Abstract
As they grow up, approximately 25% of children in the United States become myopic (nearsighted) ( Sperduto and others 1983 ). A much smaller percentage become significantly hyperopic (farsighted), and the majority develop little or no refractive error and thus are “emmetropic” ( Sorsby and others 1957 ; Stenstrom 1948 ; Stromberg 1936 ). The causes of refractive error, especially myopia, have been the subject of debate for more than a century. Some have held that myopia is primarily an inherited disorder ( Sorsby and others 1962 ; Steiger 1913 ; Zadnik 1997 ) and others, that myopia is caused by protracted near work ( Donders 1864 ), especially by accommodation during protracted near work ( Sato 1957 ; Young 1965 ). It has not been possible, based solely on clinical observations, to resolve the relative roles of heredity versus environment in the development of refractive error.