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Time spent outdoors as an intervention for myopia prevention and control in children: an overview of systematic reviews

Dhakal, R., Shah, R. ORCID: 0000-0002-6134-0936, Huntjens, B. ORCID: 0000-0002-4864-0723 , Verkicharla, P. K. & Lawrenson, J. G. ORCID: 0000-0002-2031-6390 (2022). Time spent outdoors as an intervention for myopia prevention and control in children: an overview of systematic reviews. Ophthalmic and Physiological Optics, 42(3), pp. 545-558. doi: 10.1111/opo.12945


Purpose: Outdoor light exposure is considered a safe and effective strategy to reduce myopia development and aligns with existing public health initiatives to promote healthier lifestyles in children. However, it is unclear whether this strategy reduces myopia progression in eyes that are already myopic. This study aims to conduct an overview of systematic reviews (SRs) reporting time spent outdoors as a strategy to prevent myopia or slow its progression in children.

Methods: We searched the Cochrane Library, EMBASE, MEDLINE and CINAHL from inception to 1 November 2020 to identify SRs that evaluated the association between outdoor light exposure and myopia development or progression in children. Outcomes included incident myopia, prevalent myopia and change in spherical equivalent refractive error (SER) and axial length (AL) to evaluate annual rates of myopia progression. The methodological quality and risk of bias of included SRs were assessed using the AMSTAR-2
and ROBIS tools, respectively.

Results: Seven SRs were identified, which included data from 47 primary studies with 63,920 participants. Pooled estimates (risk or odds ratios) consistently demonstrated that time outdoors was associated with a reduction in prevalence and incidence of myopia. In terms of slowing progression in eyes that were already myopic, the reported annual reductions in SER and AL from baseline were small (0.13–0.17 D) and regarded as clinically insignificant. Methodological quality assessment using AMSTAR-2 found that all reviews had one or more critical flaws and the ROBIS tool identified a low risk of bias in only two of the included SRs.

Conclusion: This overview found that increased exposure to outdoor light reduces myopia development. However, based on annual change in SER and AL, there is insufficient evidence for a clinically significant effect on myopia progression. The poor methodological quality and inconsistent reporting of the included systematic reviews reduce confidence in the estimates of effect.

Publication Type: Article
Additional Information: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2022 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists
Publisher Keywords: children, intervention, light exposure, Myopia, outdoor time, overview
Subjects: R Medicine > RE Ophthalmology
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Departments: School of Health & Psychological Sciences > Optometry & Visual Sciences
SWORD Depositor:
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