{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:02:05Z","timestamp":1784548925442,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Myopia has emerged as one of the most pressing global public health challenges, characterized by rapidly increasing prevalence, earlier onset, and growing risk of vision-threatening complications. While genetic susceptibility contributes to refractive development, accumulating evidence indicates that environmental exposures play a dominant role in shaping ocular growth trajectories. Spatial altitude represents a unique ecological exposure integrating hypobaric hypoxia, enhanced solar radiation, distinctive climatic conditions, and lifestyle patterns. Epidemiological observations consistently demonstrate lower myopia prevalence among high-altitude populations compared with lowland regions, suggesting potential protective environmental influences. This review synthesizes current epidemiological findings and mechanistic hypotheses regarding altitude-associated differences in refractive status. We discuss potential pathways involving light-induced dopaminergic signaling, hypoxia-mediated molecular regulation, behavioral adaptations, circadian synchronization, and gene\u2013environment interactions. We further highlight limitations of existing evidence and propose future research directions integrating environmental monitoring, longitudinal cohort studies, and multi-omics approaches. Understanding altitude-related influences on ocular growth may provide novel insights into environmental interventions for myopia prevention and contribute to strategies addressing the global myopia epidemic.<\/jats:p>","DOI":"10.3389\/fmed.2026.1841970","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:10:23Z","timestamp":1784545823000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Spatial altitude factors on the association with myopia: a narrative review"],"prefix":"10.3389","volume":"13","author":[{"given":"Jian","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, The First Affiliated Hospital of Jinzhou Medical University","place":["Jinzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqiong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, The First Affiliated Hospital of Jinzhou Medical University","place":["Jinzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunming","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Eye Disease, Baotou, Chaoju Eye Hospital","place":["Baotou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref1","first-page":"5","article-title":"High myopia and its risks","volume":"32","author":"Williams","year":"2019","journal-title":"Community Eye Health J"},{"key":"ref2","first-page":"35","article-title":"Myopia: a growing global problem with sight-threatening complications","volume":"28","author":"Holden","year":"2015","journal-title":"Community Eye Health J."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.preteyeres.2017.09.004","article-title":"The epidemics of myopia: aetiology and prevention","volume":"62","author":"Morgan","year":"2018","journal-title":"Prog Retin Eye Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global prevalence of myopia and high myopia and temporal trends from 2000 through 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