Outdoor Activity during Class Recess Reduces Myopia Onset and Progression in School Children
TL;DR: Outdoor activities during class recess in school have a significant effect on myopia onset and myopic shift, especially in nonmyopic children.
About: This article is published in Ophthalmology.The article was published on 2013-05-01. It has received 473 citations till now.
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TL;DR: Among 6-year-old children in Guangzhou, China, the addition of 40 minutes of outdoor activity at school compared with usual activity resulted in a reduced incidence rate of myopia over the next 3 years, and the efficacy of increasing time spent outdoors at school in preventing incident myopia was assessed.
Abstract: Importance Myopia has reached epidemic levels in parts of East and Southeast Asia. However, there is no effective intervention to prevent the development of myopia. Objective To assess the efficacy of increasing time spent outdoors at school in preventing incident myopia. Design, Setting, and Participants Cluster randomized trial of children in grade 1 from 12 primary schools in Guangzhou, China, conducted between October 2010 and October 2013. Interventions For 6 intervention schools (n = 952 students), 1 additional 40-minute class of outdoor activities was added to each school day, and parents were encouraged to engage their children in outdoor activities after school hours, especially during weekends and holidays. Children and parents in the 6 control schools (n = 951 students) continued their usual pattern of activity. Main Outcomes and Measures The primary outcome measure was the 3-year cumulative incidence rate of myopia (defined using the Refractive Error Study in Children spherical equivalent refractive error standard of ≤−0.5 diopters [D]) among the students without established myopia at baseline. Secondary outcome measures were changes in spherical equivalent refraction and axial length among all students, analyzed using mixed linear models and intention-to-treat principles. Data from the right eyes were used for the analysis. Results There were 952 children in the intervention group and 951 in the control group with a mean (SD) age of 6.6 (0.34) years. The cumulative incidence rate of myopia was 30.4% in the intervention group (259 incident cases among 853 eligible participants) and 39.5% (287 incident cases among 726 eligible participants) in the control group (difference of −9.1% [95% CI, −14.1% to −4.1%]; P P = .04). Elongation of axial length was not significantly different between the intervention group (0.95 mm) and the control group (0.98 mm) (difference of −0.03 mm [95% CI, −0.07 to 0.003 mm]; P = .07). Conclusions and Relevance Among 6-year-old children in Guangzhou, China, the addition of 40 minutes of outdoor activity at school compared with usual activity resulted in a reduced incidence rate of myopia over the next 3 years. Further studies are needed to assess long-term follow-up of these children and the generalizability of these findings. Trial Registration clinicaltrials.gov Identifier:NCT00848900
621 citations
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TL;DR: Short-sightedness is reaching epidemic proportions. Some scientists think they have found a reason why as mentioned in this paper. But they have not found a solution to the root cause of shortsightedness.
Abstract: Short-sightedness is reaching epidemic proportions. Some scientists think they have found a reason why.
606 citations
TL;DR: Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge.
551 citations
Cites background or result from "Outdoor Activity during Class Reces..."
...…rates reported, the child will exceed the threshold for highmyopia in 5e6 years, at about the age of 11 or 12, consistent with the age of onset of increasing high myopia in the data from Taiwan (Lin et al., 2004), and with more recent data from China (Guo et al., 2015; Wu et al., 2013b)....
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...The evidence from randomized clinical trials which have shown that increased time outdoors reduces incident myopia (He et al., 2015; Wu et al., 2013a), provides evidence of a causal association....
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...…agreement that there is little evidence for regulation of progression, defined as myopic shifts in refraction in those who are already myopic (French et al., 2013a, b; He et al., 2015; Jones et al., 2007; Jones-Jordan et al., 2012; Rose et al., 2008a; Wu et al., 2013a, b; Xiong et al., 2017)....
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...…of myopia and high myopia in various sites in East and Southe Data taken from the following sources: Lin et al., 2004; Jung et al., 2012; Lee et al., 2013; Wu et al., 2013a, b; Koh et al., 2014; Guo but it would not be wise to assume that “acquired” highmyopia has no pathological consequences....
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...…Ip et al., 2008; Jones et al., 2007; JonesJordan et al., 2011, 2012; Khader et al., 2006; Lin et al., 2014; Mutti et al., 2002; Onal et al., 2007; Parssinen and Lyyra, 1993; Rose et al., 2008a, b; Sherwin et al., 2012; Wu et al., 2010, 2013b, 2015a, b; Xiong et al., 2017; You et al., 2012, 2014)....
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TL;DR: The fundamentals of light–matter interactions are revisited, the applications of light in imaging, diagnosis, therapy and surgery are described, their clinical use is overviewed, and the promise of emerging light-based technologies are discussed.
Abstract: Light and optical techniques have made profound impacts on modern medicine, with numerous lasers and optical devices being currently used in clinical practice to assess health and treat disease. Recent advances in biomedical optics have enabled increasingly sophisticated technologies - in particular those that integrate photonics with nanotechnology, biomaterials and genetic engineering. In this Review, we revisit the fundamentals of light-matter interactions, describe the applications of light in imaging, diagnosis, therapy and surgery, overview their clinical use, and discuss the promise of emerging light-based technologies.
481 citations
St Thomas' Hospital1, University Hospital of North Norway2, UCL Institute of Child Health3, Erasmus University Rotterdam4, Aristotle University of Thessaloniki5, French Institute of Health and Medical Research6, Institut national de la recherche agronomique7, Oslo University Hospital8, Queen's University Belfast9, University of Cambridge10, University of Bordeaux11, University of London12, Technische Universität München13, UCL Institute of Ophthalmology14, King's College London15
TL;DR: Myopia is becoming more common in Europe; although education levels have increased and are associated with myopia, higher education seems to be an additive rather than explanatory factor.
342 citations
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TL;DR: In the Sydney Myopia Study as discussed by the authors, the authors assessed the relationship of near, mid-working distance, and outdoor activities with prevalence of myopia in school-aged children and found that higher levels of outdoor activity (sport and leisure activities) were associated with more hyperopic refractions and lower myopia prevalence in the 12-year-old students.
1,022 citations
TL;DR: The prevalent risks of glaucoma were higher in myopic adults, and risks of chorioretinal abnormalities such as retinal detachment, choriatorinal atrophy and lacquer cracks increased with severity of myopia and greater axial length.
858 citations
TL;DR: The prevalence of myopia in the United States appears to be substantially higher in 1999-2004 than 30 years earlier, and identifying modifiable risk factors for myopia could lead to the development of cost-effective interventional strategies.
Abstract: Objective To compare US population prevalence estimates for myopia in 1971-1972 and 1999-2004. Methods The 1971-1972 National Health and Nutrition Examination Survey provided the earliest nationally representative estimates for US myopia prevalence; myopia was diagnosed by an algorithm using either lensometry, pinhole visual acuity, and presenting visual acuity (for presenting visual acuity ≥20/40) or retinoscopy (for presenting visual acuity ≤20/50). Using a similar method for diagnosing myopia, we examined data from the 1999-2004 National Health and Nutrition Examination Survey to determine whether myopia prevalence had changed during the 30 years between the 2 surveys. Results Using the 1971-1972 method, the estimated prevalence of myopia in persons aged 12 to 54 years was significantly higher in 1999-2004 than in 1971-1972 (41.6% vs 25.0%, respectively; P P P −2.0 diopters [D]: 17.5% vs 13.4%, respectively [ P −7.9 D: 22.4% vs 11.4%, respectively [ P P Conclusions When using similar methods for each period, the prevalence of myopia in the United States appears to be substantially higher in 1999-2004 than 30 years earlier. Identifying modifiable risk factors for myopia could lead to the development of cost-effective interventional strategies.
764 citations
Journal Article•
TL;DR: The results indicate that whereas myopia is 1.5 to 2.5 times more prevalent in adult Chinese residing in Singapore than in similarly aged European-derived populations in the United States and Australia, the sociodemographic associations are similar.
Abstract: PURPOSE. To determine the epidemiology of refractive errors in an adult Chinese population in Singapore. METHODS. A disproportionate, stratified, clustered, random-sampling procedure was used to select names of 2000 Chinese people aged 40 to 79 years from the 1996 Singapore electoral register in the Tanjong Pagar district in Singapore. These people were invited to a centralized clinic for a comprehensive eye examination, including refraction. Refraction was also performed on nonrespondents in their homes. Myopia, high myopia, and hyperopia were defined as a spherical equivalent (SE) in the right eye of less than -0.5 D, less than -5.0 D, and more than +0.5 D, respectively. Astigmatism was defined as less than -0.5 D of cylinder. Anisometropia was defined as a difference in SE of more than 1.0 D between the two eyes. Only phakic eyes were analyzed. RESULTS. From 1717 eligible people, 1232 (71.8%) were examined. Adjusted to the 1997 Singapore population, the overall prevalence of myopia, hyperopia, astigmatism, and anisometropia was 38.7% (95% confidence interval [CI]: 35.5, 42.1), 28.4% (95% CI: 25.3, 31.3), 37.8% (95% CI: 34.6, 41.1), and 15.9% (95% CI: 13.5, 18.4), respectively. The prevalence of high myopia was 9.1% (95% CI: 7.2, 11.2), with women having significantly higher rates than men. The age pattern of myopia was bimodal, with higher prevalence in the 40 to 49 and 70 to 81 age groups and lower prevalence between those age ranges. Prevalence was reversed in hyperopia, with a higher prevalence in subjects aged 50 to 69. There was a monotonic increase in prevalence with age for both astigmatism and anisometropia. Increasing educational levels, higher individual income, professional or office-related occupations, better housing, and greater severity of nuclear opacity were all significantly associated with higher rates of myopia, after adjustment for age and sex. CONCLUSIONS. The results indicate that whereas myopia is 1.5 to 2.5 times more prevalent in adult Chinese residing in Singapore than in similarly aged European-derived populations in the United States and Australia, the sociodemographic associations are similar.
721 citations
Journal Article•
TL;DR: Hredity was the most important factor associated with juvenile myopia, with smaller independent contributions from more near work, higher school achievement, and less time in sports activity.
Abstract: PURPOSE. To quantify the degree of association between juvenile myopia and parental myopia, near work, and school achievement. METHODS. Refractive error, parental refractive status, current level of near activities (assumed working distance-weighted hours per week spent studying, reading for pleasure, watching television, playing video games or working on the computer), hours per week spent playing sports, and level of school achievement (scores on the Iowa Tests of Basic Skills [ITBS]) were assessed in 366 eighth grade children who participated in the Orinda Longitudinal Study of Myopia in 1991 to 1996. RESULTS. Children with myopia were more likely to have parents with myopia; to spend significantly more time studying, more time reading, and less time playing sports; and to score higher on the ITBS Reading and Total Language subtests than emmetropic children ( 2 and Wilcoxon rank-sum tests; P 0.024). Multivariate logistic regression models showed no substantial confounding effects between parental myopia, near work, sports activity, and school achievement, suggesting that each factor has an independent association with myopia. The multivariate odds ratio (95% confidence interval) for two compared with no parents with myopia was 6.40 (2.17‐18.87) and was 1.020 (1.008 ‐1.032) for each diopter-hour per week of near work. Interactions between parental myopia and near work were not significant (P 0.67), indicating no increase in the risk associated with near work with an increasing number of parents with myopia. CONCLUSIONS. Heredity was the most important factor associated with juvenile myopia, with smaller independent contributions from more near work, higher school achievement, and less time in sports activity. There was no evidence that children inherit a myopigenic environment or a susceptibility to the effects of near work from their parents. (Invest Ophthalmol Vis Sci. 2002;43:3633‐3640)
677 citations