New Study Suggests Indoor Visual Habits May Be Driving Myopia Surge
For years, the global rise in myopia has largely been blamed on increased screen time, particularly among children and young adults. But new research from scientists at the SUNY College of Optometry suggests the explanation may be more nuanced—and rooted in a common indoor visual behavior.
In a study published in Cell Reports, researchers propose that myopia progression may be influenced less by screens themselves and more by prolonged close-up focus in low-light environments, which limits the amount of light reaching the retina. The findings introduce a new hypothesis that could help explain a long-standing puzzle in vision science: why a wide range of factors—from near work and dim lighting to atropine eye drops, multifocal lenses, and time spent outdoors—appear to affect myopia development.
“Myopia has reached near-epidemic levels worldwide, yet we still don’t fully understand why,” Jose-Manuel Alonso, MD, PhD, SUNY Distinguished Professor and senior author of the study, said in a SUNY College of Optometry article. “Our findings suggest that a common underlying factor may be how much light reaches the retina during sustained near work—particularly indoors.”
Myopia affects nearly 50% of young adults in the United States and Europe and up to 90% in parts of East Asia. Although genetics play a significant role, the rapid rise in prevalence over just a few generations points strongly to environmental influences.
In the Cell Reports study, researchers have long observed that:
Spending more time outdoors appears to protect against myopia
Extended near work is associated with increased risk
Treatments as varied as atropine eye drops, multifocal lenses, and contrast-reducing optics can slow progression
What has remained unclear is why such diverse interventions seem to work.
The SUNY Optometry team proposes a unifying explanation centered on the pupil..
“In bright outdoor light, the pupil constricts to protect the eye while still allowing ample light to reach the retina,” said Urusha Maharjan, a SUNY Optometry doctoral student who conducted the study. “When people focus on close objects indoors, such as phones, tablets, or books, the pupil can also constrict, not because of brightness, but to sharpen the image. In dim lighting, this combination may significantly reduce retinal illumination.”
According to the researchers’ hypothesis, reduced retinal stimulation over prolonged periods may weaken specific neural pathways involved in visual processing, contributing to the development and progression of myopia.
The proposed mechanism may help explain several established observations in myopia research:
Outdoor time as protective: Bright light increases retinal stimulation
Atropine’s effect: The medication limits pupil constriction, allowing more light to enter the eye
Multifocal and specialty lenses: These reduce the need for strong, sustained close-up focusing
Indoor near work under low light: This may combine pupil constriction with reduced environmental illumination, decreasing retinal input
The researchers emphasize that the study does not conclude that screens directly cause myopia, that light alone determines eye growth, or that genetics are irrelevant. Instead, it reframes how visual behavior, lighting conditions, and pupil dynamics may interact in shaping refractive development.
While the findings do not immediately change clinical guidelines, they may influence future research directions and public health messaging—particularly as digital device use becomes increasingly embedded in childhood and adolescence. The study was conducted by Urusha Maharjan in the laboratories of Jose-Manuel Alonso at the SUNY College of Optometry. Researchers say the next steps will involve further experimental testing to determine how retinal illumination and neural signaling directly affect eye growth over time.
Originally published online on Eyewire+.