://www.webmd.com/eye-health/macular-degeneration/what-is-myopic-macular-degeneration 

Medically Reviewed by Whitney Seltman, OD on February 21, 2023

Author: Stephanie Watson

50. Doctor Eye Health. (2024, January 8). Do Glasses Make Your Eyes worse?! Eye doctor Debunks Top Vision Myths [Video]. YouTube. https://www.youtube.com/watch?v=5H1ISYRhY8w

51. Doctor Eye Health. (2020b, February 18). Do BLUE LIGHT GLASSES work? - Fact or Fiction [Video]. YouTube. https://www.youtube.com/watch?v=up0-YHf3WZ

 52. Biswas, S., Kareh, A. E., Qureshi, M., Lee, D. M. X., Sun, C., Lam, J. S., Saw, S., & Najjar, R. P. (2024). The influence of the environment and lifestyle on myopia. Journal of PHYSIOLOGICAL ANTHROPOLOGY, 43(1). https://doi.org/10.1186/s40101-024-00354-7. 

53. Dr. Eric Berg DC. (2019b, June 3). Is your computer destroying your vision? – Dr.Berg on Computer Vision Syndrome [Video]. YouTube. https://www.youtube.com/watch?v=UWXNclfUntE

54. How do myopia control soft contact lenses work? | My Kids Vision. (n.d.). https://www.mykidsvision.org/knowledge-centre/how-do-myopia-control-soft-contact-lenses-work

55. Spherical equivalent, axial length, or both to measure myopia progression? | BHVI. (2021, June 7). BHVI. https://bhvi.org/news/spherical-equivalent-axial-length-or-both-to-measure-myopia-progression/#:~:text=In%20myopia%20management%2C%20commonly%20used,2%2C3

Author: Thomas Naduvilath, MSc Biostatistics, PhD

56. Russ. (2021b, July 14). Myopia and vision therapy - Optometrists.org. Optometrists.org. https://www.optometrists.org/childrens-vision/guide-to-pediatric-eye-conditions/what-is-myopia/myopia-and-vision-therapy/

57. Lingham, G., Yazar, S., Lucas, R. M., Milne, E., Hewitt, A. W., Hammond, C. J., MacGregor, S., Rose, K. A., Chen, F. K., He, M., Guggenheim, J. A., Clarke, M. W., Saw, S., Williams, C., Coroneo, M. T., Straker, L., & Mackey, D. A. (2021). Time spent outdoors in childhood is associated with reduced risk of myopia as an adult. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-85825-y

 58. Myopia Profile | Myopia Control & Management. (n.d.). https://www.myopiaprofile.com/

 59. Visionspecial_Admin. (2024, May 24). Convergence Excess: causes, symptoms, treatment. Vision Specialists of Michigan. https://www.vision-specialists.com/blog/convergence-excess-symptoms-treatment/

60. Admin. (2025, February 18). Understanding esophoria: causes and treatment options - Specialty Vision. Specialty Vision. https://specialty.vision/article/understanding-esophoria-causes-and-treatment-options/

61. Admin. (2024, December 19). Convergence Excess: Symptoms, causes, diagnosis and treatment. Specialty Vision. https://specialty.vision/article/convergence-excess-symptoms-causes-diagnosis-and-treatment/

62. Do you need to treat esophoria in an emmetropic patient? | Myopia Profile. (n.d.-d). https://www.myopiaprofile.com/articles/esophoria-pre-myopia

63. Chung, K. M., & Chong, E. (2000). Near esophoria is associated with high myopia. Clinical and Experimental Optometry, 83(2), 71–75. https://doi.org/10.1111/j.1444-0938.2000.tb04895.

 64. Eyes On Eyecare - Optometry. (2023, April 20). Eyes on Myopia 2023: Overview of myopia and current treatment options [Video]. YouTube. https://www.youtube.com/watch?v=uvP9PqNmzYA

Presented by: Mark Bullimore, MCOptom, PhD, FAAO.

65. Insight Vision Center Optometry. (2024b, December 1). How atropine eye drops are revolutionizing myopia treatment: Guide from a myopia control specialist [Video]. YouTube. https://www.youtube.com/watch?v=6TtnKJSl-KE

66. PubChem. (n.d.-b). Atropine. PubChem. https://pubchem.ncbi.nlm.nih.gov/compound/174174

 67. Atropine, engaging with science and responsible practice – with Prof Karla Zadnik. (2020, June 26). Apple Podcasts. https://podcasts.apple.com/in/podcast/atropine-engaging-with-science-and-responsible/id1487871450?i=1000480091362

 68. Good Optometry Morning: EYE CARE MADE simple. (2020b, December 7). MYOPIA ATROPINE: ATOM 2 Myopia control with Atropine [Video]. YouTube. https://www.youtube.com/watch?v=gdXoLRG1Zu0

 69. Insight Vision Center Optometry. (2022, July 15). 4 Best Ways to treat your Child’s Myopia [Video]. YouTube. https://www.youtube.com/watch?v=n-ZsjBrvQ-g

70. Do you need to treat esophoria in an emmetropic patient? | Myopia Profile. (n.d.-b). https://www.myopiaprofile.com/articles/esophoria-pre-myopia#:~:text=Esophoria%20is%20known%20to%20be,orthoptic%20management%20is%20worth%20pursuit

 71. Clouclip. (n.d.). https://www.clouclip.com/webCarbon/pc.html

 72. MYOPIA - a GROWING EPIDEMIC — Toronto’s Orthokeratology & Myopia Control Clinic. (n.d.). Toronto’s Orthokeratology & Myopia Control Clinic. https://www.orthoktoronto.com/myopia-a-growing-epidemic

 73. What is a Spherical Equivalent? (2024). https://eyeque.zendesk.com/hc/en-us/articles/115008523768-What-is-a-Spherical-Equivalent

74. Lanca, C., & Saw, S. (2020, March). The association between digital screen time and myopia: A systematic review. Ophthalmic and Physiological Optics, 40(2), 216–229. https://doi.org/10.1111/opo.12657

75. Foreman, J., Salim, A. T., Praveen, A., Fonseka, D., Ting, D. S. W., He, M. G., Bourne, R. R. A., Crowston, J., Wong, T. Y., & Dirani, M. (2021). Association between digital smart device use and myopia: a systematic review and meta-analysis. The Lancet Digital Health, 3(12), e806–e818. https://doi.org/10.1016/s2589-7500(21)00135-7

76. Gajjar, S., & Ostrin, L. A. (2021). A systematic review of near work and myopia: measurement, relationships, mechanisms and clinical corollaries. Acta Ophthalmologica, 100(4), 376–387. https://doi.org/10.1111/aos.15043

77. Mommy Dear. (2020c, April 22). How to Control Myopia Progression in Children | Myth Debunk & Methods Explained [Video]. YouTube. https://www.youtube.com/watch?v=-z5M5Z-7Tpg

78. "Hale, M. (2024, May 24). Lens File: Making the Miyosmart move. Optician Online. https://www.opticianonline.net/content/features/lens-file-making-the-miyosmart-move"

79. Wen, L., Cao, Y., Cheng, Q., Li, X., Pan, L., Li, L., Zhu, H., Lan, W., & Yang, Z. (2020, November). Objectively measured near work, outdoor exposure and myopia in children. British Journal of Ophthalmology, bjophthalmol-315258. https://doi.org/10.1136/bjophthalmol-2019-315258

80. Dutheil, F., Oueslati, T., Delamarre, L., Castanon, J., Maurin, C., Chiambaretta, F., Baker, J. S., Ugbolue, U. C., Zak, M., Lakbar, I., Pereira, B., & Navel, V. (2023, January). Myopia and Near Work: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 20(1), 875. https://doi.org/10.3390/ijerph20010875

81. Xiong, S., Sankaridurg, P., Naduvilath, T., Zang, J., Zou, H., Zhu, J., Lv, M., He, X., & Xu, X. (2017). Time spent in outdoor activities in relation to myopia prevention and control: a meta‐analysis and systematic review. Acta Ophthalmologica, 95(6), 551–566. https://doi.org/10.1111/aos.13403

82. Hepsen, I. F., Evereklioglu, C., & Bayramlar, H. (2001). The effect of reading and near-work on the development of myopia in emmetropic boys: a prospective, controlled, three-year follow-up study. Vision Research, 41(19), 2511–2520. https://doi.org/10.1016/s0042-6989(01)00135-3

 83. Meng, Z., Yang, L., & Zhou, P. (2024d). Ciliary muscles contraction leads to axial length extension——The possible initiating factor for myopia. PLoS ONE, 19(4), e0301844. https://doi.org/10.1371/journal.pone.0301844

84. Cao, Y., Lan, W., Wen, L., Li, X., Pan, L., Wang, X., & Yang, Z. (2020). An effectiveness study of a wearable device (Clouclip) intervention in unhealthy visual behaviors among school-age children. Medicine, 99(2), e17992. https://doi.org/10.1097/md.0000000000017992

85. Why does my child need a cycloplegic refraction? - Optometrists.org. (2021, December 12). Optometrists.org. https://www.optometrists.org/childrens-vision/guide-to-childrens-eye-exams/why-does-my-child-need-a-cycloplegic-refraction/

86.  Anatomy of the eye | Children’s Wisconsin. (n.d.). https://childrenswi.org/medical-care/eye-program/eye-care/anatomy-of-the-eye#:~:text=Suspensory%20ligament%20of%20lens%20%2D%20a,lens%2C%20holding%20it%20in%20place.%20anatomy%20of%20eye,%20children's%20winsconsin

87. Glaucoma - Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/glaucoma/symptoms-causes/syc-20372839

88. Cataracts - Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cataracts/symptoms-causes/syc-20353790

89. Myopic maculopathy. (n.d.). SingHealth. https://www.singhealth.com.sg/patient-care/conditions-treatments/myopic-maculopathy

90. What is Childhood Myopia? | Myopia Focus. (n.d.). Myopia Focus. https://www.myopiafocus.org/what-is-childhood-myopia

91. MinuteEarth. (2022, March 1). Screens are NOT the reason kids need glasses 👀 [Video]. YouTube. https://www.youtube.com/watch?v=vbCobKbLJls

92. Healthy Sleep, Healthy Eyes: New Insights into Myopia Prevention. (n.d.-b). https://www.zeiss.com/myopia/en/articles--insights/myopia-and-sleep.html

93. Doctor Eye Health. (2022, June 2). 5 Best foods for eye health and Vision [Video]. YouTube. https://www.youtube.com/watch?v=0YNotclndsk

94. Surya. (2025, January 3). Spherical vs Cylindrical Power | Key Differences Explained. www.suryaeye.com. https://www.suryaeye.com/difference-between-spherical-vs-cylindrical-power

I used https://www.scribbr.com/citation/generator/apa/ - citation generator from scribbr to format my citations, I went over them to see if all the information was correct or not, and added some extra information in some places.

 

I would like to acknowledge Ms. Holmes and Ms. Mohanan who gave me the opportunity to participate in the science fair and guided me on the way. I also want to thank and acknowledge Dr. Jessica Yang (optometrist) at Eyedeology Optometry, Rockyview Health Centre, Calgary (contact: info@eyedeology.ca) who gave time to interview her on this subject and provided tremendous feedback and insightful information on various aspects of myopia. My parents have encouraged and supported me all throughout my journey for making these ideas come to life!