Editor’s Perspective

Recommendations That Impact All Pre-Myopic and Myopic Children

October 2, 2023

By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE

Myopia development and progression are multifactorial, with a complex interaction between genetic (non-modifiable) and environmental (modifiable) risk factors influencing myopigenesis. 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. 

Many children and adolescents have developed unhealthy lifestyles, which affect their visual and overall health. The COVID pandemic increased attention to modifiable risk factors such as reading distance, screen time, sleep, and sedentary lifestyle. Less time outdoors significantly increased the incidence of myopia, especially in younger children (aged 6-8 years). Therefore, at a minimum, lifestyle advice and visual health guidance should be provided to all pre-myopic and myopic children. This advice encompasses outdoor exposure, close work time, working distance, and sleep.

Specifically, to delay myopia onset and potentially slow progression, eye care professionals should advise all pre-myopic/myopic children and their parents to:

  • Apply the WHO guidelines to children under 5 years of age.
  • Avoid a sedentary lifestyle. Ensure that children over the age of 5 spend more time outdoors and less time on digital devices. 
    • Spending more time outdoors is protective against myopia onset.
  • Outdoor light exposure during childhood is the most critical lifestyle factor known thus far.  
  • Recommend outdoor sport and play of at least two hours per day in total (even on cloudy days), spread between outdoor school activity and after school.
  • The more time spent outdoors, the better.
  • Take visual breaks every 20-30 minutes when using a digital device or reading by looking across the room or out a window for 20-30 seconds, and spend a minimum of two hours per day outdoors — 20-20-2 Rule
  • Recommend that children do not spend more than three hours a day — in addition to school time — on close work such as reading, homework, or screen time.
  • Ensure that reading and digital device usage is performed at a distance of at least 12 inches (30 cm.)
  • Counsel adequate sleep.
    • Peer-reviewed research has identified an inverse relationship between sleep duration and juvenile-onset myopia, i.e., less than optimal sleep results in a greater prevalence of myopia.
    • The U.S National Sleep Foundation advises the following sleep guidelines: 
      • Preschoolers (ages 3-5): 10-13 hours per night
      • School-age children (ages 6-13): 9-11 hours per night
      • Teenagers (ages 14-17): 8-10 hours per night 

Regardless of whether a child has also been prescribed myopic therapy, e.g., myopia control soft contact lenses, orthokeratology, topical low-dose atropine, next-generation spectacles, etc., these lifestyle and visual health recommendations can significantly impact myopic trajectory. 


Best professional regards,

Dwight H. Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Chief Medical Editor

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