This article was originally published in a sponsored newsletter.

Parents often ask what they can do to help their child’s prescription from worsening. What they really want to know is whether traditional myopia management options like contact lenses, eye drops, or glasses are their only options. Recently, there has been a flood of information about modifiable risk factors that can have positive impacts on a child’s myopia progression. Let’s explore a few that are related to simple lifestyle changes.

Near Work

One of the strongest known influences on myopia progression is near work.^1,2 In addition, a substantial amount of evidence supports a causal relationship between myopia and education level—each additional year of education equates to a myopic increase of approximately –0.27D/year.³ Although we do not want to discourage academic achievements, we can make recommendations for near work that may counteract some of the visual impacts of a rigorous workload, including a working distance of greater than 30cm and discontinuing near work every 30 minutes.⁴

Outdoor Time

Currently, the meaning of “outdoor time” is still somewhat ambiguous, but we can make general suggestions. Simply encourage patients to spend time outside during the day—even on cloudy days—and engage in activities that mostly stimulate distance vision. The recommended amount of outdoor time is at least two hours per day, but the more time spent outdoors, the better.⁵ Although time outdoors has been proven to prevent or delay the onset of myopia, it has not been definitively proven to slow progression.5 Nonetheless, children who are already myopic can indirectly benefit from time outdoors because it can potentially offset the risk factors of parental myopia and increased near work and result in less overall myopia.^6,7

Sleep

Appropriate quantity and quality of sleep has a significant impact on a child’s overall health. According to two recent studies, we now know there is an increased risk of myopia in children who sleep less than five to seven hours per night compared to those who sleep more than nine hours per night.^8,9 Furthermore, results from a study in China found that children who went to sleep at 9:30 p.m. or later were much more likely to be myopic at baseline, develop myopia during the two-year trial, and have more significant myopic progression.¹⁰ Thus, we should recommend a consistent, early bed time to ensure an appropriate amount of sleep each night.

References

1. Atowa UC, Wajuihian SO, Munsamy AJ. Associations between near work, outdoor activity, parental myopia and myopia among school children in Aba, Nigeria. Int J Ophthalmol. 2020 Feb 18;13:309-316.
2. Huang HM, Chang DS, Wu PC. The Association between Near Work Activities and Myopia in Children-A Systematic Review and Meta-Analysis. PLoS One. 2015 Oct 20;10:e0140419.
3. Mountjoy E, Davies NM, Plotnikov D, et al. Education and myopia: assessing the direction of causality by mendelian randomization. BMJ. 2018;361:k2022.
4. Huang P, Hsiao Y, Tsai C, et al. Protective behaviors of near work and time outdoors in myopia prevalence and progression in myopic children: a 2-year prospective population study. Br J Ophthalmol. 2020 Jul;104:956-961.
5. Xiong S, Sankaridurg P, Naduvilath T, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review. Acta Ophthalmol. 2017 Sep;95:551-566.
6. Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008 Aug;115:1279-1285.
7. Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental history of myopia, sports and outdoor activities, and future myopia. Invest Ophthalmol Vis Sci. 2007 Aug;48:3524-3532.
8. Jee D, Morgan IG, Kim EC. Inverse relationship between sleep duration and myopia. Acta Ophthalmol. 2016 May;94:e204-e210.
9. Gong Y, Zhang X, Tian D, et al. Parental myopia, near work, hours of sleep and myopia in Chinese children. Health. 2014 Jan;6:64-70.
10. Liu XN, Naduvilath TJ, Wang J, et al. Sleeping late is a risk factor for myopia development amongst school-aged children in China. Sci Rep. 2020 Oct 14;10:17194.