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The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis. Sherwin Justin C,Reacher Mark H,Keogh Ruth H,Khawaja Anthony P,Mackey David A,Foster Paul J Ophthalmology OBJECTIVE:To summarize relevant evidence investigating the association between time spent outdoors and myopia in children and adolescents (up to 20 years). DESIGN:Systematic review and meta-analysis. PARTICIPANTS:Results from 7 cross-sectional studies were pooled in a meta-analysis. A further 16 studies (8 cross-sectional not meeting criteria for meta-analysis; 7 prospective cohort studies; 1 randomized, controlled trial [RCT]) were reported in the systematic review. METHODS:The literature search included 4 databases (Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials [CENTRAL]), and reference lists of retrieved studies. Estimates of association were pooled using random effects meta-analysis. We summarized data examining the association between time spent outdoors and prevalent myopia, incident myopia, and myopic progression. MAIN OUTCOME MEASURES:Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for myopia for each additional hour spent outdoors per week from a meta-analysis. RESULTS:The pooled OR for myopia indicated a 2% reduced odds of myopia per additional hour of time spent outdoors per week, after adjustment for covariates (OR, 0.981; 95% CI, 0.973-0.990; P<0.001; I(2), 44.3%). This is equivalent to an OR of 0.87 for an additional hour of time spent outdoors each day. Three prospective cohort studies provided estimates of risk of incident myopia according to time spent outdoors, adjusted for possible confounders, although estimates could not be pooled, and the quality of studies and length of follow-up times varied. Three studies (2 prospective cohort and 1 RCT) investigated time spent outdoors and myopic progression and found increasing time spent outdoors significantly reduced myopic progression. CONCLUSIONS:The overall findings indicate that increasing time spent outdoors may be a simple strategy by which to reduce the risk of developing myopia and its progression in children and adolescents. Therefore, further RCTs are warranted to investigate the efficacy of increasing time outdoors as a possible intervention to prevent myopia and its progression. 10.1016/j.ophtha.2012.04.020
Bio-environmental factors associated with myopia: An updated review. Galvis V,Tello A,Camacho P A,Parra M M,Merayo-Lloves J Archivos de la Sociedad Espanola de Oftalmologia Experimental studies in animals, as well as observational and intervention studies in humans, seem to support the premise that the development of juvenile myopia is promoted by a combination of the effect of genetic and environmental factors, with a complex interaction between them. The very rapid increase in myopia rates in some parts of the world, such as Southeast Asia, supports a significant environmental effect. Several lines of evidence suggest that humans might respond to various external factors, such as increased activity in near vision, increased educational pressure, decreased exposure to sunlight outdoors, dietary changes (including increased intake of carbohydrates), as well as low light levels indoors. All these factors could be associated with a higher prevalence of myopia. 10.1016/j.oftal.2016.11.016
Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Xiong Shuyu,Sankaridurg Padmaja,Naduvilath Thomas,Zang Jiajie,Zou Haidong,Zhu Jianfeng,Lv Minzhi,He Xiangui,Xu Xun Acta ophthalmologica Outdoor time is considered to reduce the risk of developing myopia. The purpose is to evaluate the evidence for association between time outdoors and (1) risk of onset of myopia (incident/prevalent myopia); (2) risk of a myopic shift in refractive error and c) risk of progression in myopes only. A systematic review followed by a meta-analysis and a dose-response analysis of relevant evidence from literature was conducted. PubMed, EMBASE and the Cochrane Library were searched for relevant papers. Of the 51 articles with relevant data, 25 were included in the meta-analysis and dose-response analysis. Twenty-three of the 25 articles involved children. Risk ratio (RR) for binary variables and weighted mean difference (WMD) for continuous variables were conducted. Mantel-Haenszel random-effects model was used to pool the data for meta-analysis. Statistical heterogeneity was assessed using the I test with I  ≥ 50% considered to indicate high heterogeneity. Additionally, subgroup analyses (based on participant's age, prevalence of myopia and study type) and sensitivity analyses were conducted. A significant protective effect of outdoor time was found for incident myopia (clinical trials: risk ratio (RR) = 0.536, 95% confidence interval (CI) = 0.338 to 0.850; longitudinal cohort studies: RR = 0.574, 95% CI = 0.395 to 0.834) and prevalent myopia (cross-sectional studies: OR = 0.964, 95% CI = 0.945 to 0.982). With dose-response analysis, an inverse nonlinear relationship was found with increased time outdoors reducing the risk of incident myopia. Also, pooled results from clinical trials indicated that when outdoor time was used as an intervention, there was a reduced myopic shift of -0.30 D (in both myopes and nonmyopes) compared with the control group (WMD = -0.30, 95% CI = -0.18 to -0.41) after 3 years of follow-up. However, when only myopes were considered, dose-response analysis did not find a relationship between time outdoors and myopic progression (R  = 0.00064). Increased time outdoors is effective in preventing the onset of myopia as well as in slowing the myopic shift in refractive error. But paradoxically, outdoor time was not effective in slowing progression in eyes that were already myopic. Further studies evaluating effect of outdoor in various doses and objective measurements of time outdoors may help improve our understanding of the role played by outdoors in onset and management of myopia. 10.1111/aos.13403
Early Intervention and Nonpharmacological Therapy of Myopia in Young Adults. Zorena Katarzyna,Gładysiak Aleksandra,Ślęzak Daniel Journal of ophthalmology Myopia is a condition of the eye where parallel rays focus in front of, instead of on, the retina, which results in excessive refractive power of the cornea or the lens or eyeball elongation. Studies carried out in recent years show that the etiology of myopia is complex with genetic and environmental factors playing a role. Refraction defects decrease the quality of vision, while progressing myopia can lead to partial loss of vision, which can be particularly dramatic in young adults. Therefore, it is so crucial to take appropriate actions aimed at preventing myopia progression. This is a review of nonpharmacological therapeutic possibilities of refraction defect prevention in young adults, with special regard to myofascial therapy, osteopathy, and massage of acupuncture points surrounding the eye. 10.1155/2018/4680603
IMI - Interventions Myopia Institute: Interventions for Controlling Myopia Onset and Progression Report. Wildsoet Christine F,Chia Audrey,Cho Pauline,Guggenheim Jeremy A,Polling Jan Roelof,Read Scott,Sankaridurg Padmaja,Saw Seang-Mei,Trier Klaus,Walline Jeffrey J,Wu Pei-Chang,Wolffsohn James S Investigative ophthalmology & visual science Myopia has been predicted to affect approximately 50% of the world's population based on trending myopia prevalence figures. Critical to minimizing the associated adverse visual consequences of complicating ocular pathologies are interventions to prevent or delay the onset of myopia, slow its progression, and to address the problem of mechanical instability of highly myopic eyes. Although treatment approaches are growing in number, evidence of treatment efficacy is variable. This article reviews research behind such interventions under four categories: optical, pharmacological, environmental (behavioral), and surgical. In summarizing the evidence of efficacy, results from randomized controlled trials have been given most weight, although such data are very limited for some treatments. The overall conclusion of this review is that there are multiple avenues for intervention worthy of exploration in all categories, although in the case of optical, pharmacological, and behavioral interventions for preventing or slowing progression of myopia, treatment efficacy at an individual level appears quite variable, with no one treatment being 100% effective in all patients. Further research is critical to understanding the factors underlying such variability and underlying mechanisms, to guide recommendations for combined treatments. There is also room for research into novel treatment options. 10.1167/iovs.18-25958
Review: Myopia control strategies recommendations from the 2018 WHO/IAPB/BHVI Meeting on Myopia. Ang Marcus,Flanagan Judith L,Wong Chee Wai,Müller Andreas,Davis Amanda,Keys Drew,Resnikoff Serge,Jong Monica,Wong Tien Yin,Sankaridurg Padmaja The British journal of ophthalmology Myopia is a major public health problem, particularly in East Asia. In this summary report, we present key findings and recommendations on strategies for myopia control discussed during the meeting jointly organised by the WHO Regional Office for the Western Pacific, the International Agency for the Prevention of Blindness and the Brien Holden Vision Institute. First, myopia prevalence was reported to be increasing, with up to 80% of junior school students with myopia in East Asia. However, common challenges in implementing myopia control strategies on a national level included lack of school screening programme, and paucity of accurate prevalence data. Second, there continues to be broad public misconception about myopia and myopia control, including lack of parental awareness and resistance to wearing spectacles. Third, best practices for myopia management were shared, and recommendations for policy implementation are presented in this review. Key recommendations from this meeting include increased public education to raise parent and teacher awareness; encouragement of increased outdoor time of 2-3 hours per day for schoolchildren-as a practical public health intervention that has been shown to potentially reduce onset and progression of myopia. Governments and non-governmental organisations are encouraged to collaborate, especially education and health ministries to develop national myopia prevention programme. Lastly, it is important to emphasise that the key recommendations, such as increasing outdoor time for schoolchildren, are specific for East Asian nations in the Western Pacific region and may not be entirely applicable for Western nations. 10.1136/bjophthalmol-2019-315575
Recent Epidemiology Study Data of Myopia. Xiang Zhao-Yu,Zou Hai-Dong Journal of ophthalmology Myopia, a pandemic refractive error, is affecting more and more people. The progression of myopia could cause numerously serious complications, even leading to blindness. This review summarizes the epidemiological studies on myopia after 2018 and analyzes the risk factors associated with myopia. The prevalence of myopia varies in different regions, age, and observation time. East Asia has been gripped by an unprecedented rise in myopia, and other parts of the world have also seen an increase. The prevalence of myopia in children continues to rise and aggravates with age. The prevalence of high myopia has also increased along with myopia. Racial dependence and family aggregation can be seen frequently in myopia patients. Increased outdoor activities are proven to be protective factors for myopia, as near-distance work and higher education levels affect in the opposite. The impact of gender or urbanization on myopia is controversial. The relationship between nutrition, digital screens, Kawasaki disease, pregnant women smoking during pregnancy, and myopia is still not clear for lack of sufficient evidence. Understanding the various factors that affect myopia helps to clarify the mechanism of myopia formation and also to formulate reasonable prevention and control measures of myopia to protect people's health, especially for adolescents. 10.1155/2020/4395278
IMI Risk Factors for Myopia. Morgan Ian G,Wu Pei-Chang,Ostrin Lisa A,Tideman J Willem L,Yam Jason C,Lan Weizhong,Baraas Rigmor C,He Xiangui,Sankaridurg Padmaja,Saw Seang-Mei,French Amanda N,Rose Kathryn A,Guggenheim Jeremy A Investigative ophthalmology & visual science Risk factor analysis provides an important basis for developing interventions for any condition. In the case of myopia, evidence for a large number of risk factors has been presented, but they have not been systematically tested for confounding. To be useful for designing preventive interventions, risk factor analysis ideally needs to be carried through to demonstration of a causal connection, with a defined mechanism. Statistical analysis is often complicated by covariation of variables, and demonstration of a causal relationship between a factor and myopia using Mendelian randomization or in a randomized clinical trial should be aimed for. When strict analysis of this kind is applied, associations between various measures of educational pressure and myopia are consistently observed. However, associations between more nearwork and more myopia are generally weak and inconsistent, but have been supported by meta-analysis. Associations between time outdoors and less myopia are stronger and more consistently observed, including by meta-analysis. Measurement of nearwork and time outdoors has traditionally been performed with questionnaires, but is increasingly being pursued with wearable objective devices. A causal link between increased years of education and more myopia has been confirmed by Mendelian randomization, whereas the protective effect of increased time outdoors from the development of myopia has been confirmed in randomized clinical trials. Other proposed risk factors need to be tested to see if they modulate these variables. The evidence linking increased screen time to myopia is weak and inconsistent, although limitations on screen time are increasingly under consideration as interventions to control the epidemic of myopia. 10.1167/iovs.62.5.3
[Prevalence of myopia and influencing factors among primary and middle school students in 6 provinces of China]. Zhou Jia,Ma Yinghua,Ma Jun,Zou Zhiyong,Meng Xiangkun,Tao Fangbiao,Luo Chunyan,Jing Jin,Pan Dehong,Luo Jiayou,Zhang Xin,Wang Hong,Zhao Haiping Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi OBJECTIVE:To understand the prevalence of myopia in primary and middle school students in 6 provinces and the possible influencing factors. METHODS:Primary and middle school students were selected through multistage cluster sampling in 60 primary and middle schools in 6 provinces in China. The questionnaire survey and eyesight test were conducted among all the students selected according to the national student's physique and health survey protocol. Pearson chi-square test and binary multivariate logistic regression analysis were done to identify the influencing factors for myopia in students. RESULTS:The prevalence of myopia among primary and middle school students surveyed was 55.7%, the gender specific difference was statistically significant (59.7% for girls, 51.9% for boys) (P<0.01). The prevalence of myopia increased with age obviously. The prevalence was 35.8% in age group 6-8 years, 58.9% in age group 10-12 years, 73.4% in age group 13-15 years and 81.2% in age group 16-18 years, the differences were statistically significant (P<0.001). Single factor and multivariate analysis showed that parents' myopia, distance between computer screen and eyes, distance less than 30 cm between eyes and book while reading, distance less than 10 cm between chest and the table edge while studying, distance less than 3 cm between fingers and pen tip, sleep time, average outdoor activity time during last week, school sport activities in the afternoon, the size of television set at home, time spent on watching TV and playing computer were the influencing factors for myopia. CONCLUSIONS:The prevalence of myopia is till high in primary and middle school students. Myopia is associated with both genetic factors and individual eye health related behaviors. 10.3760/cma.j.issn.0254-6450.2016.01.006
Student Health Implications of School Closures during the COVID-19 Pandemic: New Evidence on the Association of e-Learning, Outdoor Exercise, and Myopia. Liu Ji,Li Baihuiyu,Chen Qiaoyi,Dang Jingxia Healthcare (Basel, Switzerland) The coronavirus disease 2019 (COVID-19) pandemic forced many education systems to consider alternative remote e-learning modalities, which have consequential behavioral and health implications for youth. In particular, increased e-learning engagement with digital screens and reduction in outdoor activities are two likely channels posing adverse risks for myopia development. This study investigated the association between e-learning screen use, outdoor activity, lighting condition, and myopia development among school-age children in China, during the first wave of the COVID-19 pandemic. Data were collected from 3405 school-age children attending primary, lower-secondary, and upper-secondary schools in China. Univariate parametric and nonparametric tests, and multivariate logistic regression analysis were used. Findings show that each diopter hour increase in daily e-learning screen use is significantly associated with progression of myopia symptoms (OR: 1.074, 95% CI: 1.058-1.089; < 0.001), whereas engaging in outdoor exercise four to six times per week (OR: 0.745, 95% CI: 0.568-0.977; = 0.034) and one to three times per week (OR: 0.829, 95% CI: 0.686-0.991; = 0.048) is associated with a lower likelihood of myopia progression than none at all. In addition, we found that indoor lighting that is either "too dim" (OR: 1.686, 95% CI: 1.226-2.319; = 0.001) or "too bright" (OR: 1.529, 95% CI: 1.007-2.366; = 0.036) is significantly associated higher likelihood of myopic symptoms. Findings in this study uncover the less observable vision consequences of the COVID-19 pandemic on youths through digital online learning and highlight the importance of considering appropriate mitigation strategies to deal with this emerging public health challenge. 10.3390/healthcare9050500
[Responsible use of screens: recommendations to limit myopia in children and young people]. Iyer V,Landsmeer E A,Reijneveld S A Nederlands tijdschrift voor geneeskunde The excessive use of screens is a contemporary problem that can have a number of effects on health. It is of particular influence on the onset and exacerbation of myopia, and for these reasons a group of professionals decided to draw up recommendations on a more sensible use of screens. The group comprised an ophthalmologist-epidemiologist, an orthoptist, paediatric and adolescent physicians, a youth health care nurse, an orthopaedic surgeon, a movement therapist-epidemiologist, health scientists and psychologists. They recommend that on history-taking, standard questions concerning screen use and its associated problems should be asked. The parents can then be given targeted lifestyle advice for the child, i.e. after 20-30 minutes continuous screen use there should be a change of activity, and that the child should spend 2 hours a day outdoors. These recommendations will promote the health of children's eyes as well as their general development.
Influence of Near Tasks on Posture in Myopic Chinese Schoolchildren. Bao Jinhua,Drobe Björn,Wang Yuwen,Chen Ke,Seow Eu Jin,Lu Fan Optometry and vision science : official publication of the American Academy of Optometry PURPOSE:To investigate near-vision posture in Chinese myopic schoolchildren and compare near-vision posture during different near-vision tasks (i.e., playing video games, reading, and writing). METHODS:The study investigated 120 myopic children (grades 1 through 6 and aged 6 to 13 years). An electromagnetic motion-tracking system was used for continuous measurements of the working distance and head declination of the subjects while they were playing video games or reading or writing at a desk. The reading and writing documents were adjusted by grade level (i.e., grades 1 to 2, 3 to 4, and 5 to 6). For analysis, the subjects were grouped in two refractive groups according to their median spherical equivalent refractive error (-1.50D). RESULTS:The myopic schoolchildren used close working distances for all tasks: 21.3 ± 5.2 cm (video games), 27.2 ± 6.4 cm (reading), and 24.9 ± 5.8 cm (writing). The mean head declinations were 63.5 ± 12.2 deg (video games), 37.1 ± 12.8 deg (reading), and 44.5 ± 14.1 deg (writing). Working distance decreased significantly across time for the reading and writing tasks (p < 0.001). Head declination increased significantly across time only for the reading task (p < 0.001). Grade level significantly influenced working distance, but the difference was not significant when working distance was adjusted by the subject's size. No differences were observed within the refractive or the accommodative lag groups in terms of the posture data (p > 0.05). Working distance was negatively correlated with head declination (r = -0.53, p < 0.001). CONCLUSIONS:Close working distances were observed for Chinese myopic schoolchildren. The attention dedicated to each task, the task difficulty, and the page/screen size may affect near working distance and head declination. Handheld video games were associated with the closest working distance, which may be a risk factor for myopia progression, according to previous studies. 10.1097/OPX.0000000000000658
The impact of computer use on myopia development in childhood: The Generation R study. Enthoven Clair A,Tideman J Willem L,Polling Jan Roelof,Yang-Huang Junwen,Raat Hein,Klaver Caroline C W Preventive medicine Environmental factors are important in the development of myopia. There is still limited evidence as to whether computer use is a risk factor. The aim of this study is to investigate the association between computer use and myopia in the context of other near work activities. Within the birth cohort study Generation R, we studied 5074 children born in Rotterdam between 2002 and 2006. Refractive error and axial length was measured at ages 6 and 9. Information on computer use and outdoor exposure was obtained at age 3, 6 and 9 years using a questionnaire, and reading time and reading distance were assessed at age 9 years. Myopia prevalence (spherical equivalent ≤-0.5 dioptre) was 11.5% at 9 years. Mean computer use was associated with myopia at age 9 (OR = 1.005, 95% CI = 1.001-1.009), as was reading time and reading distance (OR = 1.031; 95% CI = 1.007-1.055 (5-10 h/wk); OR = 1.113; 95% CI = 1.073-1.155 (>10 h/wk) and OR = 1.072; 95% CI = 1.048-1.097 respectively). The combined effect of near work (computer use, reading time and reading distance) showed an increased odds ratio for myopia at age 9 (OR = 1.072; 95% CI = 1.047-1.098), while outdoor exposure showed a decreased odds ratio (OR = 0.996; 95% CI = 0.994-0.999) and the interaction term was significant (P = 0.036). From our results, we can conclude that within our sample of children, increased computer use is associated with myopia development. The effect of combined near work was decreased by outdoor exposure. The risks of digital devices on myopia and the protection by outdoor exposure should become widely known. Public campaigns are warranted. 10.1016/j.ypmed.2020.105988
Incidence and progression of myopia and associated factors in urban school children in Delhi: The North India Myopia Study (NIM Study). Saxena Rohit,Vashist Praveen,Tandon Radhika,Pandey Ravindra M,Bhardawaj Amit,Gupta Vivek,Menon Vimala PloS one AIM:To evaluate the incidence and progression of myopia and factors associated with progression of myopia in school going children in Delhi. METHODS:Prospective longitudinal study of 10,000 school children aged 5 to 15 years screened after an interval of 1 year to identify new myopes (Spherical Equivalent≤ -0.5D) and progression of myopia in previously diagnosed myopic children. Association between risk factors and progression was analyzed using adjusted odds ratio. RESULTS:Of the 9,616 children re-screened (97.3% coverage), annual incidence of myopia was 3.4%with mean dioptric change of -1.09 ± 0.55. There was a significant higher incidence of myopia in younger children compared to older children (P = 0.012) and among girls compared to boys (P = 0.002). Progression was observed in 49.2%children with mean dioptric change of -0.27 ± 0.42 diopters. The demographic and behavioral risk factors were analyzed for children with progression (n = 629) and adjusted odds ratio values were estimated. Hours of reading-writing/week (p<0.001), use of computers/ video games (P<0.001) and watching television (P = 0.048) were significant risk factors for progression of myopia. Outdoor activities / time spent outdoors> 2 hours in a day were protective with an inverse association with progression of myopia (P< 0.001). CONCLUSION:Myopia is an important health issue in India and is associated with long hours of reading and screen time with use of computers and video games. An annual eye vision screening should be conducted, and outdoor activities be promoted to prevent the increase of myopia among school children. 10.1371/journal.pone.0189774
Association of multimedia teaching with myopia: A national study of school children. Hinterlong James E,Holton Valerie L,Chiang Chi-Chen,Tsai Ching-Yao,Liou Yiing-Mei Journal of advanced nursing AIM:The aim of this study was to determine whether students' exposure to digitally projected, multimedia teaching material under naturally varying classroom lighting conditions is associated with myopia risk and severity. DESIGN:A population-based, cross-sectional study in 2012 of children in grades 4-6 across 87 schools in Taiwan. METHODS:Students (N = 3,686) reported demographic information, outdoor time, physical activity and near work. Parents provided their myopia status. Student-reported multimedia teaching frequency and classroom lighting levels were confirmed with direct observation. School nurses conducted vision screening and ophthalmologist referral. Myopia status and severity were measured by spherical equivalent refraction; SE ≤-0.5 dioptres was coded as myopic. Binary logistic and tobit regression were used to estimate the contributions of classroom multimedia exposure and lighting to myopia risk and severity controlling for risk factors. RESULTS/FINDINGS:Age, parental myopia and hours of near work increased the odds of myopia and predicted greater severity. Physical activity and outdoor time predicted lower risk and severity. Multimedia exposure in relatively bright classrooms was associated with greater odds of myopia. Classroom lighting levels during multimedia teaching were inversely related to severity; exposure frequency was unrelated. CONCLUSIONS:Multimedia exposure under brighter classroom conditions may contribute to the myopia incidence in schoolchildren. IMPACT:Teaching with digital projection technology is increasingly prevalent. This may increase children's odds of developing myopia, which has far-reaching and lifelong deleterious effects. School nurses should raise awareness of and promote strategies that reduce this risk, including working with children, parents, school personnel and system leaders to adopt eye-healthy behaviours, practices and policies. 10.1111/jan.14206
Parental attitudes to myopia: a key agent of change for myopia control? McCrann Saoirse,Flitcroft Ian,Lalor Kevin,Butler John,Bush Aaron,Loughman James Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) PURPOSE:With the increasing prevalence in myopia there is growing interest in active myopia prevention. This study aims to increase our understanding of parental attitudes to myopia development and control, as a means to inform future health planning and policy. It evaluates, for the first time, the attitude of parents to myopia and its associated risks, as well as assessing the exposure of Irish children to environmental factors that may influence their risk profile for myopia development. METHODS:Parents of 8-13 year old children in eight participating schools completed a questionnaire designed to assess their knowledge of and attitudes towards myopia and its risk factors. A structured diary was also used to capture daily activities of children in relation to myopia risk factors. RESULTS:Of 329 parents, just 46% considered that myopia presented a health risk to their children, while an identical number (46%) regarded it as an optical inconvenience. Myopia was also, but less frequently, considered an expense (31% of parents), a cosmetic inconvenience (14% of parents) and, by some, as a sign of intelligence (4% of parents) 76% of parents recognised the potential of digital technology to impact the eye, particularly as a cause of eyestrain and need for spectacles. Only 14% of parents expressed concern should their child be diagnosed with myopia. Compared to non myopic parents, myopic parents viewed myopia as more of an optical inconvenience (p < 0.001), an expense (p < 0.005) and a cosmetic inconvenience (p < 0.001). There was a trend for myopic parents to limit screen time use in their household more than non-myopic parents (p = 0.05). Parents who considered myopia a health risk sought to limit screen time more than parents who did not regard myopia as a health risk to their child (p = 0.01). Children spent significantly longer performing indoor proximal tasks (255 min) compared to time spent outdoors (180 min; p < 0.0001) daily. Older (p = 0.001), urban (p = 0.0005) myopic (=0.04) children spent significantly more time at digital screens compared to younger non-myopic children from a rural background. CONCLUSION:Parental attitudes to myopia were typically nonchalant in relation to health risk. This is of particular concern given the impact parents have on children's behaviour and choices with respect to such risk factors, demonstrating an acute need for societal sensitisation to the public health importance of myopia. 10.1111/opo.12455
Combination Effect of Outdoor Activity and Screen Exposure on Risk of Preschool Myopia: Findings From Longhua Child Cohort Study. Huang Lihua,Schmid Katrina L,Yin Xiao-Na,Zhang Jingyu,Wu Jianbo,Yang Guiyou,Ruan Zeng-Liang,Jiang Xiao-Qin,Wu Chuan-An,Chen Wei-Qing Frontiers in public health Evidence regarding screen use and outdoor activity during very early childhood (i. e., from aged 1 to 3 years) and their potential combined links to the later preschool myopia is limited. This information is needed to release effective public health messages and propose intervention strategies against preschool myopia. We collected information regarding very early childhood screen use, outdoor activity and the kindergartens vision screenings of 26,611 preschoolers from Longhua Child Cohort Study by questionnaires. Logistic regression models were used to examine the associations between reported outdoor activity, screen use from 1 to 3 years of age, and preschool myopia. Throughout very early childhood, from 1 to 3 years, the proportion of children exposed to screens increased (from 35.8 to 68.4%, < 0.001), whereas the proportion of children who went outdoors ≥7 times/week (67.4-62.1%, < 0.001) and who went outdoors for ≥60 min/time (53.3-38.0%, < 0.001) declined. Exposure to fixed screen devices [adjusted odds ratio (AOR) = 2.66, 95% confidence interval (CI) = 2.09-3.44], mobile screen devices (AOR = 2.76, 95% CI = 2.15-3.58), and limited outdoor activity (AOR = 1.87, 95% CI = 1.42-2.51) during early childhood were associated with preschool myopia. Among children whose parents were myopic, the interactions between outdoor activity and fixed or mobile screen use on later preschool myopia were significant; the ORs and 95% CI were 3.34 (1.19-9.98) and 3.04 (1.06-9.21), respectively. Our findings suggest the possibility that the impact of screen exposure during early childhood on preschool myopia could be diminished by outdoor activity for children whose parents have myopia. 10.3389/fpubh.2021.607911
Associations Between Screen Exposure in Early Life and Myopia amongst Chinese Preschoolers. Yang Gui-You,Huang Li-Hua,Schmid Katrina L,Li Chen-Guang,Chen Jing-Yi,He Guan-Hao,Liu Li,Ruan Zeng-Liang,Chen Wei-Qing International journal of environmental research and public health This study aimed to explore the association between screen exposure in early life and preschool myopia. During the baseline survey of the Longhua Child Cohort Study (LCCS), data of 29,595 preschoolers were collected via a caregiver-reported questionnaire regarding children's socio-demographic characteristics, visual status, screen exposure and relevant parental information. Data of 26,433 preschoolers with normal eyesight or myopia were included in the analysis and cox regression modelling was employed to assess the associations. Results suggested the hypothesis that screen exposure in early life could be significantly and positively associated with preschool myopia, and in agreement with this hypothesis was the association being strengthened with the increasing daily exposure duration and total years of exposure; in the stratification analysis based on the presence of parental myopia, these associations still existed, and the strength of associations was stronger in preschoolers with myopic parents than those without. Moreover, a statistically significant association was only observed between initial screen exposure that occurred during 0-1-years old and myopia for preschoolers without myopic parents, while the significant associations were observed between initial screen exposure that occurred during 0-1, 1-2, 2-3, and after 3 years old and myopia for preschoolers who had myopic parents, with the strongest association found in the group of children initially exposed to electronic screens during 0-1 year old. Thus our findings indicated the hypothesis that screen exposure in early life might be associated with the occurrence of preschool myopia, and that the postnatal first year might be the sensitive period for the association. However, it is premature to conclude that early screen time leads to myopia with current data. Further longitudinal studies performed with cycloplegia are necessary to verify the hypothesis and shed light on the more urgent question whether early screen exposure contributes to the later myopia epidemic of school-aged children. 10.3390/ijerph17031056
Myopia. Baird Paul N,Saw Seang-Mei,Lanca Carla,Guggenheim Jeremy A,Smith Iii Earl L,Zhou Xiangtian,Matsui Kyoko-Ohno,Wu Pei-Chang,Sankaridurg Padmaja,Chia Audrey,Rosman Mohamad,Lamoureux Ecosse L,Man Ryan,He Mingguang Nature reviews. Disease primers Myopia, also known as short-sightedness or near-sightedness, is a very common condition that typically starts in childhood. Severe forms of myopia (pathologic myopia) are associated with a risk of other associated ophthalmic problems. This disorder affects all populations and is reaching epidemic proportions in East Asia, although there are differences in prevalence between countries. Myopia is caused by both environmental and genetic risk factors. A range of myopia management and control strategies are available that can treat this condition, but it is clear that understanding the factors involved in delaying myopia onset and slowing its progression will be key to reducing the rapid rise in its global prevalence. To achieve this goal, improved data collection using wearable technology, in combination with collection and assessment of data on demographic, genetic and environmental risk factors and with artificial intelligence are needed. Improved public health strategies focusing on early detection or prevention combined with additional effective therapeutic interventions to limit myopia progression are also needed. 10.1038/s41572-020-00231-4
Reducing the Progression of Myopia. Bressler Neil M JAMA 10.1001/jama.2020.10953
Breaking the myopia myth. Nature 10.1038/d41586-019-01108-7
Mobile touch screen device use and associations with musculoskeletal symptoms and visual health in a nationally representative sample of Singaporean adolescents. Toh Siao Hui,Coenen Pieter,Howie Erin K,Mukherjee Swarup,Mackey David A,Straker Leon M Ergonomics This study aimed to describe contemporary technology use, especially smartphones and tablets (mobile touch screen devices), and examine associations with musculoskeletal symptoms and visual health among adolescents in Singapore. A representative sample of 1884 adolescents (50.4% girls) from grades primary 5 to post-secondary (10-18 years old), recruited from 13 schools, completed an online questionnaire in class. Total technology use was high, with smartphone duration being highest (mean = 264 [SD = 243] min/day). Patterns of use, including multitasking and bout length, were influenced by gender, school level, type of device and activities. Musculoskeletal discomfort and visual symptoms were commonly reported. After adjusting for potential confounders, more hours/day of smartphone use was associated with increased risk of neck/shoulders, upper back, arms and wrist/hand discomfort (OR = 1.04[95%CI = 1.01-1.07] to 1.07[1.03-1.10]) and visual symptoms (OR = 1.05[1.02-1.08]), but was associated with decreased odds of myopia (OR = 0.97[0.94-0.99]). No significant associations were found for tablet use. 1884 adolescents in Singapore completed an in-depth questionnaire regarding their use of technology. The smartphone was the device with the highest usage, and greater smartphone use was associated with increased odds of musculoskeletal and visual symptoms. High use of smartphones has physical health implications for adolescents. 10.1080/00140139.2018.1562107
Low physical activity and higher use of screen devices are associated with myopia at the age of 16-17 years in the CCC2000 Eye Study. Hansen Mathias Hvidtfelt,Laigaard Poul Pedersen,Olsen Else Marie,Skovgaard Anne Mette,Larsen Michael,Kessel Line,Munch Inger Christine Acta ophthalmologica PURPOSE:To determine the myopia prevalence in a Danish cohort aged 16-17 years and its relation to physical activity and use of screen-based electronic devices. METHODS:The Copenhagen Child Cohort 2000 Eye Study is a prospective, population-based, observational study. Information about use of screen devices and physical activity was obtained using questionnaires. Myopia was defined as non-cycloplegic subjective spherical equivalent refraction ≤-0.50 D in right eye. RESULTS:We included 1443 participants (45% boys) with a median age (±IQR) of 16.6 years (±0.3). The prevalence of myopia was 25% (CI95% 23-28, n = 360) with no differences between sexes (p = 0.10). The odds ratio (OR) for myopia was 0.57 (CI95% 0.42-0.76, p = 0.0002) in participants physically active 3-6 hr/week (n = 502) and 0.56 (CI95% 0.42-0.76, p = 0.0002) if active >6 hr/week (n = 506), both compared with participants physically active <3 hr/week (n = 396). The use of screen devices >6 hr/day was associated with increased OR for myopia compared with screen device use <2 hr/day in both weekdays (OR = 1.95, CI95% 1.16-3.30, p = 0.012) and weekends (OR = 2.10, CI95% 1.17-3.77, p = 0.013). CONCLUSION:In this cohort of healthy 16-17-year olds, lower physical activity and more use of screen devices contributed significantly to the observed 25% prevalence of myopia with a roughly doubled risk of having myopia if physically active <3 hr/week or if using screen devices >6 hr/day. Our results support physical activity being a protective factor and near work a risk factor for myopia in adolescents. 10.1111/aos.14242
Disordered sleep and myopia among adolescents: a propensity score matching analysis. Pan Chen-Wei,Liu Jing-Hong,Wu Rong-Kun,Zhong Hua,Li Jun Ophthalmic epidemiology PURPOSE:Observational studies have suggested a possible relationship between disordered sleep and myopia, but the association may be subject to selection biases. We aimed to minimize selection biases and assess the association by applying a propensity score matching (PSM) approach. METHODS:The study was designed as a school-based cross-sectional study on a Chinese cohort aged 13-14 years in rural areas of China. The Chinese version of the Children's Sleep Habits Questionnaire was used for the measurement of sleep quality and a score of 41 or more was used to define the presence of disordered sleep. Each participant's refractive status was measured after cycloplegia using an autorefractor and myopia was defined as spherical equivalent <-0.50 D. The propensity scores for disordered sleep were formulated using nine potential confounders. We matched the propensity scores for subjects with and without disordered sleep within a caliper of 0.01 of logit function of propensity scores. RESULTS:In this study, 474 pairs (1 subject with vs. 1 subject without disordered sleep) were successfully matched based on propensity scores. The odds ratio (OR) of myopia for disordered sleep before PSM reached conventional levels of statistical significance (OR: 1.43 95% confidence interval [CI] 1.05, 2.58, p = 0.01). After matching, the magnitude of association was reduced and the OR of myopia was not significant (OR: 1.54 95% CI 0.90, 2.57, p = 0.46). CONCLUSIONS:At current stage, there are insufficient evidence indicating that disordered sleep could affect the development of myopia in adolescents. 10.1080/09286586.2018.1554159
[Association between time spent on physical exercise, sleep, homework and suspected myopia among students]. Xu S J,Wan Y H,Xu Z H,Zhang H,Xu L,Wang B,Tao F B Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi OBJECTIVE:To investigate the prevalence of suspected myopia among students and to examine the relationship between time spent on physical exercise, sleep, homework and suspected myopia. METHODS:A total of 8 030 primary and secondary school students from 4(th) to 12(th) grades were selected from the National Student Constitution and Health Survey (NSCHS) in Anhui province in 2014. Time spent on exercise, sleep and homework per day were collected using a self-administrated questionnaire. Visual acuity was examined using the Standard Logarithmic Visual Acuity Chart. RESULTS:The overall prevalence of suspected myopia was 69.03%. Prevalence rates of suspected myopia appeared higher in girls, in urban students, with the highest in the 16 to 18 year-old groups. RESULTS from the multiple logistic regression analysis showed that the amount of time spent on physical exercise, sleep and homework per day were all significantly associated with suspected myopia. Suspected myopia was associated with longer time on physical exercise among students aged 8 to 12 years (OR=0.80, 95%CI: 0.64-0.99), and longer sleep time among students in the age groups of 13 to 15 years and 16 to 18 years (OR=0.73, 95% CI: 0.56-0.94;OR=0.38, 95% CI: 0.21-0.68, respectively). Longer time spent on homework significantly increased the risk of suspected myopia among students in the age groups of 8 to 12 years and 13 to 15 years (OR=1.41, 95%CI: 1.11-1.79; OR=1.74, 95% CI: 1.36-2.23, respectively). CONCLUSION:Suspected myopia appeared common among students. Comprehensive intervention programs focusing on sufficient physical exercise and sleep but less homework might help to prevent myopia among students at different ages. 10.3760/cma.j.issn.0254-6450.2016.02.006
Decreased sleep quality in high myopia children. Ayaki Masahiko,Torii Hidemasa,Tsubota Kazuo,Negishi Kazuno Scientific reports The aim of the present study was to evaluate sleep quality in myopic children and adults. This cross sectional study surveyed 486 participants aged from 10 to 59 years with refractive errors using a questionnaire containing the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS). Children (< 20 years) in the high myopia group exhibited the poorest PSQI scores (P < 0.01), while the adults showed no such correlations. Subscales of PSQI and HADS in children disclosed that the high myopia groups had the shortest sleep duration (P < 0.01), worst subjective sleep scores (P < 0.001), and latest bedtime (P < 0.05). Regression analyses in children significantly correlated myopic errors with PSQI (P < 0.05), sleep duration (P < 0.01), and bedtime (P < 0.01). Sleep efficacy (P < 0.05) and daytime dysfunction (P < 0.05) were significantly better in contact-lens users compared to the respective non-user groups across all participants. In conclusion, sleep quality in children was significantly correlated with myopic error, with the high myopia group worst affected. 10.1038/srep33902
Disordered sleep and myopia risk among Chinese children. Zhou Zhongqiang,Morgan Ian G,Chen Qianyun,Jin Ling,He Mingguang,Congdon Nathan PloS one PURPOSE:Disordered sleep and myopia are increasingly prevalent among Chinese children. Similar pathways may be involved in regulation of both sleep cycles and eye growth. We therefore sought to examine the association between disordered sleep and myopia in this group. METHODS:Urban primary school children participating in a clinical trial on myopia and outdoor activity underwent automated cycloplegic refraction with subjective refinement. Parents answered questions about children's sleep duration, sleep disorders (Children's Sleep Habits Questionnaire [CSHQ]), near work and time spent outdoors. RESULTS:Among 1970 children, 1902 (96.5%, mean [standard deviation SD] age 9.80 [0.44] years, 53.1% boys) completed refraction and questionnaires. Myopia < = -0.50 Diopters was present in both eyes of 588 (30.9%) children (1329/3804 = 34.9% of eyes) and 1129 children (59.4%) had abnormal CSHQ scores (> 41). In logistic regression models by eye, odds of myopia < = -0.50D increased with worse CSHQ score (Odds Ratio [OR] 1.01 per point, 95% Confidence Interval [CI] [1.001, 1.02], P = 0.014) and more night-time sleep (OR 1.02, 95% CI [1.01, 1.04, P = 0.002], while male sex (OR 0.82, 95% CI [0.70, 0.95], P = 0.008) and time outdoors (OR = 0.97, 95% CI [0.95, 0.99], P = 0.011) were associated with less myopia. The association between sleep duration and myopia was not significant (p = 0.199) for total (night + midday) sleep. CONCLUSIONS:Myopia and disordered sleep were both common in this cohort, but we did not find consistent evidence for an association between the two. TRIAL REGISTRATION:clinicaltrials.gov NCT00848900. 10.1371/journal.pone.0121796
Inverse relationship between sleep duration and myopia. Jee Donghyun,Morgan Ian G,Kim Eun Chul Acta ophthalmologica PURPOSES:To investigate the association between sleep duration and myopia. METHODS:This population-based, cross-sectional study using a nationwide, systemic, stratified, multistage, clustered sampling method included a total of 3625 subjects aged 12-19 years who participated in the Korean National Health and Nutrition Examination Survey 2008-2012. All participants underwent ophthalmic examination and a standardized interview including average sleep duration (hr/day), education, physical activity and economic status (annual household income). Refractive error was measured by autorefraction without cycloplegia. Myopia and high myopia were defined as ≤-0.50 dioptres (D) and ≤-6.0 D, respectively. Sleep durations were classified into 5 categories: <5, 6, 7, 8 and >9 hr. RESULTS:The overall prevalence of myopia and high myopia were 77.8% and 9.4%, respectively, and the overall sleep duration was 7.1 hr/day. The refractive error increased by 0.10 D per 1 hr increase in sleep after adjusting for potential confounders including sex, age, height, education level, economic status and physical activity. The adjusted odds ratio (OR) for refractive error was 0.90 (95% confidence interval [CI], 0.83-0.97) per 1 hr increase in sleep. The adjusted OR for myopia was decreased in those with >9 hr of sleep (OR, 0.59; 95% CI, 0.38-0.93; p for trend = 0.006) than in those with <5 hr of sleep. However, high myopia was not associated with sleep duration. CONCLUSIONS:This study provides the population-based, epidemiologic evidence for an inverse relationship between sleep duration and myopia in a representative population of Korean adolescents. 10.1111/aos.12776
Sleeping late is a risk factor for myopia development amongst school-aged children in China. Liu Xiao Nicole,Naduvilath Thomas John,Wang Jingjing,Xiong Shuyu,He Xiangui,Xu Xun,Sankaridurg Padmaja R Scientific reports Myopia, a leading cause of distance vision impairment, is projected to affect half of the world's population in 30 years. We analysed the relationship between certain demographic, environmental, and behavioural factors and myopia from a 2-year school-based, prospective trial conducted in Shanghai, China. This trial enrolled 6295 school-aged children at baseline and followed them up for 24 months. The relationship between abovementioned factors and myopia was examined and the role of sleep in childhood myopia development was highlighted. Our results suggest that 'sleeping late' is a risk factor for myopia prevalence at baseline (odds ratio [OR] = 1.55, p = 0.04), 2-year myopia incidence (odds ratio [OR] = 1.44, p = 0.02) and progression over 24 months (p = 0.005), after adjusting for residency area, age, gender, sleep duration, and time spent outdoors. The identification and consistency of results with late sleepers being a susceptible group to both myopia onset and progression suggests a complex relationship between circadian rhythm, indoor environment, habitual indoor activities and myopia development and progression. These results can offer new insights to future myopia aetiology studies as well as aid in decision-making of myopia prevention strategies. 10.1038/s41598-020-74348-7
[Prevention of myopia]. Schaeffel F Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft To avoid complications of high myopia the best solution would be to prevent myopia development from the very beginning. Many studies have suggested that the frequently quoted myopia boom is related to changes in visual experiences during more demanding education and not due to changes in genetic factors. To avoid myopia development it would therefore be best to carry out a better control of visual experience of children. In this article new approaches are described to record and improve visual habits in children, e.g. new sensors attached to the spectacle frames to document brightness, reading distance and reading duration, changes in text contrast polarity during reading, potential role of smartphones and some not yet fully explored orally applied substances to inhibit myopia. 10.1007/s00347-019-0892-4
[Effective prevention and control of myopia in children and adolescents]. Qu J,Lyu F,Xu L D [Zhonghua yan ke za zhi] Chinese journal of ophthalmology Myopia prevention and control is an important health issue related to children and adolescents, general public physical fitness and national defense security. In 2018, General Secretary Xi Jinping gave instructions on students' myopia. Ministry of Education and other seven ministries and commissions issued the Implementation Plan of the Myopia Prevention and Control for Children and Adolescents. As the myopia prevalence continues to develop into an urgent situation, myopia prevention and control has become a national strategy. In the battle fighting against prevalent myopia, medical and scientific researchers, as professionals, play a key role in guiding the effective implementation of the project and coordinating among five parties including government, schools, medical institutions, families and individual students. It is of great significance to effectively prevent and control myopia for children and adolescents and to achieve the overall goal of prevention and control. This article summarizes the potential effective methods in myopia prevention and control, hoping to provide useful reference and help for the national prevention and control work. -. 10.3760/cma.j.issn.0412-4081.2019.02.001