The upshot is that dopamine regulates eye lengthening, and more light stimulates more dopamine.
Based on recent studies in Australia and Asia they recommend two hours of daily time outdoors for children to prevent myopia.
So it isn’t caused by looking at things close up, the confound was that people who spend a lot of time looking at things close up tend to do so under artificial light.
Three years ago at age 25 I booked an eye exam due after getting some new floaters. After imaging my eye doc came in and asked if I was comfortable driving while dilated, because he would be dilating and numbing my eyes before sending me off to the retina specialist for an urgent exam. The ophthalmologist immediately diagnosed me with lattice degeneration and saw a horseshoe tear. That same afternoon he sat me in a chair and used a laser to create a barrier of scar tissue around the tear to prevent it from progressing. Three years later I have had two rounds of prophylactic treatment of those weak spots in each eye. I most likely will never experience a retinal detachment, but annual dilated eye exams are in my future.
I don't even have very bad myopia (-2.75/-3.25), but I kick myself for not spending as much time outside during my childhood as some of my friends did.
I had the exact same situation happen, except my optometrist was visibly concerned. I usually explain it as spot welding my retina in place there. That was the weirdest sensation/discomfort ever. Last month or so I got a scan done and was able to see a really high res image of it.
Do you (/anyone?) know of any treatment that gets rid of floaters? I've seen a reference to some laser treatment, but not enough to seem trustworthy. If you don't mind me asking, did the laser-to-the-retina treatment generate any new floaters?
Isn't the main problem that myopia is genetically aggressive, and natural evolution stopped working because we correct for myopia through prescription glasses and contact lenses etc.?
The article talks about that a bit, there have been a number of 'causes' of myopia that are 'common knowledge' but end up not holding water. Genetics and close-up work being the two major scapegoats. Modern studies are showing a lack of dopamine in the eyeball to be the most likely factor, without a strong link to genetics.
According to TA, most cases of myopia are caused by being inside all day. There might be a genetic component, but it doesn't seem to be that relevant (yet).
You do realize that "natural evolution" doesn't happen within time scales of less than a single generation, right? The environment can change faster than that.
This is like saying “well I’m 70 years old and perfectly healthy after smoking my whole life”.
We’re talking about probabilities and statistics over large populations. Not every child who plays outside will avoid myopia, like yourself. But looking at the population, the expectation is that children who get more sunlight tend to have a lower incidence of myopia and weaker myopia.
Full midday sunlight is about 100,000 lux. Recommended illumination levels for office buildings are 300-500 lux. Domestic rooms will often be lit at less than 100 lux.
My workbench is illuminated to 10,000 lux, which compares to common daylight conditions. Just lighting that small area requires 120 watts of high-efficiency LEDs. Lighting the whole room to that level would require nearly two kilowatts of LEDs. Most "super strong indoor lighting" is in fact very dim compared to sunlight. We don't realise it, because our visual system is incredibly adaptable to changing illumination conditions.
Wouldn't the indoor light have to be strong enough to make you want to wear sunglasses indoors?
You would probably have to put stage lighting in your house to get the same affect as being outside. My eyes behave pretty different and seem to get a "workout" when I am outside in sunny weather.
Possibly unrelated, but a specific frequency of infrared light has been found to have a protective and possibly even regenerative effect on aging eyes.
"Upon transcranial delivery, NIR light has been shown to significantly increase cytochrome oxidase and superoxide dismutase activities which suggests its role in inducing metabolic and antioxidant beneficial effects. Furthermore, NIR light may also boost cerebral blood flow and cognitive functions in humans without adverse effects. In this review, we highlight the value of NIR therapy as a novel paradigm for treatment of visual and neurological conditions, and provide scientific evidence to support the use of NIR therapy with emphasis on molecular and cellular mechanisms in eye diseases." [1]
NIR = near infrared light, 670 nm wavelength. This wavelength is present in sunlight, but not found in basically any indoor lighting with the possible exception of full spectrum LEDs and IR bulbs. Another study found improvement from NIR exposure, but only from exposure in the morning (for three minutes, once a week, at 670nm wavelength), and only in individuals older than 38. The study proposes that the effects they found from NIR exposure is due to improved mitochondrial function in the retina. [2]
The human retina ages faster than other organs, with a 70% decline in functional ATP production by mitochondria over a lifetime. The aging mitochondria, in addition to not producing as much ATP, also spit out junk amino acids that can cause chronic inflammation in the area (and signal cell death where none is called for?). As an aside, improved mitochondrial function is also proposed to be responsible for the significant health benefits of fasting and prolonged calorie restriction.
Another study also theorizes this mechanism:
"Our data suggest, 670 nm light can significantly improve aged retinal function, perhaps by providing additional adenosine triphosphate production for photoreceptor ion pumps or reduced aged inflammation." [3]
More study is clearly called for the better understand what is going on here and why. It seems like it could potentially have implications for age-related degeneration throughout the entire body, not just in the retina.
Floaters have many causes. An early sign of retinal detachment will be floaters until it progresses closer to the macular hole, at which point the symptoms will be more of a curtain being drawn across your vision.
I was able to catch a retinal tear that had a very high chance of proceeding to a retinal detachment (horsehoe tear with sub-retinal fluid) by getting some new floaters checked out.
Floaters are commonly caused by a (mostly) benign aging phenomenon called posterior vitreous detachment, where the vitriol gel liquefies as a person ages.
> Floaters are commonly caused by a (mostly) benign aging phenomenon called posterior vitreous detachment, where the vitriol gel liquefies as a person ages.
And, the longer your eye is (the higher your myopia is), the earlier this happens.
Retinal detachment is rare though, even with tons of floaters and high myopia.
> Floaters are commonly caused by a (mostly) benign aging phenomenon called posterior vitreous detachment, where the vitriol gel liquefies as a person ages.
I've had floaters since I was 18. A couple of years ago at 59 all of the sudden I had a huge increase in floaters accompanied by flashes in the left eye. I was sure I was having a retinal detachment. Got into an eye doc right away and she said told me it was the vitreous detachment and is something that happens normally at my age. It went on for several months with the flashing and floaters. The right eye followed suit about 6 months later. I had no idea that this was something that happens to pretty much everyone around age 60. Apparently, though, a lot of people don't notice it happening.
I remember as a kid I used to peek through this semi-transparent hole in a blanket to look at floaters. I saw dozens and dozens of them. I thought they looked beautiful. At that time I wasn't sure exactly what caused them if it was related to my eyes or the blanket or perhaps dust or something. Nothing happened to my eyesight then or since, and I don't even have myopia.
I started to see floaters this year. First, it scared the shit out of me, because I only have one healthy eye and starting to see this flying dots and strings was a really scary experience. It also was just really annoying.
After the ophthalmologist checked my eye, she said what I'm seeing is called "mouches volantes" and it's something that happens when people get older. I'm "only" 37 and don't have any problems with my eyesight, which makes me wonder what caused these floaters in my case.
Anyway, it's something I have to get used to. It only really is annoying on sunny days because then I can see them clearly floating around.
Build schools outside, more hybrid spaces/semi-indoor, spend more time doing activities outside, teach your kids sailing,mountain climbing, astronomy... Etc, engage with more nature. Learning happens in the real natural world as much as it happens in books. Take the books and apply it's lessons to reality. Step out of Plato's cave and discover the world. I grew up with myopia since I was 12. I always wondered why it exists evolutionarily it seems like a huge problem for survival. It's another modern disease. I know what to do to change things for my kids in the future.
Actually the followup to the initial paper it turns out it's shifting focus from near to far and back. I spent hours outside, maybe school caught up with me I was myopic by 2nd grade. I heard about that focus shift far, short, far is a big part. I taught my kid to focus up on tall buildings we can see. I'm between Murray hill and Gramercy in Manhattan, we have some views out our window and my now 15 year old has perfect vision. Eye Doctor assumes his eye is mostly if not full grown and he escaped the last couple of generations on both sides of the family. His success is more the focus changes than lots of daylight. Daylight surely helps with mood so I did teach him to get 20 even 30 minutes of daylight into his retina but not hours.
I completely agree that it’s the near-far-near focusing while outdoors. I read this on HN years ago right after getting my first indication that one eye was just barely no longer 20/20. I was always proud of my perfect vision and was quite worried. Since then I have tried to do several of those near-far-near transitions outdoors every morning and my vision is back to perfect in both eyes and has stayed there.
We know how myopia works now. Low dose atropine and glasses with fogged edges reliably slow or stop myopia progression. Myopia is not reversible by natural means. Sunlight is maybe related but it is more likely the proven mechanism of near work, specifically keeping peripheral vision in focus which tells the eye to grow longer (there is no brain involvement, the eye does this alone). Myopia discussions are terrible, they are filled with people offering advice and guesses on something they don’t know anything about, and people claiming it’s curable.
This article includes interviews from multiple experts, citing data from both retrospective and case control studies, plus the pandemic which effectively provided an even broader, country-wide study that again matched their data.
I’d love to understand why you would post such a dogmatic dismissal without so much as a citation. Are you an ophthalmology researcher yourself who is familiar with contrary and well-vetted research? Are you someone with a strong personal experience that you have a hard time squaring with the data? Or are you someone who forms strong beliefs, firmly held, regardless of whatever new information life offers?
Emmitropization is a fact. Peripheral over focus causing myopia is well documented and peripheral defocus is also well studied. Peripheral defocus lenses and low dose atropine are well studied. The mechanism is understood, and proved by multiple different ways to interfere with the mechanism.
Optometrists are clothing salespeople. Only some ophthalmologists even know about atropine as an option.
So far our best guess is to make sure kids get enough sunlight every day and spend time outside, because looking at things in the distance is what regulates eye lengthening during growth. Since things are typically further away outdoors, it helps normal eye development and slows down nearsightedness.
> Sunlight is maybe related but it is more likely the proven mechanism of near work
My impression was that near work was previously a leading hypothesis but that, in agreement with this article, sunlight exposure is now considered the most likely explanation. However, I don't think there's ironclad proof either way, and a scholarly consensus is lacking.
Do you have a link to a recent review article that adjudicates between these hypotheses?
Essentially when things in your peripheral vision are in focus, aka things close to your eye like screens, your eye thinks it’s over focusing, and it grows longer to defocus, causing myopia. Preventing focus in peripheral vision removes this signal. The eye is very dumb, it grows on response to light focus. The brain is not involved.
My dad had a theory that "kids belong outside", though I think it was more of a theory that we lived in a small house and he wanted some peace and quiet to work on his thesis.
I guess he was more right than he knew :-)
Anyhow, a large part of my childhood was spent outside. I've worn glasses since I was 6, with farsighted astigmatism.
There’s a lot of comments here and in the article - and in previous (honestly better) articles by others - about the lack of sunlight, and it’s definitely a thing, but we ensured junior was outdoors for the majority of his waking life and he still needed glasses at age 9. Later than me (age 6) but we put him into MiyoSmart lenses as soon as we could and they have definitely arrested the progress of his myopia.
In fact, there’s been no change in his prescription in a year.
In fact, one side went down 0.25 as my brilliant UK Opthalmologist deduced that he was not in need of it, and many kids opt for a slightly higher power than they need during the tests. Not to be fooled, this doc. The previous tests, the first, were conducted in Germany on similar equipment, but without a master sleuth operating them.
In short - MiyoSmart lenses are fricking brilliant and kids should be put into them immediately if they need glasses. They are twice the price in Germany than in the UK, like most things, but at least we had the choice.
When I was a lad, they only had a chart of ever-shrinking letters and can-you-tell-the-difference-between-Mickey-Mouse-and-Goofy-in-this-comic before they bolted a stronger pair of goggles on, fast forward 44 years and I’m a -10, and could well have been worse had I not found my optician 31 years ago. Now we monitor my eyes for diseases and potential retinal detachment.
But yes, be outdoors AND have passionate experts looking out for your vision.
I'm 30, software engineer, and I have had glasses for most of my life. I have astigmatism from birth like a lot of people. Now, up until 25 years old, it was just that, and even hypermetropia. But suddenly from 25, it started to reverse, losing about 0.5 dioptric per year. It started super late, so I was concerned, but turns out there's no age to get myopia, it seems. Now I'm about -2.5 on each eyes. And it's irreversible. All the doctors told me to get up and look far, but they forgot to tell me to have as much sunlight as possible. Now it's my number 1 criteria for renting an apartment, because it seems to have a huge impact on limiting my myopia progress.
If someone has also an experience of late myopia, I would be curious to hear from it, e.g. I would like to know if it stops someday, and if there are good solutions for it.
I know it's nothing in itself, but the progress in a few year was significant, and my doctors told it to me. It was a huge dégradation in a matter of 5 years, while I was already old. I wondered what was the thing that started the bad progress. Maybe because I got a phone with unlimited internet and kept using it, maybe because of poor light in the offices (during my first job, despite being on the computer all the time, I had no sight loss, because the light was actually pretty good).
I think no matter what your correction is, you should take the steps to not make it worse, and I find that there's very little information about that. Even doctors just say "look far once in a while" which doesn't see so efficient.
hypermetropia and astigmatism stack on top of each other, with astigmatism it was always blurry, and then on top of this you get the hypermetropia or myopia. So, I never had a normal vision because of astigmatism, but if I didn't have it, I guess so ? But like anyone has a normal vision until they have myopia. What shocked me is that it developed so quick, after being grown up.
I don’t have time to go down a YouTube rabbit hole but in my experience it’s quite simple - you just have to do near-far-near focusing while outdoors. I read this on HN years ago right after getting my first indication that one eye was just barely no longer 20/20. I was always proud of my perfect vision and was quite worried. Since then I have tried to do several of those near-far-near transitions outdoors every morning and my vision is back to perfect in both eyes and has stayed there. Look at a finger, look at a tree far away, back to my finger. I would highly encourage anyone to start doing this regardless of current vision.
A July 2023 report from NIH (the US government's biomedical and public health research body) is titled "Low-dose atropine eyedrops no better than placebo for slowing myopia progression".
It infers a possible significant racial or genetic divide in the effectiveness of the atropine treatment, also given that some other atropine studies, which show success, tend (as far as I've seen) to involve Asian demographics.
In any case, I am a total layperson, only here to note that fairly authoritative sources (e.g. in this case, a co-author being a professor of ophthalmology at Johns Hopkins University) appear to still be at odds about the application and demographic effectiveness of the atropine treatment, about which several general claims are made elsewhere in these HN comments.
This seems like it can be proven or nullified by long at geographic data. Do people living closer to the north pole where it's colder, at the very least for winter where people would be inside more, have a greater occurrence of myopia than those living around the equator where it's a comfortable temperature all year round and people are more likely to be outside more often?
Taiwan's successful strategy is a two hours outside per day policy in schools. Being outside two hours in total per day is bearable even in cooler climates. And nowadays, also life for people in tropical countries tends to move inside buildings where jobs and air conditioners are. There might be a signal when comparing with agrarian countries, even though it is possible that myopia is not accurately tracked by statistics there.
Readit News
Based on recent studies in Australia and Asia they recommend two hours of daily time outdoors for children to prevent myopia.
So it isn’t caused by looking at things close up, the confound was that people who spend a lot of time looking at things close up tend to do so under artificial light.
I don't even have very bad myopia (-2.75/-3.25), but I kick myself for not spending as much time outside during my childhood as some of my friends did.
If it’s genetic, the numbers should stay relatively stable.
If its from a behaviour, there might be variation
You do realize that "natural evolution" doesn't happen within time scales of less than a single generation, right? The environment can change faster than that.
We’re talking about probabilities and statistics over large populations. Not every child who plays outside will avoid myopia, like yourself. But looking at the population, the expectation is that children who get more sunlight tend to have a lower incidence of myopia and weaker myopia.
My workbench is illuminated to 10,000 lux, which compares to common daylight conditions. Just lighting that small area requires 120 watts of high-efficiency LEDs. Lighting the whole room to that level would require nearly two kilowatts of LEDs. Most "super strong indoor lighting" is in fact very dim compared to sunlight. We don't realise it, because our visual system is incredibly adaptable to changing illumination conditions.
You would probably have to put stage lighting in your house to get the same affect as being outside. My eyes behave pretty different and seem to get a "workout" when I am outside in sunny weather.
"Upon transcranial delivery, NIR light has been shown to significantly increase cytochrome oxidase and superoxide dismutase activities which suggests its role in inducing metabolic and antioxidant beneficial effects. Furthermore, NIR light may also boost cerebral blood flow and cognitive functions in humans without adverse effects. In this review, we highlight the value of NIR therapy as a novel paradigm for treatment of visual and neurological conditions, and provide scientific evidence to support the use of NIR therapy with emphasis on molecular and cellular mechanisms in eye diseases." [1]
NIR = near infrared light, 670 nm wavelength. This wavelength is present in sunlight, but not found in basically any indoor lighting with the possible exception of full spectrum LEDs and IR bulbs. Another study found improvement from NIR exposure, but only from exposure in the morning (for three minutes, once a week, at 670nm wavelength), and only in individuals older than 38. The study proposes that the effects they found from NIR exposure is due to improved mitochondrial function in the retina. [2]
The human retina ages faster than other organs, with a 70% decline in functional ATP production by mitochondria over a lifetime. The aging mitochondria, in addition to not producing as much ATP, also spit out junk amino acids that can cause chronic inflammation in the area (and signal cell death where none is called for?). As an aside, improved mitochondrial function is also proposed to be responsible for the significant health benefits of fasting and prolonged calorie restriction.
Another study also theorizes this mechanism:
"Our data suggest, 670 nm light can significantly improve aged retinal function, perhaps by providing additional adenosine triphosphate production for photoreceptor ion pumps or reduced aged inflammation." [3]
More study is clearly called for the better understand what is going on here and why. It seems like it could potentially have implications for age-related degeneration throughout the entire body, not just in the retina.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738953/\\ [2] https://academic.oup.com/biomedgerontology/article/75/9/e49/... [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364001/
So maybe just being outside isn't enough, but it obviously has other health benefits.
Dead Comment
Flashing light/dark spots are a sign of retinal detachment. Floaters are something different [0].
[0] https://www.webmd.com/eye-health/benign-eye-floaters
I was able to catch a retinal tear that had a very high chance of proceeding to a retinal detachment (horsehoe tear with sub-retinal fluid) by getting some new floaters checked out.
Floaters are commonly caused by a (mostly) benign aging phenomenon called posterior vitreous detachment, where the vitriol gel liquefies as a person ages.
Sometimes it worries me, but the condition is "stable".
And, the longer your eye is (the higher your myopia is), the earlier this happens.
Retinal detachment is rare though, even with tons of floaters and high myopia.
I've had floaters since I was 18. A couple of years ago at 59 all of the sudden I had a huge increase in floaters accompanied by flashes in the left eye. I was sure I was having a retinal detachment. Got into an eye doc right away and she said told me it was the vitreous detachment and is something that happens normally at my age. It went on for several months with the flashing and floaters. The right eye followed suit about 6 months later. I had no idea that this was something that happens to pretty much everyone around age 60. Apparently, though, a lot of people don't notice it happening.
After the ophthalmologist checked my eye, she said what I'm seeing is called "mouches volantes" and it's something that happens when people get older. I'm "only" 37 and don't have any problems with my eyesight, which makes me wonder what caused these floaters in my case.
Anyway, it's something I have to get used to. It only really is annoying on sunny days because then I can see them clearly floating around.
https://youtu.be/jj6C7CP2czc?si=nD6I6vLlFLFhntkH
I’d love to understand why you would post such a dogmatic dismissal without so much as a citation. Are you an ophthalmology researcher yourself who is familiar with contrary and well-vetted research? Are you someone with a strong personal experience that you have a hard time squaring with the data? Or are you someone who forms strong beliefs, firmly held, regardless of whatever new information life offers?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328548/
https://www.nih.gov/news-events/news-releases/low-dose-atrop...
Is this your first time on hacker news?
Optometrists are clothing salespeople. Only some ophthalmologists even know about atropine as an option.
https://www.nih.gov/news-events/news-releases/low-dose-atrop...
So far our best guess is to make sure kids get enough sunlight every day and spend time outside, because looking at things in the distance is what regulates eye lengthening during growth. Since things are typically further away outdoors, it helps normal eye development and slows down nearsightedness.
My impression was that near work was previously a leading hypothesis but that, in agreement with this article, sunlight exposure is now considered the most likely explanation. However, I don't think there's ironclad proof either way, and a scholarly consensus is lacking.
Do you have a link to a recent review article that adjudicates between these hypotheses?
Until you have a fix you are going to suffer these terrible discussions, after all is it more terriblier than having actual myopia?
Proven how? The article is pretty explicit about the relationship between near work and myopia being just a correlation, not causation.
I guess he was more right than he knew :-)
Anyhow, a large part of my childhood was spent outside. I've worn glasses since I was 6, with farsighted astigmatism.
In fact, there’s been no change in his prescription in a year.
In fact, one side went down 0.25 as my brilliant UK Opthalmologist deduced that he was not in need of it, and many kids opt for a slightly higher power than they need during the tests. Not to be fooled, this doc. The previous tests, the first, were conducted in Germany on similar equipment, but without a master sleuth operating them.
In short - MiyoSmart lenses are fricking brilliant and kids should be put into them immediately if they need glasses. They are twice the price in Germany than in the UK, like most things, but at least we had the choice.
When I was a lad, they only had a chart of ever-shrinking letters and can-you-tell-the-difference-between-Mickey-Mouse-and-Goofy-in-this-comic before they bolted a stronger pair of goggles on, fast forward 44 years and I’m a -10, and could well have been worse had I not found my optician 31 years ago. Now we monitor my eyes for diseases and potential retinal detachment.
But yes, be outdoors AND have passionate experts looking out for your vision.
If someone has also an experience of late myopia, I would be curious to hear from it, e.g. I would like to know if it stops someday, and if there are good solutions for it.
Get glasses and/or contacts and deal with it. You can't drive properly without correction, but 90% of daily activities are just fine.
I think no matter what your correction is, you should take the steps to not make it worse, and I find that there's very little information about that. Even doctors just say "look far once in a while" which doesn't see so efficient.
So it got better and better, until it became myopia? Was there a point in the middle where you had normal vision?
I’m going to leave this link [1] here for you to follow. Since I am just falling down this rabbit hole myself.
But if you do go down this rabbit hole, feel free to share info in this thread…I might also add my email in the bio. Anyways, good luck!
[1] https://youtu.be/YtL9rL-u_7g?si=yatVs11qOt9U-iZq
A July 2023 report from NIH (the US government's biomedical and public health research body) is titled "Low-dose atropine eyedrops no better than placebo for slowing myopia progression".
https://www.nih.gov/news-events/news-releases/low-dose-atrop...
It infers a possible significant racial or genetic divide in the effectiveness of the atropine treatment, also given that some other atropine studies, which show success, tend (as far as I've seen) to involve Asian demographics.
In any case, I am a total layperson, only here to note that fairly authoritative sources (e.g. in this case, a co-author being a professor of ophthalmology at Johns Hopkins University) appear to still be at odds about the application and demographic effectiveness of the atropine treatment, about which several general claims are made elsewhere in these HN comments.