April 1, 2025
By Eman Alzghoul, PhD, FIACLE, FBCLA
Photo Credit: Getty Images
Modern environmental factors such as increased near work, reduced outdoor exposure, and artificial lighting are believed to be disrupting the eye’s natural ability to develop proper focus. This disruption leads to abnormal eye growth and excessive axial elongation, contributing to the global rise in myopia.
The association between near work and myopia development remains controversial, as some well-conducted human studies have found no definitive link. However, research on this topic is ongoing. Given that restricting modern education and technology is neither feasible nor ethical, practitioners have proposed preventive strategies like the 20/20/20 rule. This advises taking a 20-second break to look at an object at a distance of 20 feet every 20 minutes. However, no peer-reviewed studies on PubMed support the effectiveness of this specific practice.
Clinical Perspective
In their clinical perspective, Pucker and Gawne argue that 20-second breaks from near work are insufficient to impact ocular growth. Studies done on chickens found that five minutes of myopia-preventing visual stimuli was necessary. This means that 20 seconds isn’t likely enough. Based on these findings, taking a five-minute break every hour may be more effective than the 20/20/20 rule. Ideally, these breaks should involve not only pausing near work. Instead, patients should also be spending time outdoors and focusing on distant objects for a sustained period.
Sustained near work is an unavoidable part of modern education and daily life. This highlights the importance of promoting regular breaks to mitigate myopia development and progression. While the 20/20/20 rule is memorable and easy to recall, there is limited evidence supporting these specific numbers. Although current evidence is limited to animal studies, it is suggested that breaks should last at least five minutes, though they may not need to be as frequent as every 20 minutes.
Abstract
Fighting Myopia with Intermittent Nearwork Breaks: 20 Seconds Every 20 Minutes Might Not Be Enough Time
Pucker, Andrew D. OD, PhD, FAAO; Gawne, Timothy J. PhD, FAAO
Practitioners commonly prescribe the 20/20/20 rule with hopes that, if patients follow it, they will reduce their myopic progression. This clinical perspective provides evidence that 20-second break from nearwork every 20 minutes are not enough time to impact ocular growth. The ongoing myopia epidemic is a major public health crisis. Although the correlation between nearwork tasks such as reading, computers, and smartphones and myopia development is controversial, multiple lines of research suggest that sustained nearwork contributes to myopia development. Clinicians have proposed that children should take short breaks from nearwork with a 20-second break every 20 minutes being a common suggestion. Animal model data do strongly support the idea that multiple short breaks across time can cancel out the effects of longer periods of myopia-promoting activities. However, the animal model data also suggest that repeated episodes of 20 seconds are ineffective at reducing myopia development and instead indicate that sustained breaks of 5 minutes or more every hour are needed to negate myopigenic effects.
Pucker, A. D., & Gawne, T. J. (2023). Fighting myopia with intermittent nearwork breaks: 20 seconds every 20 minutes might not be enough time. Optometry and Vision Science, 100(1), 31-32.
DOI: https://doi.org/10.1097/opx.0000000000001965
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Eman Alzghoul, PhD, FIACLE, FBCLA, recently completed her doctorate in Vision Science from UNSW Sydney’s School of Optometry and Vision Science. With eight years of experience as an optometrist and researcher, she now serves as an Assistant Professor in the Department of Optometry at Jordan University of Science and Technology (JUST). Her work focuses on contact lens compliance and myopia control treatments. |
