Most people attribute vision loss to genetics or aging, but a sweeping new synthesis argues that the cumulative burden of environmental exposures — air pollution, heavy metals, climate variables, and even microplastics — may be as consequential as any inherited risk. For health-conscious adults, this reframes eye health as something substantially within reach of environmental and behavioral modification, not merely an inherited fate.
Published in Progress in Retinal and Eye Research, this comprehensive review introduces an anatomy-informed ocular exposome atlas organized along the visual axis — from the tear film and corneal surface through the lens to the retina and optic nerve. The authors systematically evaluate how external exposures translate into biological injury across five major disease categories: ocular surface diseases, cataracts, refractive errors, glaucoma, and retinal diseases including age-related macular degeneration and diabetic retinopathy. The unifying mechanistic pathways identified are oxidative stress, inflammatory signaling, immune dysregulation, and vascular dysfunction — each amplified differently depending on the anatomical target. Emerging threats such as nano- and microplastics receive notable attention alongside more established hazards like particulate matter air pollution and persistent organic pollutants.
The review's analytical ambition is its greatest strength and also its principal limitation: as a synthesis of heterogeneous clinical, epidemiological, and mechanistic studies, it cannot resolve the causal hierarchy among exposures or account for cumulative interaction effects. Much of the foundational evidence remains observational, with cross-sectional study designs dominating the literature. Nevertheless, the exposome framework itself is genuinely useful — it operationalizes the concept that the eye is a metabolically exposed interface, not a sealed biological chamber. For adults in urban environments, the convergence of air pollution, UV radiation, and metal contamination represents an underappreciated, partially modifiable risk profile. This review is an important organizing framework for a fragmented field, though intervention-level evidence remains nascent.