This article was originally published in a sponsored newsletter.

The patients and their families in our orthokeratology clinic tend to have a lot of questions about home behavior regarding protecting their eyes, and these questions are not always about their orthokeratology lenses. They also want to know more about the amount of screen time and schoolwork that could negatively affect their myopia control efforts. To best prescribe orthokeratology lenses and potential adjunct therapy for these patients, it’s helpful to have some understanding about our patient’s day-to-day lifestyle, so that we can minimize factors that may contribute to their myopia progression.

Near work is a topic that continues to be extensively studied with regards to limiting myopia progression. It has been noted that both the amount of time spent doing near work and working distance during near work can contribute to myopia progression.¹

Screen time use, a form of near work, continues to increase, as academic tools and social interactions are accessed through devices. It’s been reported that 8- to 12-year-olds spend more than five hours on screens each day.² The good ol’ 20-20-20 rule—for every 20 minutes a person looks at a screen, they should look at something 20 feet away for 20 seconds—still rings true. According to research, 10-year-olds exhibit higher levels of myopia in the patient group that does not take visual breaks compared to a patient based that does utilize take a visual break every 30 minutes.³ Children who read more than two or more books per week are also more likely to have higher myopia compared to those who read less.⁴

When conversing with patients and their parents, consider asking what their study setup looks like at home and at school. Specifically, do they lean close to their study material? Do they study on a laptop screen? It has been found that children with working distances shorter than 30cm are more myopic than those who maintain a working distance beyond 30cm.³ Another study notes that children who spend 3.5 hours on near work each day, with a 22cm or less working distance, present with faster rates of myopia progression.¹

With regards to near work, the International Myopia Institute (IMI) recommends that children should not be prevented from performing near work, but steps should be taken to lessen their risk for related myopia progression.⁵ These steps include taking regular breaks, switching fixation from near to far during near work tasks, and encouraging sufficient outdoor time.⁵

With the above guidelines and some small workspace modifications, our young patients can continue to enjoy their near work activities while reducing some of the risks that contribute to myopia progression.

References:

1. Karthikeyan SK, Ashwini DL, Priyanka M, Nayak A, Biswas S. Physical activity, time spent outdoors, and near work in relation to myopia prevalence, incidence, and progression: An overview of systematic reviews and meta-analyses. Indian J Ophthalmol. 2022 Mar;70:728-739.
2. Backlinkto Team in collaboration with Semrush. Revealing Average Screentime Statistics. 2024 Mar 11. Available at backlinko.com/screen-time-statistics. Accessed 2024 Jul 2.
3. Huang PC, Hsiao YC, Tsai CY, et al. Protective behaviours 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.
4. Saw S-M, Chua W-H, Hong C-Y, et al. Nearwork in early-onset myopia. Invest Ophthalmol Vis Sci. 2002 Feb;43:332-339.
5. Gifford KL, Richdale K, Kang P, et al. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb;60:M184-M203.

Brooke M. Messer, OD, FSLS, received her doctor of optometry degree from Southern California College of Optometry, and subsequently went on to specialize in Cornea and Specialty Contact Lenses by completing a one-year residency. She is highly trained in fitting specialty contact lenses for keratoconus and post-surgical corneas, as well as multifocal contact lenses and orthokeratology lenses for myopia management. Dr. Messer has authored articles for publications such as Contact Lens Spectrum and Review of Optometry, and enjoys teaching other doctors complex contact lens fitting techniques in classroom and clinical settings. Dr. Messer is a fellow of the American Academy of Optometry and the Scleral Lens Education Society. Outside the office, Dr. Messer loves to golf, hike, and visit family back in her hometown of Dickinson, North Dakota.