Perhaps one of the most universal experiences of childhood involves parental admonishments warning of dire outcomes as a result of unacceptable behaviour. Tree climbing leads to “broken skulls and necks,” television viewing leads to “mushy brains,” and sweet consumption to “rotten teeth.” Ocular admonishments are particularly prevalent with stick playing leading to “putting one's eye out,” voluntary eye crossing becoming “permanently stuck,” and reading in the dark “ruining your eyes.” The notion that how we use our eyes will determine eventual refractive outcome has long been held a popular truism but dismissed as a scientific fact by many eye care professionals. While most agree that refractive error is, for the most part, genetically determined, there is a growing body of evidence that how we use our eyes influences eventual refractive status.1

In this era of high index spectacles, modern contact lens materials, and refractive surgery one may ask the question, “why study myopia?” The answer lies in the understanding that myopia and pathological myopia are common causes of vision loss and blindness in both developed and emerging countries.2 In Taiwan, the prevalence of myopia approaches 75% and in many east Asian countries, pathological myopia is one of the leading causes of blindness.3 Myopic macular degeneration and myopic retinal detachment are not prevented through refractive surgery, a fact often not understood by many high myopes undergoing this form of surgery. The prevention of the development of high myopia has become a priority in many …