Near Exophoria May Lead to Higher Risk of Myopia, Study Suggests

Near exophoria may be significantly correlated to myopia severity in children, suggesting binocular vision anomalies may contribute to disease progression, according to a recent study presented at the 2025 American Optometric Conference in Minneapolis, MN.

Previous studies conducted in East Asia have indicated a significant prevalence of exophoria at near fixation, as well as a strong association with myopia in children. Myopia has been suggested as a risk factor for concomitant exotropia; conversely, intermittent exotropia has also been suggested as a risk factor for myopia.2

Presented by Saif Hassan Alrasheed, PhD, faculty of optometry and visual sciences, Al-Neelain University, this descriptive, cross-sectional, hospital-based study examined the relationship between near-work activities, such as use of smartphones and computers, and the ongoing global increase in myopia rates.1

According to the study, children aged 6 to 11 frequently hold reading materials 10 to 40 cm away. Those with consistently short reading distances are more likely to develop higher levels of myopia. Near exophoria is commonly associated with myopia development in this fashion.1

“The study emphasizes the importance of comprehensive eye examinations for myopic children, including assessments of binocular vision,” Alrasheed and colleagues wrote. “Detecting and managing binocular vision disorders, such as exophoria, could help slow myopia progression and enhance visual comfort during near work.”1

To that end, the study examined 117 children, aged 6 to 15, at the Al-Neelain Eye Hospital in Sudan. Included children presented with myopia of 1-6 diopters and exophoria at near fixation. Exclusion criteria consisted of a history of ocular conditions such as amblyopia, manifest strabismus, or previous refractive surgery.1

Of the 117 children included, 81.2% (n = 95) had a parental history of myopia. Investigators saw no difference between genders (P = .185). Mean myopic sphere equivalent was -1.76 +/- .90 D in the right eye and -1.79 +/- .97 D in the left eye (P = .227). Alrasheed and colleagues cite this as support for the influence of genetics in myopia development.1

Investigators measured the visual acuity, amplitude of accommodation, near point of convergence, and near exophoria in each child. Mean (Standard Deviation [SD]) near exophoria was 4.65 D +/- 3.47, with a .281 correlation (P = .002); near point of convergence had a mean (SD) of 6.89 +/- .945 and a correlation of -.02 (P = .833); monocular accommodation had a mean (SD) of 12.64 +/- 1.69 cm and a correlation of .086 (P = .359); and binocular accommodation displayed a mean of 12.94 +/- 1.61 and a correlation of .118 (P = .205).1

Via a scatterplot, investigators found a strong positive correlation between near exophoria and the spherical equivalent of myopia. They also noted, however, that accommodation amplitude and NPC did not show significant associations with myopia severity. 1

“Further research is needed to investigate the dynamic relationships between binocular vision, environmental factors, and myopia progression in children,” Alrasheed and colleagues wrote.1

References

1. Alrasheed, S. Myopia severity in children: impact of near exophoria, vergence, and accommodation. Abstract presented at the 2025 American Optometric Association Conference in Minneapolis, MN, June 25-28, 2025.

2. Hsu JH, Lai LJ, Tung TH, Hsu WH. Physiological exophoria did not increase the incidence of myopia in rural school children in Taiwan. Medicine (Baltimore). 2022;101(25):e29482. Published 2022 Jun 24. doi:10.1097/MD.0000000000029482