- Greater outdoor exposure remains the most consistently supported modifiable factor associated with lower myopia risk.
- Observational associations between low vitamin D levels and myopia do not establish causality and may largely reflect reduced time outdoors.
- Omega-3 PUFAs demonstrated the strongest nutritional evidence for a possible protective association against axial elongation and myopia progression, though clinical significance remains uncertain.
- Current evidence does not support routine vitamin D testing or nutritional supplementation specifically for myopia prevention or control.
- Most available evidence is observational, heterogeneous, and susceptible to residual confounding, limiting clinical inference.
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