Extraocular Muscles’ Biomechanical Actions on Ocular Sheaths and Their Potential Role in Myopia Etiology and Prevention: integrative review
Rodrigues, Henrique (2025)
2025
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Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:amk-2025121536499
https://urn.fi/URN:NBN:fi:amk-2025121536499
Tiivistelmä
Introduction:
Myopia etiology mechanism and prevention strategies are less than desirable and pose a growing challenging endeavor in the public health agenda. Existing literature focus is directed to retina signaling, pharmacological therapies and more recently red-light stimulation. In the beginning of the XX century the effects of the eye muscles contributing to myopia was suggested but was never followed by relevant research, obfuscated by the advancements in biochemistry and pharmacology in general. The theory that by the actions of the extraocular muscles EOMs, the ocular tissues could distend and cause elongation of the globe, a main marker for myopia, suggests that more attention should be targeted to this theory, and gather more recent literature that could help understand it.
Purpose:
The purpose of the work was to gather and summarize literature that covered the potential role of the EOMs on myopia etiology and prevention, propose and describe a possible EOMs biofeedback mechanism that feeds axial elongation, and describe a possible path to alleviate the stress induced by EOMs on the ocular sheaths.
Methods:
The search query “myopia AND (reading OR near OR accommodation) AND (emmetropia OR emmetropes OR "non-myope") AND (EOMs OR "extraocular muscle")”, was used in January 2025 to retrieve 259 peer-reviewed studies in PubMed (16), ScienceDirect (105), Google Scholar (86), OAMK EBSCO Academic search premier and MEDLINE (52), excluding animal models-based research and subjects with pathologies. The lowest positive score on the five studies considered to integrate the review, using the JBI quality assessment was 77.78%, indicating a low risk of bias.
Results:
Five studies were retrieved and quality scrutinized. They provide valuable evidence of biomechanical effects of near work, gaze shifts and refractive error on different ocular parameters (AxL, ChT, ocular torsion, refractive error and pitch related to head posture). Transient changes induced by EOM forces, ciliary muscle contraction, or uncorrected ametropia may contribute to myopia progression, particularly in progressing or high myopes.
Conclusion:
It was possible to structure the results in, ocular response to disparity, biomechanical forces, cumulative remodelling, amplification and behavioural responses. Promising findings were found that correlate EOMs and myopia and future longitudinal randomized control studies designed to confirm the interplay of the oblique muscles with torsional and vertical disparity are needed.
Myopia etiology mechanism and prevention strategies are less than desirable and pose a growing challenging endeavor in the public health agenda. Existing literature focus is directed to retina signaling, pharmacological therapies and more recently red-light stimulation. In the beginning of the XX century the effects of the eye muscles contributing to myopia was suggested but was never followed by relevant research, obfuscated by the advancements in biochemistry and pharmacology in general. The theory that by the actions of the extraocular muscles EOMs, the ocular tissues could distend and cause elongation of the globe, a main marker for myopia, suggests that more attention should be targeted to this theory, and gather more recent literature that could help understand it.
Purpose:
The purpose of the work was to gather and summarize literature that covered the potential role of the EOMs on myopia etiology and prevention, propose and describe a possible EOMs biofeedback mechanism that feeds axial elongation, and describe a possible path to alleviate the stress induced by EOMs on the ocular sheaths.
Methods:
The search query “myopia AND (reading OR near OR accommodation) AND (emmetropia OR emmetropes OR "non-myope") AND (EOMs OR "extraocular muscle")”, was used in January 2025 to retrieve 259 peer-reviewed studies in PubMed (16), ScienceDirect (105), Google Scholar (86), OAMK EBSCO Academic search premier and MEDLINE (52), excluding animal models-based research and subjects with pathologies. The lowest positive score on the five studies considered to integrate the review, using the JBI quality assessment was 77.78%, indicating a low risk of bias.
Results:
Five studies were retrieved and quality scrutinized. They provide valuable evidence of biomechanical effects of near work, gaze shifts and refractive error on different ocular parameters (AxL, ChT, ocular torsion, refractive error and pitch related to head posture). Transient changes induced by EOM forces, ciliary muscle contraction, or uncorrected ametropia may contribute to myopia progression, particularly in progressing or high myopes.
Conclusion:
It was possible to structure the results in, ocular response to disparity, biomechanical forces, cumulative remodelling, amplification and behavioural responses. Promising findings were found that correlate EOMs and myopia and future longitudinal randomized control studies designed to confirm the interplay of the oblique muscles with torsional and vertical disparity are needed.