Outdoor time can help reduce the likelihood of shortsightedness

The increasing incidence of Myopia (shortsightedness) is a global problem. Outdoor time has been shown to reduce the prevalence of shortsightedness development in those who have a family history of myopia but have not yet developed the condition. Patients who are shortsighted have an increased chance of developing retinal detachment and glaucoma. The higher the glasses strength the higher the chance of development.  We encourage patients who are concerned to see an eyecare practitioner that can guide you about treatment options as opposed to simply updating spectacles or contact lenses. The treatment options aim to stabilise your glasses strength with a goal to not have them increase or require a change. To find out more about Myopia and the prevalence then please click here to be taken to the WHO report.

Acta Ophthalmol. 2017 Sep;95(6):551-566. doi: 10.1111/aos.13403. Epub 2017 Mar 2.

Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review.

Xiong S1,2, Sankaridurg P3,4, Naduvilath T3, Zang J5, Zou H1,2, Zhu J1, Lv M1, He X1,6, Xu X1,2.

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Outdoor time is considered to reduce the risk of developing myopia. The purpose is to evaluate the evidence for association between timeoutdoors and (1) risk of onset of myopia (incident/prevalent myopia); (2) risk of a myopic shift in refractive error and c) risk of progression in myopes only. A systematic review followed by a meta-analysis and a dose-response analysis of relevant evidence from literature was conducted. PubMed, EMBASE and the Cochrane Library were searched for relevant papers. Of the 51 articles with relevant data, 25 were included in the meta-analysis and dose-response analysis. Twenty-three of the 25 articles involved children. Risk ratio (RR) for binary variables and weighted mean difference (WMD) for continuous variables were conducted. Mantel-Haenszel random-effects model was used to pool the data for meta-analysis. Statistical heterogeneity was assessed using the I2 test with I2  ≥ 50% considered to indicate high heterogeneity. Additionally, subgroup analyses (based on participant's age, prevalence of myopia and study type) and sensitivity analyses were conducted. A significant protective effect of outdoor time was found for incident myopia (clinical trials: risk ratio (RR) = 0.536, 95% confidence interval (CI) = 0.338 to 0.850; longitudinal cohort studies: RR = 0.574, 95% CI = 0.395 to 0.834) and prevalent myopia (cross-sectional studies: OR = 0.964, 95% CI = 0.945 to 0.982). With dose-response analysis, an inverse nonlinear relationship was found with increased time outdoors reducing the risk of incident myopia. Also, pooled results from clinical trials indicated that when outdoor time was used as an intervention, there was a reduced myopic shift of -0.30 D (in both myopes and nonmyopes) compared with the control group (WMD = -0.30, 95% CI = -0.18 to -0.41) after 3 years of follow-up. However, when only myopes were considered, dose-response analysis did not find a relationship between time outdoors and myopic progression (R2  = 0.00064). Increased time outdoors is effective in preventing the onset of myopia as well as in slowing the myopic shift in refractive error. But paradoxically, outdoor time was not effective in slowing progression in eyes that were already myopic. Further studies evaluating effect of outdoor in various doses and objective measurements of time outdoors may help improve our understanding of the role played by outdoors in onset and management of myopia.

A recent review of how we approach myopia and its control

Curr Opin Ophthalmol. 2017 May;28(3):267-275. doi: 10.1097/ICU.0000000000000367.

Current approaches to myopia control.

Leo SW1; Scientific Bureau of World Society of Paediatric Ophthalmology and Strabismus (WSPOS).

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Myopia is a global problem, being particularly prevalent in the urban areas of east and southeast Asia. In addition to the direct economic and social burdens, associated ocular complications may lead to substantial vision loss. With prevalence of myopia above 80% and high myopia over 20%, it is crucial to control myopia. The aim of this review to is provide an update on the interventions to slow the onset of myopia and retard its progression.


The epidemic of myopia is characterized by increasingly early onset, combined with high myopia progression rates. There are two pathways for myopia control: firstly to slow the onset of myopia and secondly to reduce or prevent progression. Increased time outdoors can reduce the onset of myopia. Atropine 0.01% dose offers an appropriate risk-benefit ratio, with no clinically significant visual side effects balanced against a significant 50% reduction in myopia progression. Orthokeratology contact lenses can slow axial length elongation, but infective keratitis is a risk. Peripheral defocussing lenses may both have a role in slowing myopic progression in a subset of children and further help our understanding of the physiologic control of ocular growth.


Myopia control can be achieved by slowing the onset of myopia, which now appears to be possible through increasing time outdoors and slowing the progression of myopia with interventions like atropine and orthokeratology.



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Take Action

We are currently recommending 2 hours a day of outdoor play as a strategy  as well as following the 20-20-20 rule to combat the development of myopia. The 20-20-20 rule is look away from devices every 20 minutes for 20 seconds and look at least 20 feet (6m) away. Click the link below to be taken to our page of links for parents to find out more.

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Measures for the detection and management of myopia should be an integral part of plans
for the provision of eye-care services.
— https://www.brienholdenvision.org/images/pdfs/WHO_Report_Myopia_2016.pdf