Abstract.Progressive myopia may result from an inherited biomechanical weakness of the sclera that allows it to stretch (creep) in response to stress. Increased intraocular pressure could be the mediator of stress produced by the inclined head position and the accommodation/convergence aspects of near work. This paper reviews data that relate to this hypothesis including work on sclera, intraocular pressure, animal models of myopia, and attempts at human treatment. Although the weight of evidence appears to support the proposed notion, no firm conclusion can be drawn due to imperfections in the design of prior studies. A future research agenda is proposed, including a controlled clinical trial of pharmacologically sustained ocular hypotension in young progressive myopes.