New research suggests myopia is driven by how we use our eyes indoors

(Press-News.org) New York, NY — For years, rising rates of myopia — or nearsightedness — have been widely attributed to increased screen time, especially among children and young adults. But new research from scientists at the SUNY College of Optometry suggests the story may be more complicated — and more human. In a new study to be published in Cell Reports, researchers propose that myopia may be driven less by screens themselves and more by a common indoor visual habit: prolonged close-up focus in low-light environments, which limits how much light reaches the retina. 

“Myopia has reached near-epidemic levels worldwide, yet we still don’t fully understand why,” said Jose-Manuel Alonso, MD, PhD, SUNY Distinguished Professor and senior author of the study. “Our findings suggest that a common underlying factor may be how much light reaches the retina during sustained near work — particularly indoors.” 

Myopia (nearsightedness) is a visual disease that blurs vision at far distance and is becoming a world epidemic affecting nearly 50 percent of young adults in the United States and Europe and close to 90 percent in parts of East Asia. While genetics play an important role, rapid increases over just a few generations suggest environmental factors are also critical. 

The disease can be induced in animal models with visual deprivation or negative lenses, and the two induction processes are thought to involve different neuronal mechanisms. Clinicians also control myopia progression with a variety of approaches that are thought to engage multiple mechanisms (multifocal lenses, ophthalmic atropine, contrast-reduction, promoting time outdoors, and others). Scientists at the State University of New York (SUNY) College of Optometry propose a unifying neuronal mechanism in their article to explain all current approaches to myopia induction and control.  

The research offers a new hypothesis that could help explain a long-standing puzzle in vision science — why so many seemingly different factors, from near work and dim indoor lighting to treatments like atropine drops, multifocal lenses, and time spent outdoors, all appear to influence myopia progression. 

“In bright outdoor light, the pupil constricts to protect the eye while still allowing ample light to reach the retina,” explains Urusha Maharjan, 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 this mechanism, myopia develops when poor retinal illumination fails to generate robust retinal activity because the light sources are too dim and pupil constriction is too excessive at short viewing distances. Conversely, myopia does not develop when the eye is exposed to bright light and the pupil constriction is regulated by image brightness instead of viewing distance. 

The new study demonstrates that negative lenses reduce retinal illumination by constricting the pupil through a process known as accommodation (i.e., an accommodative increase in the lens power of the eye when focusing images at short distances). Such pupil constriction becomes stronger when accommodation is increased by shortening viewing distance or wearing excessively-strong negative lenses. Moreover, pupil constriction becomes even stronger when lens accommodation is sustained for prologued periods of time (e.g., tens of minutes), and even stronger when the eye becomes myopic. The study also demonstrates additional myopia disruptions of eye turning with accommodation and eye-blink efficacy at constricting the pupil.  

If proven correct, the mechanism proposed could lead to a paradigm shift in our understanding of myopia progression and control. According to this mechanism, myopia can be controlled by exposing the eye to safe bright light levels under limited accommodative pupil constriction. Accommodative pupil constriction can be limited by reducing accommodation strength with lenses (multifocal or contrast-reduction), blocking directly the muscles driving pupil constriction (atropine drops), or by simply spending time outdoors without engaging accommodation (looking at far distances).  

Perhaps most importantly, the new mechanism predicts that any approach to myopia control will fail if the eye is exposed to excessive accommodation indoors under low light for prolonged periods of time.   

“This is not a final answer,” Alonso emphasized. “But the study offers a testable hypothesis that reframes how visual habits, lighting, and eye focusing interact. It’s a hypothesis grounded in measurable physiology that brings together many pieces of existing evidence. More research is needed, but it gives us a new way to think about prevention and treatment.” 

The research was done by Urusha Maharjan and collaborators in the laboratories of Jose-Manuel Alonso at the SUNY College of Optometry. It will be published on February 17, 2026 at 11:00 am (Eastern Time) in Cell Reports (notice: press embargo will be lifted on this date and time).  

For more information about this study, download the study press packet.  

Abstract from the Paper: 
The human eyes are continuously adjusting refractive power, vergence angle, and pupil diameter when exploring the visual environment. Adjustment errors in these visuomotor functions reduce the stimulus contrast driving ON and OFF retinal pathways, and ON retinal pathways become weaker, slower, and less sensitive in refractive disorders such as myopia. Here we demonstrate that, in addition to these sensory deficits, myopes also have deficits in visuomotor functions driven by ON and OFF pathways during lens accommodation. We show that humans with myopia have excessive accommodative eye vergence with reduced ON-pathway dominance and excessive accommodative pupil constriction. The excessive accommodative pupil constriction that we demonstrate could potentially weaken ON-pathway responses and cause ON-pathway deficits.  This mechanism could explain why myopia increases with activities that maximize accommodative pupil constriction such as near work, and decreases with activities/treatments that reduce it such as outdoor activity, atropine, positive defocus, and low contrast. 

In Brief from the Paper: 
Maharjan et al. demonstrate that human accommodative functions are strongly modulated by stimulus contrast driving both ON and OFF pathways. They also show that myopia potentiates accommodative eye vergence and pupil constriction while disrupting pupil responses to eye blinks. 

About SUNY Optometry 
Founded in 1971 and located in New York City, the State University of New York College of Optometry is a leader in education, research, and patient care, offering the Doctor of Optometry degree as well as MS and PhD degrees in vision science. The College conducts a robust program of basic, translational, and clinical research and has 65 affiliated clinical training sites as well as an on-site clinic, the University Eye Center. SUNY Optometry is regionally accredited by the Commission on Higher Education of the Middle States Association of Colleges and Secondary Schools; its four-year professional degree program and residency programs are accredited by the Accreditation Council on Optometric Education of the American Optometric Association. To learn more about SUNY Optometry, visit www.sunyopt.edu. 

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