Why are children becoming increasingly nearsighted? And why does nearsightedness, or myopia, progress much faster in some children than in others?
Safal Khanal, OD, PhD, FAAO, and his team at the UAB School of Optometry are seeking answers by studying children's everyday visual experiences. Their work earned one of only three Meta Reality Labs Research/AAOF Myopia Research Grants awarded worldwide.
Khanal, associate professor at the UAB School of Optometry, has received a $500,000 grant through the American Academy of Optometry Foundation to investigate how children's daily visual experiences interact with the biology of the eye to influence the onset and progression of myopia.
The study aims to identify which aspects of children’s everyday visual experiences contribute to the development and progression of myopia, or nearsightedness.
Myopia is one of the fastest-growing vision problems worldwide, affecting approximately 36% of children and adolescents. Beyond requiring glasses or contact lenses, myopia increases the risk of serious, sight-threatening eye diseases later in life. While treatments can slow progression, they do not work equally well for every child, and there are currently no established treatments to prevent myopia from developing.
"Children experience very different visual environments every day, from time outdoors and exposure to light to reading, schoolwork and use of digital devices," Khanal said. "By measuring these experiences, alongside how the eye grows, focuses and responds to visual signals, we hope to better understand why some children become nearsighted and why myopia progresses more rapidly in some children than others."
Rather than relying primarily on questionnaires or snapshots of behavior, the research team will track children's real-world visual experiences over time and combine those measurements with detailed assessments of eye shape, optical quality and retinal function.
This approach could help eye care providers identify children at greatest risk of developing myopia or experiencing rapid progression and determine which environmental and biological factors contribute to that risk.
"Today, we primarily monitor how much a child's prescription and eye growth change over time," Khanal said. "We want to go a step further and understand what is driving those changes. If we identify these factors early, it could open the door to more personalized approaches to preventing or slowing myopia."
A key strength of the project is its longitudinal design. By following children over time, researchers can examine changes that occur before, during and after the onset of myopia rather than studying the condition at a single point in children's development.
"Myopia is fundamentally a disorder of eye growth," Khanal said. "To understand why that growth becomes dysregulated, we need to know what children are experiencing visually and what is happening with their eyes as those changes unfold."
The potential impact extends beyond the children participating in the study. The project is part of an open-science initiative in which the three grant recipients will collaborate and share data to accelerate discoveries in childhood myopia.
"Solving a problem of this scale requires a global collaborative effort," Khanal said. "By working with researchers around the world and building rich, openly available data sets, we aim to identify the aspects of children's visual environments that matter most for myopia. Ultimately, that knowledge could point us toward better ways to predict, prevent and treat the condition."
Study partners include Reality Labs Research, SIXTY D, the American Academy of Optometry and Global Light Commons, an international initiative focused on light exposure and visual experience research.
Children ages 7 to 13 are eligible to participate in the study. Families interested in participating or learning more can contact the research team at 205-975-3881 or so-myopia@uab.edu.