Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial

Wu, Pei-Chang; Chen, Chueh-Tan; Lin, Ken‐Kuo; Sun, Chi-Chin; Kuo, Cheng–Deng; Huang, Huei-Jean; Poon, Yi-Chieh; Yang, Mei‐Hui; Chen, Chau-Yin; Huang, Jou-Chen; Wu, Pei‐Chen; Yang, I-Hui; Yu, Hong-Jeng; Fang, Po-Chiung; Tsai, Cheng‐Ting; Chiou, Shu-Ti; Yang, Yi‐Hsin

doi:10.1016/j.ophtha.2017.12.011

Cited by 363 publications

(367 citation statements)

References 32 publications

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“…This aligns with two key points underlying of this study: that digital projection under brighter conditions may place more demands on vision; and that brighter lighting has a general protective effect on vision. These results lend further support for efforts to develop school‐based interventions that modify children's lighting during all facets of the school day, including classroom activities (Hua et al, ; Wu et al, ). Additional research should seek to replicate this finding under more controlled study designs.…”

Section: Discussionsupporting

confidence: 57%

“…Intense near work, for example, is often required despite its association with vision problems (Lee et al, ; Qian et al, ). Other observational and experimental studies recognized that school‐based activities generally occur indoors and so explored whether outdoor activity, time and light exhibit an association with myopia (Harrington, Stack, & O'Dwyer, ; He et al, ; Hua et al, ; Wu et al, ; Zhou et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Association of multimedia teaching with myopia: A national study of school children

Hinterlong¹,

Holton²,

Chiang

et al. 2019

Journal of Advanced Nursing

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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.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Association of multimedia teaching with myopia: A national study of school children

Hinterlong¹,

Holton²,

Chiang

et al. 2019

Journal of Advanced Nursing

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show abstract

“…To date, four interventional studies have considered the effect of outdoor time on myopia onset, with relatively small sample sizes (generally <500 per group) with the exception of a study from Guangzhou . The large sample size (6295 participants with a cycloplegia rate of over 93%) of our trial ensures greater conformity with the prevalence of refractive error in Shanghai and in cities with a similar urban structure, socio‐economic status and refractive error prevalence and improves confidence in generalizing the results to large populations.…”

Section: Discussionmentioning

confidence: 99%

“…However, with an extra 80 min/d, test group II is reach 2 h/d and likely to satisfy the criteria as determined by Jones et al Therefore, we chose to implement both 40 and 80 min and to determine differences if any between the groups. A recent trial determined that outdoor time of 11 h/week showed positive effect in reducing myopia progression in both non‐myopic and myopic children but only a small sample was considered …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, there is an increasing interest in researching the behaviour of children with respect to their visual environment to determine risk factors and reduce risk for onset and progression. In this respect, improved outdoor time was shown to reduce the incidence of myopia, but its role in slowing progression was not conclusive . Moreover, previous studies explored a limited time outdoors (mostly 40 min) and thus it remains to be explored if a further increase in time outdoors would result in an improved effect.…”

Section: Introductionmentioning

confidence: 96%

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Shanghai Time Outside to Reduce Myopia trial: design and baseline data

Sankaridurg

Xiong

et al. 2018

Clinical Exper Ophthalmology

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School-Based Myopia Prevention Effort—Reply

Morgan

2016

JAMA

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Time spent outdoors is well recognized as a factor preventing the development of myopia onset, and measures including adding an outdoor class, locking classroom doors during class recess, or glassed roof and walls incorporated in a classroom have been developed. But promotion to increase time spent outdoors as a school-based intervention program remains challenging especially in East Asia. • Near work activity has been suggested as a risk factor for myopia although the evidence is not entirely consistent. The total duration of near work activity may not be as important as the type of near work activity. Core techniques to implementing interventions of near work activities include effective measures of near work-related parameters, real-time data analyses, and alert systems.

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Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial

Cited by 363 publications

References 32 publications

Association of multimedia teaching with myopia: A national study of school children

Association of multimedia teaching with myopia: A national study of school children

Shanghai Time Outside to Reduce Myopia trial: design and baseline data

School-Based Myopia Prevention Effort—Reply

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