How sleep disturbance promotes myopia: A perspective on potential biological mechanisms

Myopia is an urgent public health concern. However, its pathogenesis remains unclear. Sleep disturbance is a potential environmental risk factor for myopia; however, the underlying mechanisms linking sleep and myopia remain largely unexplored. This review outlines three pathways through which sleep disturbance may contribute to the onset and progression of myopia. First, disruption of the circadian rhythm associated with sleep disturbance alters retinal dopamine dynamics and the balance between dopamine receptor subtypes, ultimately promoting myopia, with melatonin and intrinsically photosensitive retinal ganglion cells likely mediating this effect. Second, reduced choroidal blood flow caused by increased sympathetic tone during sleep disturbance may induce scleral hypoxia and myopic changes. Third, ocular inflammation triggered by sleep disturbance may further accelerate myopia progression. Elucidating these mechanisms could guide the development of targeted preventive and therapeutic strategies. Future studies should use well-designed animal models with sleep interventions to elucidate these mechanisms.