A Comprehensive Scientific Review: Early Detection, Genetic Underpinnings, and Personalized Management of Pediatric Astigmatism and Its Synergistic Progression with Myopia

Astigmatism, a common refractive error characterized by an irregular corneal or lenticular curvature, represents a significant pediatric public health concern with profound implications for visual development and long-term ocular health. This review synthesizes contemporary evidence on the complex, multifactorial etiology of astigmatism, emphasizing its critical and synergistic relationship with myopia progression. We delineate the substantial genetic component, with heritability estimates of 40-60%, involving polygenic inheritance patterns and specific SNPs in loci such as PDGFRA and CTNNA2. The pathophysiology is further explored through physiological triggers, including extraocular muscle imbalance, dynamic eyelid pressure, and corneal biomechanical weakening. Modern environmental accelerants, notably prolonged near work and digital device usage, are examined for their role in disrupting emmetropization. The core thesis of this manuscript advocates for a paradigm shift towards early infantile screening and personalized, multi-modal intervention strategies. We critically evaluate conventional therapies (spectacles, toric contact lenses, orthokeratology), emerging pharmacological agents (low-dose atropine), and evidence-based lifestyle modifications (increased outdoor exposure, nutritional optimization). Furthermore, we explore the integration of advanced diagnostics (anterior-segment OCT, Scheimpflug tomography, genetic risk profiling) and complementary approaches like Nutritional optimization and traditional medicine systems, such as Ayurvedic Netra Tarpana and yogic eye exercises, within a holistic management framework. The convergence of genetic insights, advanced biometry, and personalized medicine heralds a new era in preventing astigmatism-related amblyopia and mitigating its role in axial elongation, ultimately preserving lifelong visual function.