This article was originally published in a sponsored newsletter.

We have yet to understand the exact mechanisms that light has in myopic progression. In fact, the more we learn as researchers and clinicians, the more questions we uncover. One thing is clear, however: light plays an important role in many facets of visual development and, therefore, potentially has a role in myopia management.

Outdoor time has been widely accepted as protective against the onset of myopia.¹ Seasonal studies have further demonstrated that light exposure affects myopic progression by showing slower axial length growth and myopic progression during the summer (i.e., longer daylight hours).² Articles from several decades have worked toward explaining why and how outdoor conditions impact myopic onset and progression. A literature review in 2020 found that the risk for myopia may be decreased by bright light exposure.³ Other factors in “outdoor time-associated prevention of myopia” studies have included peripheral retinal defocus, depth of focus related to pupil miosis, relaxed accommodation, and increased high spatial frequency.⁴

Light exposure has also been more recently postulated to affect circadian rhythm, melatonin level, and ocular growth.⁵Tablets and handheld devices that have blue LED backlight display are widely used. Blue light filtering spectacle lenses are often marketed for safe eye health, but have not been proven. The impact of blue light blockers on school-aged myopic progression is also unknown/conflicted in the literature. Clinical trials have been performed to determine whether blue light filtering spectacle lenses affect myopia progression, but they have not been published.⁶

The effect of red light on myopia has gained some steam recently. Far-red/near-infrared (FR/NIR) light has the potential to control myopia.⁷ Two studies published in 2022 demonstrated this effect by showing the safety and efficacy of slowing axial elongation in school-aged myopia using red light exposure treatment. However, the devices may not be practical in delivering red light conveniently, and the dose dependency (analogous to atropine studies) will require further study to determine the most optimal treatment.^8-10

It has been suggested that there is a visual benefit of at least 120 minutes daily of outdoor light exposure for children and adolescents.⁸ When applying this information to clinical practice in a practical and meaningful way, looking at the overall “big picture” of well-being can be helpful to increase compliance of adequate outdoor time. In addition to ophthalmic benefits, spending time outdoors and in nature is linked to both cognitive advantages and improvements in mood, mental health, and emotional well-being, all of which contribute to the best overall quality of life for our patients.¹¹

1. Jones-Jordan LA, Sinnott LT, Cotter SA, et al. Time outdoors, visual activity, and myopia progression in juvenile-onset myopes. Invest Ophthalmol Vis Sci. 2012 Oct 1;53:7169-7175.

2. Fulk GW, Cyert LA, Parker DA. Seasonal variation in myopia progression and ocular elongation. Optom Vis Sci. 2002 Jan;79:46-51.

3. Gareth L, Mackey D, Lucas R, Yazar S. How does spending time outdoors protect against myopia? A review. Br J Ophthalmol. 2020 May;104:593-599.

4. French AN, Ashby RS, Morgan IG, Rose KA. Time outdoors and the prevention of myopia. Exp Eye Res. 2013 Sep;114:58-68.

5. Verkicharla PK, Thakur S. Role of light exposure in myopia management. Rev Myopia Management. 2023 Jan 3. Available at reviewofmm.com/role-of-light-exposure-in-myopia-management. Accessed Apr. 26, 2023.

6. The Hong Kong Polytechnic University. The Effect of Blue-light Filtering Spectacle Lenses on Myopia Progression in Schoolchildren. ClinicalTrials.gov Identifier NCT03538002. Available at clinicaltrials.gov/ct2/show/NCT03538002. Accessed Apr. 26, 2023.

7. Zhang P, Zhu H. Light Signaling and Myopia Development: A Review. Ophthalmol Ther. 2022 Jun;11:939–957.

8. Ackerman D. Light as a tool for myopia control. Rev Myopia Management. 2022 Dec 1. Available at reviewofmm.com/light-as-a-tool-for-myopia-control. Accessed Apr. 26, 2023.

9. Jiang Y, Zhu Z, Tan X, et al. Effect of Repeated Low-Level Red Light Therapy for Myopia Control in Children: A Multicenter Randomized Controlled Trial. Ophthalmology. 2022 May:129:509-519.

10. Dong J et al. Myopia Control Effect of Repeated Low-Level Red-Light Therapy in Chinese Children: A Randomized, Double-Blind, Controlled Clinical Trial. Ophthalmology. 2022 Feb:130:198-204.

11. Weir K. Nurtured by nature. Monitor on Psychology. 2020 April 1;51:50. Available at apa.org/monitor/2020/04/nurtured-nature. Accessed Apr. 26, 2023.