August 1, 2022
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Progressive myopia is increasingly common in children. With increasing prevalence, more and more children develop high myopia, i.e., a spherical equivalent of -6.00D or more and an axial length of 26 mm or more. Because eye health complications of myopia are often irreversible in adulthood, the time to slow myopia Rx and axial length progression is during childhood.
Myopia development and progression are multifactorial, with a complex interaction between genetic (non-modifiable) and environmental (modifiable) risk factors influencing myopigenesis. According to the International Myopia Institute’s Risk Factors for Myopia report, several epidemiological studies have demonstrated a positive association between the prevalence of myopia in parents and a child’s risk of developing myopia. Furthermore, children with two myopic parents have a higher risk of developing myopia than those with one myopic parent.
Most children, especially those living in an urban environment, live in a myopigenic environment (high near work, low time outdoors). They are almost continuously exposed to myopia-inducing stimuli. The COVID pandemic has brought greater attention to modifiable risk factors such as reading distance, screen time, and sedentary lifestyle. More screen timing during the pandemic has significantly increased the prevalence of myopia, especially in cohorts of younger children (aged 6-8 years). Therefore, at a minimum, lifestyle advice and visual hygiene guidance should be provided to all pre-myopic and myopic children. This advice encompasses outdoor exposure, close work time, and working distance.
Outdoor exposure during childhood is the most critical lifestyle risk factor known thus far. Outdoor exposure prevents or delays the onset of myopia and potentially slows progression. For a more in-depth look at this critical topic of outdoor time, please read the excellent article, “How Much Outdoor Time Do Children Require,” by Dr. Angelica Ly.
In summary, to impact myopigenesis, eye care professionals should advise ALL children and parents to:
- Apply the WHO guidelines for children under 5 years of age.
- Ensure that children over the age of 5 spend more time outdoors and less time on digital devices.
- Recommend outdoor sport and play of at least two hours per day in total, spread between outdoor school activity and after school.
- Take breaks every 20 minutes by looking across the room for 20 seconds when using a digital device or reading and spend a minimum of two hours per day outdoors — 20-20-2 rule.
- Children should not spend more than three hours a day — in addition to school time — on close work such as reading, homework, or screen time.
- Reading and digital device usage should be performed at a distance of at least 12 inches (30 cm.)
I urge you to commit to the highest level of care and prescribe the most appropriate evidence-based interventions to children at risk of progressive myopia. Let’s get proactive about myopia management!
Best professional regards,
Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor