Time Outdoors and Physical Activity as Predictors of Incident Myopia in Childhood: A Prospective Cohort Study

Guggenheim, Jeremy A.; Northstone, Kate; McMahon, George; Ness, Andy R; Deere, Kevin; Mattocks, Calum; Pourcain, Beaté St; Williams, Cathy

doi:10.1167/iovs.11-9091

Cited by 332 publications

(346 citation statements)

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“…Information about parental self-reported myopia, parental social class, maternal age, gestational age, breastfeeding, maternal smoking, time spent reading for pleasure, time spent outdoors and parity were collected as described elsewhere 48,49 Fat mass (as an indicator of obesity) was estimated by whole-body dual-energy X-ray absorptiometry (DXA)-scanning, with a Lunar Prodigy narrow fan-beam densitometer (GE Healthcare, Bedford, UK).…”

Section: Additional Covariatesmentioning

confidence: 99%

Body Stature Growth Trajectories during Childhood and the Development of Myopia

et al. 2013

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Purpose-Stature at a particular age can be considered the cumulative result of growth during a number of preceding growth trajectory periods. We investigated whether height and weight growth trajectories from birth to age 10 years were related to refractive error at ages 11 and 15 years, and eye size at age 15 years. Design-Prospective analysis in a birth cohort.Participants-Children participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) United Kingdom birth cohort (minimum N=2,676).Methods-Growth trajectories between birth and 10 years were modeled from a series of height and weight measurements (N=6,815). Refractive error was assessed by non-cycloplegic autorefraction at ages 11 and 15 years (minimum N=4,737). Axial length and radius of corneal curvature were measured with an IOLmaster at age 15 years (minimum N=2,676). Growth trajectories, and an allelic score for 180 genetic variants associated with adult height, were tested for association with refractive error and eye size.Main outcome measures-Non-cycloplegic autorefraction at ages 11 and 15 years, and axial length and corneal curvature at age 15 years.Results-Height growth trajectory during the linear phase between 2.5-10 years was negatively associated with refractive error at 11 and 15 years (P<0.001), but explained <0.5% of inter-subject variation. Height and weight growth trajectories, especially shortly after birth, were positively associated with axial length and corneal curvature (P<0.001), predicting 1-5% of trait variation. Height growth after 2.5 years was not associated with corneal curvature, whilst the association with axial length continued up to 10 years. The height allelic score was associated with corneal curvature (P=0.03) but not with refractive error or axial length.Address for correspondence and requests for reprints: Dr Kate Northstone, Department of Social Medicine, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 1TQ, UK, Tel: +44 (0) Conclusions-Up to the age of 10 years, shared growth mechanisms contribute to scaling of eye and body size but minimally to the development of myopia.

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Section: Additional Covariatesmentioning

confidence: 99%

Body Stature Growth Trajectories during Childhood and the Development of Myopia

et al. 2013

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“…Guggenheim et al (2012) also suggested that time outdoors at the age of 8 -9 years significantly predicted the future development of myopia. A recent longitudinal study (4-years follow-up) that investigated the factors associated with myopia development and progression in primary school children in China also revealed that less time spent outdoors and longer time spent indoors was significantly associated with greater ocular axial elongation and myopia progression (Guo et al, 2017).…”

Section: Outdoor Activitymentioning

confidence: 96%

“…Several studies have shown that children who spend more time outdoors are less likely to become myopic (Parssinen & Lyyra, 1993;Mutti et al, 2002;Jones et al, 2007;Rose et al, 2008a;Rose et al, 2008b;Dirani et al, 2009;Jones-Jordan et al, 2011;Guggenheim et al, 2012;French et al, 2013a;French et al, 2013c;Guo et al, 2013a;Wu et al, 2013;Read et al, 2014;He et al, 2015;Li et al, 2015b;Guo et al, 2017) (Table 1.1). Low levels of outdoor activity have been reported in children living in urban Beijing (1 hour/day) (Guo et al, 2013a), Taiwan (0.5 hours/day) and Singapore (0.5 hours/day) (Rose et al, 2008b), and all of these locations are documented to have a high prevalence of myopia in young populations.…”

Section: Outdoor Activitymentioning

confidence: 99%

“…Guggenheim et al (2012) also assessed time spent outdoors (using questionnaires) and objective physical activity in childhood myopia, and suggested that the association between physical activity and myopia incidence is primarily due to physical activity measures…”

Section: Physical Activity and Myopiamentioning

confidence: 99%

“…These potential drawbacks associated with questionnaires have been the catalyst for a number of recent studies that have quantified the light exposure (Backhouse & Phillips, 2011;Dharani et al, 2012;Alvarez & Wildsoet, 2013;Schmid et al, 2013;Read et al, 2014Read et al, , 2015Ostrin, 2017) and/or physical activity (Deere et al, 2009;Guggenheim et al, 2012;Read et al, 2014Read et al, , 2015 using objective techniques such as wearable sensors (Dharani et al, 2012;Alvarez & Wildsoet, 2013).…”

Section: Light Exposure and Human Myopiamentioning

confidence: 99%

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The Influence of Light Exposure and Seasonal Changes on Short-Term and Longer-Term Changes in Axial Length of the Human Eye

Ulaganathan¹

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It is widely accepted that environmental factors play a significant role in regulating eye growth and myopia development. There is also considerable evidence that ambient light exposure is an important environmental risk factor associated with eye growth in children, however, the underlying mechanism remains unclear. Furthermore, animal studies have shown that diurnal variations in ocular components appear to be involved in the mechanisms controlling eye growth. Animal studies also suggest that altering light exposure disrupts normal diurnal variations and can lead to the development of refractive errors. Despite this evidence, the exact role of light exposure and ocular diurnal rhythms in the regulation of human eye growth, and the interaction between these factors is not well understood. Myopia development and progression have been widely documented in young adults and typically occurs due to axial elongation, but there has been limited research examining the potential impact of ambient light exposure upon eye growth and myopia development and progression in young adults.Therefore, this research examined the habitual light exposure patterns in a population of young adult emmetropes and progressing myopes using objective techniques, and assessed the influence of light exposure upon daily axial length variations and longitudinal axial eye growth in this population. The potential association between daily axial length fluctuations and longer-term changes in axial length was also explored.Since there is no consensus on the optimal sampling strategy required for capturing personal objective light exposure measurements, in the first study, we systematically examined the impact of different measurement durations and measurement frequencies upon objective light exposure measures, in order to determine the optimal sampling strategy to reliably capture habitual light exposure patterns of both children (Age: 11 to vi The influence of light exposure and seasons upon the axial length changes in humans 15 years) and young adults (Age: 18 to 30 years). Ambient light exposure data were obtained using a wrist-worn light sensor (Actiwatch 2), which was configured to measure instantaneous light levels every 30 seconds, 24 hours a day for a period of 14 consecutive days in children (n = 30) and young adults (n = 31). Daily time exposed to bright outdoor (>1000 lux) light levels was derived from the raw 14 days of data with 30 second sampling, and was subsequently derived from data re-sampled from 12, 10, 8, 6, 4 and 2 randomly selected measurement days using 1, 2, 3, 4, 5 and 10 minute sampling rates. Calculating daily outdoor light exposure time using a lower number of days and coarser sampling frequencies did not significantly alter the mean time spent in bright (outdoor) light. However, a significant increase in measurement variability occurred for outdoor light exposure derived from less than 8 days and from 3 minutes or coarser measurement frequencies in adults, and from less than 8 days and from 4 minutes or coarser...

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Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia

Wang

Zhu

et al. 2023

JAMA Netw Open

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ImportanceMyopia is a global concern, but effective prevention measures remain limited. Premyopia is a refractive state in which children are at higher risk of myopia, meriting preventive interventions.ObjectiveTo assess the efficacy and safety of a repeated low-level red-light (RLRL) intervention in preventing incident myopia among children with premyopia.Design, Setting, and ParticipantsThis was a 12-month, parallel-group, school-based randomized clinical trial conducted in 10 primary schools in Shanghai, China. A total of 139 children with premyopia (defined as cycloplegic spherical equivalence refraction [SER] of −0.50 to 0.50 diopter [D] in the more myopic eye and having at least 1 parent with SER ≤−3.00 D) in grades 1 to 4 were enrolled between April 1, 2021, and June 30, 2021; the trial was completed August 31, 2022.InterventionsChildren were randomly assigned to 2 groups after grade stratification. Children in the intervention group received RLRL therapy twice per day, 5 days per week, with each session lasting 3 minutes. The intervention was conducted at school during semesters and at home during winter and summer vacations. Children in the control group continued usual activities.Main Outcomes and MeasuresThe primary outcome was the 12-month incidence rate of myopia (defined as SER ≤−0.50 D). Secondary outcomes included the changes in SER, axial length, vision function, and optical coherence tomography scan results over 12 months. Data from the more myopic eyes were analyzed. Outcomes were analyzed by means of an intention-to-treat method and per-protocol method. The intention-to-treat analysis included participants in both groups at baseline, while the per-protocol analysis included participants in the control group and those in the intervention group who were able to continue the intervention without interruption by the COVID-19 pandemic.ResultsThere were 139 children (mean [SD] age, 8.3 [1.1] years; 71 boys [51.1%]) in the intervention group and 139 children (mean [SD] age, 8.3 [1.1] years; 68 boys [48.9%]) in the control group. The 12-month incidence of myopia was 40.8% (49 of 120) in the intervention group and 61.3% (68 of 111) in the control group, a relative 33.4% reduction in incidence. For children in the intervention group who did not have treatment interruption secondary to the COVID-19 pandemic, the incidence was 28.1% (9 of 32), a relative 54.1% reduction in incidence. The RLRL intervention significantly reduced the myopic shifts in terms of axial length and SER compared with the control group (mean [SD] axial length, 0.30 [0.27] mm vs 0.47 [0.25] mm; difference, 0.17 mm [95% CI, 0.11-0.23 mm]; mean [SD] SER, –0.35 [0.54] D vs –0.76 [0.60] D; difference, –0.41 D [95% CI, –0.56 to –0.26 D]). No visual acuity or structural damage was noted on optical coherence tomography scans in the intervention group.Conclusions and RelevanceIn this randomized clinical trial, RLRL therapy was a novel and effective intervention for myopia prevention, with good user acceptability and up to 54.1% reduction in incident myopia within 12 months among children with premyopia.Trial RegistrationClinicalTrials.gov Identifier: NCT04825769

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Time Outdoors and Physical Activity as Predictors of Incident Myopia in Childhood: A Prospective Cohort Study

Cited by 332 publications

References 72 publications

Body Stature Growth Trajectories during Childhood and the Development of Myopia

Body Stature Growth Trajectories during Childhood and the Development of Myopia

The Influence of Light Exposure and Seasonal Changes on Short-Term and Longer-Term Changes in Axial Length of the Human Eye

Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia

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