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REVIEW article

Front. Med.

Sec. Ophthalmology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1638184

Myopia Development: Multifactorial interplay、Molecular Mechanisms and Possible Strategies

Provisionally accepted
  • 1Chengdu University of Traditional Chinese Medicine, Chengdu, China
  • 2Dujiangyan Medical Centre, dujiangyan, China

The final, formatted version of the article will be published soon.

Myopia is a global visual impairment, and its pathological mechanism involves the complex multifactorial interplay of neurotransmitters, hormones and intracellular signaling pathways. Dopamine inhibits axial growth by activating D2 receptor-CAMP pathway, while GABA energy signals maintain refractive stability by regulating retinal excitation-inhibition balance. Sex hormones and vitamin D play a dual role by regulating scleral ECM metabolism, the former enhances corneal strength and may promote axial elongation during puberty, while the latter exhibits dose-dependent biphasic effects on collagen synthesis via VDR signaling. In the core signaling pathway, the hypoxia-HIF-1α-MMP-2 axis drives sclera ECM degradation, while TGF-β and Wnt/β-catenin pathways synergically regulate fibroblast proliferation and migration. In response to these mechanisms, multi-target intervention strategies show potential: low-dose atropine combined with outdoor light can synergically inhibit axial growth. However, while emerging technologies like gene editing (e.g., CRISPR targeting HIF-1α) and targeted MMP-2 inhibitors are entering preclinical validation, their clinical translation faces substantial hurdles. For CRISPR-based approaches, critical challenges include mitigating off-target editing risks and developing safe, efficient in vivo delivery systems to the relevant ocular tissues. Future studies need to integrate molecular mechanisms and interdisciplinary approaches to rigorously evaluate efficacy, safety, and feasibility in order to develop precise prevention and control programs to cope with the epidemic trend of myopia.

Keywords: Myopia, neurotransmitters, Hormones, Intracellular signaling pathways, Interventions

Received: 30 May 2025; Accepted: 04 Aug 2025.

Copyright: © 2025 Huang, Zhang and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dazheng Zhang, Dujiangyan Medical Centre, dujiangyan, China

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.