Practical strategies for nearsightedness in spring

Parents of children with nearsightedness can help manage their condition by dialing up some good lifestyle changes in spring.

It's that bright and invigorating time of year again - the snow is melting, the birds are chirping, and the flowers are blooming. For parents of children with nearsightedness (myopia), spring also brings longer daytime and better weather for more outdoor activities to help manage the condition.

In this article, let’s take a closer look at the science behind nearsightedness and outdoor time, and I'll share some thoughts on how I plan to adjust my son's myopia management plan starting in spring. At the end of the article, there are also some fun and engaging ideas to help your child to get outside and enjoy the benefits of natural daylight. So, let's get started!

How does outdoor time affect nearsightedness?

Outdoor time can play a significant role in controlling myopia development in children. Research has shown that spending time outdoors can have a protective effect on the progression of nearsightedness. One possible explanation for this is the light-stimulated release of dopamine from the retina, which inhibits increased axial elongation of the eye.¹

In most children, nearsightedness occurs when the shape of the eye becomes abnormally long. Spending time outdoors with sufficient daylight can help reduce the likelihood of abnormal eye growth, resulting in less progression in children.

The Refractive Errors Preferred Practice Pattern 2022 published by the American Academy of Ophthalmology (AAO) highlighted that studies indicated an increased time spent outdoors significantly decreased the risk of myopic development and progression.

A meta-analysis study also found that more outdoor activities -- around 14-15 hours per week -- slowed myopic progression by 0.14 diopters per year.⁴

While this effect may seem modest, it is a therapeutic efficacy that you don't need a prescription or would set you back many "Benjamins." And it is as simple as telling your child, "go out and play with their friends until supper time."

Adjusting interventions for nearsightedness in spring

Let's discuss how I plan to adjust my son's myopia control strategy from the winter. My son uses a combination of Orthokeratology contact lenses (Ortho-K) and 0.05% atropine to manage his nearsightedness. This intensive therapy is strong enough to be effective even during the fast-progressing winter. 

However, unlike last year, since this winter my son shows slight axial growth, we will continue the 0.05% atropine every night instead of dialing it down to every other night like last year, which was according to our eye doctor’s recommendation to reduce close-up blurriness. Furthermore, since my son's close-up blurriness from his atropine has gone away, the reduced frequency is also not necessary anymore.

Outdoor time has been found to have a positive effect on preventing nearsightedness from worsening. Therefore, we will continue to track my son's daily outdoor activities using the MyoAssist app. Furthermore, we will work with him to extend to two hours of outdoor time each day from the 80 min per day during winter time. (For this March, if he completes an average of 2 hours each day, we will have a special treat: his favorite pancake breakfast at IHOP.)  

Furthermore, we will continue a 5 minute break for every 30 min of close-up activities, looking at objects that are more than 20 feet away.

Research showed that the increased availability and use of digital hand-held devices by young children may promote onset and progression of nearsightedness.⁵ To minimize the time my son spends on these devices, his device time will be limited to less than 30 minutes per day. Furthermore, when using his chromebook at home, he will project it to TV instead.

Finally, based on the Guidance on Management Myopia published by the European Society of Ophthalmology and International Myopia Institute, we will continue to ensure that my son's homework area is well-lit with an incandescent light bulb with sufficient brightness (>500 lux) since using LED lamps was associated with more myopic refractive error and longer axial length.⁶

Outdoor activities for managing nearsightedness in spring

As previously mentioned, with the longer daylight hours, encouraging your child to play outside at least 2 hours per day can help reduce the likelihood of progression. Here are some outdoor activity ideas:

• Sports and games: Encourage your child to participate in outdoor sports like soccer, baseball, or football. Outdoor games like tag or hide and seek are also great options to get them moving and having fun.
• Nature exploration: Take your child on hikes, walks, or bike rides through local parks. Visit outdoor attractions like botanical gardens, zoos, or outdoor museums. Not only will they get to explore the great outdoors, but they will also be exposed to plenty of daylight.
• Creative outdoor activities: Encourage your child to get creative with outdoor activities like chalk drawing, outdoor painting, or building woodwork outside. The fresh air and bright light can help stimulate their creativity while reducing the progression of nearsightedness.
• Family outdoor activities: Plan weekend activities that the whole family can enjoy together, such as picnics or BBQs. This is a great way to spend quality time together and encourage your child to spend more time outside.
• Gardening: If your child does not have spring allergies, involve them in planting and caring for flowers, vegetables, or herbs. This will provide them with a sense of responsibility and help them experience the joys of gardening.
• Extra daylight going to or returning from the school: If you live close to school, consider walking to or returning from school for extra daylight. If your child takes the school bus in the morning, consider sending your child to the school bus stop a little earlier so that they can meet up with friends and spend more time outside each morning.

Key takeaways

Nearsightedness (myopia) is a common eye condition among children, but with simple lifestyle changes, you may be able to help prevent nearsightedness from progressing. To reduce or stop your child's progression, parents can encourage them to spend more time outdoors, limit screen time, take appropriate eye breaks, and ensure proper lighting in study areas.

Encouraging children to engage in outdoor activities such as sports, nature exploration, and creative activities is not only fun and healthy, but it can also provide the necessary outdoor time to slow down or stop the worsening of nearsightedness.

So, tell your little ones to "go outside and play" like our parents did when we were young. It's really for their nearsightedness, really.

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1. Zhou, Xiangtian et al. “Dopamine signaling and myopia development: What are the key challenges.” Progress in retinal and eye research vol. 61 (2017): 60-71. doi:10.1016/j.preteyeres.2017.06.003.

2. Jacobs, Deborah S et al. “Refractive Errors Preferred Practice Pattern®.” Ophthalmology vol. 130,3 (2023): P1-P60. doi:10.1016/j.ophtha.2022.10.031.

3. Sherwin, Justin C et al. “The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis.” Ophthalmology vol. 119,10 (2012): 2141-51. doi:10.1016/j.ophtha.2012.04.020. 

4. Huang, Jinhai et al. “Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis.” Ophthalmology vol. 123,4 (2016): 697-708. doi:10.1016/j.ophtha.2015.11.010. 

5. Enthoven, Clair A et al. “The impact of computer use on myopia development in childhood: The Generation R study.” Preventive medicine vol. 132 (2020): 105988. doi:10.1016/j.ypmed.2020.105988.

 6. Németh, János et al. “Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.” European journal of ophthalmology vol. 31,3 (2021): 853-883. doi:10.1177/1120672121998960.