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Williams KM, Bertelsen G, Cumberland P, Wolfram C, Verhoeven VJM, Anastasopoulos E, Buitendijk GHS, Cougnard-Grégoire A, Creuzot-Garcher C, Erke MG, Hogg R, Höhn R, Hysi P, Khawaja AP, Korobelnik JF, Ried J, Vingerling JR, Bron A, Dartigues JF, Fletcher A, Hofman A, Kuijpers RWAM, Luben RN, Oxele K, Topouzis F, von Hanno T, Mirshahi A, Foster PJ, van Duijn CM, Pfeiffer N, Delcourt C, Klaver CCW, Rahi J, Hammond CJ. Increasing Prevalence of Myopia in Europe and the Impact of Education. Ophthalmology 2015; 122:1489-97. [PMID: 25983215 PMCID: PMC4504030 DOI: 10.1016/j.ophtha.2015.03.018] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate whether myopia is becoming more common across Europe and explore whether increasing education levels, an important environmental risk factor for myopia, might explain any temporal trend. Design Meta-analysis of population-based, cross-sectional studies from the European Eye Epidemiology (E3) Consortium. Participants The E3 Consortium is a collaborative network of epidemiological studies of common eye diseases in adults across Europe. Refractive data were available for 61 946 participants from 15 population-based studies performed between 1990 and 2013; participants had a range of median ages from 44 to 78 years. Methods Noncycloplegic refraction, year of birth, and highest educational level achieved were obtained for all participants. Myopia was defined as a mean spherical equivalent ≤−0.75 diopters. A random-effects meta-analysis of age-specific myopia prevalence was performed, with sequential analyses stratified by year of birth and highest level of educational attainment. Main Outcome Measures Variation in age-specific myopia prevalence for differing years of birth and educational level. Results There was a significant cohort effect for increasing myopia prevalence across more recent birth decades; age-standardized myopia prevalence increased from 17.8% (95% confidence interval [CI], 17.6–18.1) to 23.5% (95% CI, 23.2–23.7) in those born between 1910 and 1939 compared with 1940 and 1979 (P = 0.03). Education was significantly associated with myopia; for those completing primary, secondary, and higher education, the age-standardized prevalences were 25.4% (CI, 25.0–25.8), 29.1% (CI, 28.8–29.5), and 36.6% (CI, 36.1–37.2), respectively. Although more recent birth cohorts were more educated, this did not fully explain the cohort effect. Compared with the reference risk of participants born in the 1920s with only primary education, higher education or being born in the 1960s doubled the myopia prevalence ratio–2.43 (CI, 1.26–4.17) and 2.62 (CI, 1.31–5.00), respectively—whereas individuals born in the 1960s and completing higher education had approximately 4 times the reference risk: a prevalence ratio of 3.76 (CI, 2.21–6.57). Conclusions Myopia is becoming more common in Europe; although education levels have increased and are associated with myopia, higher education seems to be an additive rather than explanatory factor. Increasing levels of myopia carry significant clinical and economic implications, with more people at risk of the sight-threatening complications associated with high myopia.
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Affiliation(s)
- Katie M Williams
- Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, United Kingdom; Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Geir Bertelsen
- Department of Ophthalmology, University Hospital of North Norway, Tromsø, Norway; Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Phillippa Cumberland
- Life Course, Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, United Kingdom
| | - Christian Wolfram
- University Medical Center, Department of Ophthalmology, Mainz, Germany
| | - Virginie J M Verhoeven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Gabriëlle H S Buitendijk
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Audrey Cougnard-Grégoire
- University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, Eye and Nutrition Research Group UMR 1324 INRA, University Hospital Dijon, France
| | - Maja Gran Erke
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Ruth Hogg
- Centre for Experimental Medicine, Institute of Clinical Science, Queen's University Belfast, Belfast, United Kingdom
| | - René Höhn
- University Medical Center, Department of Ophthalmology, Mainz, Germany
| | - Pirro Hysi
- Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Anthony P Khawaja
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jean-François Korobelnik
- University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - Janina Ried
- Institute of Genetic Epidemiology, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Johannes R Vingerling
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alain Bron
- Department of Ophthalmology, Eye and Nutrition Research Group UMR 1324 INRA, University Hospital Dijon, France
| | - Jean-François Dartigues
- University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - Astrid Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert W A M Kuijpers
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert N Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Konrad Oxele
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - Fotis Topouzis
- Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Therese von Hanno
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Ophthalmology, Nordland Hospital, Norway, Bodø, Norway
| | - Alireza Mirshahi
- University Medical Center, Department of Ophthalmology, Mainz, Germany
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | | | - Norbert Pfeiffer
- University Medical Center, Department of Ophthalmology, Mainz, Germany
| | - Cécile Delcourt
- University Bordeaux, Bordeaux, France; ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jugnoo Rahi
- Life Course, Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Christopher J Hammond
- Department of Ophthalmology, King's College London, St. Thomas' Hospital, London, United Kingdom; Department of Twin Research and Genetic Epidemiology, King's College London, St. Thomas' Hospital, London, United Kingdom.
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Abstract
Bright light therapy and the broader realm of chronotherapy remain underappreciated and underutilized, despite their empirical support. Efficacy extends beyond seasonal affective disorder and includes nonseasonal depression and sleep disorders, with emerging evidence for a role in treating attention-deficit/hyperactivity disorder, delirium, and dementia. A practical overview is offered, including key aspects of underlying biology, indications for treatment, parameters of treatment, adverse effects, and transformation of our relationship to light and darkness in contemporary life.
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Affiliation(s)
- Richard S Schwartz
- From Harvard Medical School; McLean Hospital, Belmont, MA (Dr. Schwartz); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Dr. Olds)
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353
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Abstract
PURPOSE Disordered sleep and myopia are increasingly prevalent among Chinese children. Similar pathways may be involved in regulation of both sleep cycles and eye growth. We therefore sought to examine the association between disordered sleep and myopia in this group. METHODS Urban primary school children participating in a clinical trial on myopia and outdoor activity underwent automated cycloplegic refraction with subjective refinement. Parents answered questions about children's sleep duration, sleep disorders (Children's Sleep Habits Questionnaire [CSHQ]), near work and time spent outdoors. RESULTS Among 1970 children, 1902 (96.5%, mean [standard deviation SD] age 9.80 [0.44] years, 53.1% boys) completed refraction and questionnaires. Myopia < = -0.50 Diopters was present in both eyes of 588 (30.9%) children (1329/3804 = 34.9% of eyes) and 1129 children (59.4%) had abnormal CSHQ scores (> 41). In logistic regression models by eye, odds of myopia < = -0.50D increased with worse CSHQ score (Odds Ratio [OR] 1.01 per point, 95% Confidence Interval [CI] [1.001, 1.02], P = 0.014) and more night-time sleep (OR 1.02, 95% CI [1.01, 1.04, P = 0.002], while male sex (OR 0.82, 95% CI [0.70, 0.95], P = 0.008) and time outdoors (OR = 0.97, 95% CI [0.95, 0.99], P = 0.011) were associated with less myopia. The association between sleep duration and myopia was not significant (p = 0.199) for total (night + midday) sleep. CONCLUSIONS Myopia and disordered sleep were both common in this cohort, but we did not find consistent evidence for an association between the two. TRIAL REGISTRATION clinicaltrials.gov NCT00848900.
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354
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Prevalence and associated factors of myopia in high-school students in Beijing. PLoS One 2015; 10:e0120764. [PMID: 25803875 PMCID: PMC4372519 DOI: 10.1371/journal.pone.0120764] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/26/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate prevalence and associated factors for myopia in high school students in Beijing. Methods Grade 10 and 11 high school students were randomly selected from nine randomly selected districts of Beijing. The students underwent non-cylcoplegic auto-refractometry and an interview. Results Out of 4798 eligible students, 4677 (93.4%) students (mean age:16.9±0.7years;range:16–18 years) participated. Mean refractive error of right eyes and left eyes was −2.78±2.29 diopters and −2.59±2.50 diopters, respectively. Prevalence of myopia (defined as ≤ −1.00 diopters in the worse eye) was 80.7% (95% Confidence Interval (CI): 79.6–81.8%). Out of 3773 students with myopia, 1525 (40.4%) wore glasses daily. In multiple logistic regression analysis, a higher prevalence of myopia was associated with female sex (odds ratio (OR) = 1.31;95%CI:1.11–1.55), Han ethnicity (OR = 1.64;95%CI:1.28–2.11), attending key schools (OR = 1.48;95%CI:1.24,1.77), higher family income (OR = 1.37;95%CI:1.09–1.71), longer time spent for near work (OR = 1.43;95%CI:1.06–1.93), shorter near work distance (OR = 1.87;95%CI:1.55–2.26), lower frequency of active rest during studying (OR = 1.40;95%CI:1.16–1.70), and parental myopia (OR = 2.28;95%CI:1.80–2.87). The interaction between distance from near work and time spent for near work was statistically (P = 0.03) significant. In multiple logistic regression analysis, higher prevalence of high myopia (≤-6.0 diopters) was associated with studying in key schools (OR = 1.38;95%CI:1.05,1.81), lower frequency of active rest during studying (OR = 1.40;95%CI:1.09,1.79), and a higher number of myopic parents (OR = 2.66;95%CI:2.08,3.40). Conclusions A prevalence of about 80% for myopia and a prevalence of about 10% for high myopia in students aged 16 to 18 years and attending classes of grade 10 and 11 in a Chinese metropolitan region is another example of the high prevalence of moderate and high myopia in metropolitan areas of China. With this young myopic generation getting older, myopia as cause for visual impairment and blindness may further increase in importance. Future studies may address whether active rests during studying with looking into the distance are preventive against myopia development or progression.
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355
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Hobday R. Myopia and daylight in schools: a neglected aspect of public health? Perspect Public Health 2015; 136:50-5. [DOI: 10.1177/1757913915576679] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A century ago, it was widely believed that high levels of daylight in classrooms could prevent myopia, and as such, education departments built schools with large windows to try to stop children becoming short-sighted. This practice continued until the 1960s, from which time myopia was believed to be an inherited condition. In the years that followed, less emphasis was placed on preventing myopia. It has since become more common, reaching epidemic levels in east Asia. Recent research strongly suggests that the amount of light children get as they grow determines whether they will develop short sight; however, evidence that daylight in classrooms prevents myopia is lacking. Given the rapid increase in prevalence among school children worldwide, this should be investigated.
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357
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Chin MP, Siong KH, Chan KH, Do CW, Chan HHL, Cheong AMY. Prevalence of visual impairment and refractive errors among different ethnic groups in schoolchildren in Turpan, China. Ophthalmic Physiol Opt 2015; 35:263-70. [DOI: 10.1111/opo.12193] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Man Pan Chin
- School of Optometry; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong
| | - Kar Ho Siong
- School of Optometry; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong
| | - Ka Ho Chan
- School of Optometry; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong
| | - Chi Wai Do
- School of Optometry; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong
| | - Henry Ho Lung Chan
- School of Optometry; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong
| | - Allen Ming Yan Cheong
- School of Optometry; The Hong Kong Polytechnic University; Hung Hom Kowloon Hong Kong
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358
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Wu LJ, Wang YX, You QS, Duan JL, Luo YX, Liu LJ, Li X, Gao Q, Zhu HP, He Y, Xu L, Song MS, Jonas JB, Guo XH, Wang W. Risk Factors of Myopic Shift among Primary School Children in Beijing, China: A Prospective Study. Int J Med Sci 2015; 12:633-8. [PMID: 26283882 PMCID: PMC4532970 DOI: 10.7150/ijms.12133] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/06/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To evaluate factors associated with myopic shift among primary school children. METHODS In a one-year prospective school-based study, 5052 children from ten schools were enrolled using a multi-stage random cluster approach. The baseline examination included non-cycloplegic auto-refractometry and questionnaire interview. Measurements were repeated at the follow-up. RESULTS Among 5052 students at baseline investigated, 4292 students (85.0%) returned for the follow-up examination. The mean refractive error (-1.13±1.57 diopters) had changed -0.52±0.73 diopters from the baseline to the follow-up examination. 2170 (51.0%) had a rate of significant myopic shift (significant myopic shift is defined as the change of spherical equivalent of the refraction ≤ -0.50D between the follow-up and baseline measures). We confirmed that common associated factors (older age, parental myopia, lower refractive status at baseline, shorter reading distance and lower frequency of outdoor activities during class recesses) were associated with greater shift towards myopia. After controlling for age, sex, region of habitation, parental myopia and refractive status at baseline, greater shift towards myopia was independently associated with distance from near-work (OR=1.48 , 95% CI=1.26-1.74, P<0.001) and longer time outdoors for leisure (OR=0.87, 95% CI=0.78-0.97, P<0.013). CONCLUSION Greater shift towards myopia was independently associated with modifiable factors (distance from near-work and longer time outdoors for leisure) might suggest that encouraging children to go outside for outdoor activities during class recess and after school may be a promising and feasible intervention against myopia development.
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Affiliation(s)
- Li-Juan Wu
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - You-Xin Wang
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Qi-Sheng You
- 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China
| | - Jia-Li Duan
- 4. Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Yan-Xia Luo
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Li-Juan Liu
- 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China
| | - Xia Li
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Qi Gao
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Hui-Ping Zhu
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Yan He
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Liang Xu
- 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China
| | - Man-Shu Song
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Jost B Jonas
- 3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China ; 5. Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, 68167 Mannheim, Germany
| | - Xiu-Hua Guo
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Wei Wang
- 1. School of Public Health, Capital Medical University, Beijing 100069, China ; 2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China ; 6. School of Medical Science, Edith Cowan University, Perth 6027, Australia
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359
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Lee YY, Lo CT, Sheu SJ, Yin LT. Risk factors for and progression of myopia in young Taiwanese men. Ophthalmic Epidemiol 2014; 22:66-73. [PMID: 25495661 DOI: 10.3109/09286586.2014.988874] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Purpose: To investigate the association between potential risk factors for myopia and its progression in young adult Taiwanese men. METHODS A survey of male military conscripts (aged 18-24 years) was conducted from February 2010 to March 2011 in Taiwan. Participants underwent comprehensive eye examinations, including measurements of axial length and corneal radius by optical biometry and non-cycloplegic autorefraction. Participants also provided self-reported progression of myopia and information regarding potential risk factors, including age, parental myopia, educational level, close work, outdoor activities, and urbanization. RESULTS Of 5145 eligible participants, 5048 (98.11%) provided refraction and questionnaire data; 2316 (45.88%) of the 5048 also had biometric measurements. The prevalence of myopia was 86.1% in this group, with a mean refractive error of -3.66 diopters (D). Of the 5048 participants, 1376 (27.3%) had experienced progression of their myopia during the past year. There were trends for a higher prevalence of myopia among older participants (p = 0.014), those with a history of parental myopia (p < 0.001), higher levels of education (p = 0.001), increased time spent reading (p < 0.001), less time outdoors (p = 0.003), and higher levels of urbanization (p = 0.010). However, only parental myopia, close work, and higher urbanization levels were significantly associated with self-reported progression of myopia. CONCLUSION Older age, parental myopia, higher educational level, close work, fewer outdoor activities, and higher urbanization level were associated with the prevalence of myopia in Taiwanese men.
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Affiliation(s)
- Yin-Yang Lee
- Department of Health Management, I-Shou University , Taiwan
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360
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Nebbioso M, Plateroti AM, Pucci B, Pescosolido N. Role of the dopaminergic system in the development of myopia in children and adolescents. J Child Neurol 2014; 29:1739-46. [PMID: 24996871 DOI: 10.1177/0883073814538666] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This review summarizes the experimental evidence that supports the role of dopamine in the regulation of ocular axial growth. The most important functions attributed to dopamine are light adaptation and regulation of the retinal circadian rhythm. An increase of the retinal levels of dopamine activates D1 and D2 dopaminergic receptors present throughout the retina, generating a signal that inhibits axial growth once the eye has reached emmetropization. Researchers induced form-deprivation myopia in animal models in order to assess the different changes of ocular axial growth. Other studies have shown that phenylethylamine is an endogenous precursor-neurotransmitter capable of modulating the activity of dopamine. Considering the role of the dopaminergic system in the development of myopia (in children and adolescents) and the fact that phenylethylamine improves the consequences of a dopamine deficit, it would be interesting to study the effect of phenylethylamine on the regulation of axial growth, which represents the genesis of myopia.
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Affiliation(s)
- Marcella Nebbioso
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Bruna Pucci
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Nicola Pescosolido
- Department of Cardiovascular, Respiratory, Nephrology, Geriatric, and Anesthetic Sciences, Sapienza University of Rome, Rome, Italy
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Guggenheim JA, Williams C, Northstone K, Howe LD, Tilling K, St Pourcain B, McMahon G, Lawlor DA. Does vitamin D mediate the protective effects of time outdoors on myopia? Findings from a prospective birth cohort. Invest Ophthalmol Vis Sci 2014; 55:8550-8. [PMID: 25406278 DOI: 10.1167/iovs.14-15839] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE More time outdoors is associated with a lesser risk of myopia, but the underlying mechanism is unclear. We tested the hypothesis that 25-hydroxyvitamin D (vitamin D) mediates the protective effects of time outdoors against myopia. METHODS We analyzed data for children participating in the Avon Longitudinal Study of Parents and Children (ALSPAC) population-based birth cohort: noncycloplegic autorefraction at age 7 to 15 years; maternal report of time outdoors at age 8 years and serum vitamin D2 and D3 at age 10 years. A survival analysis hazard ratio (HR) for incident myopia was calculated for children spending a high- versus low-time outdoors, before and after controlling for vitamin D level (N = 3677). RESULTS Total vitamin D and D3, but not D2, levels were higher in children who spent more time outdoors (mean [95% confidence interval (CI)] vitamin D in nmol/L: Total, 60.0 [59.4-60.6] vs. 56.9 [55.0-58.8], P = 0.001; D3, 55.4 [54.9-56.0] vs. 53.0 [51.3-54.9], P = 0.014; D2, 5.7 [5.5-5.8] vs. 5.4 [5.1-5.8], P = 0.23). In models including both time outdoors and sunlight-exposure-related vitamin D, there was no independent association between vitamin D and incident myopia (Total, HR = 0.83 [0.66-1.04], P = 0.11; D3, HR = 0.89 [0.72-1.10], P = 0.30), while time outdoors retained the same strong negative association with incident myopia as in unadjusted models (HR = 0.69 [0.55-0.86], P = 0.001). CONCLUSIONS Total vitamin D and D3 were biomarkers for time spent outdoors, however there was no evidence they were independently associated with future myopia.
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Affiliation(s)
- Jeremy A Guggenheim
- Centre for Myopia Research, School of Optometry, Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region, China
| | - Cathy Williams
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Kate Northstone
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Laura D Howe
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, United Kingdom
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, United Kingdom
| | - Beate St Pourcain
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, United Kingdom
| | - George McMahon
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, United Kingdom
| | - Debbie A Lawlor
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, United Kingdom
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362
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Lan W, Feldkaemper M, Schaeffel F. Intermittent episodes of bright light suppress myopia in the chicken more than continuous bright light. PLoS One 2014; 9:e110906. [PMID: 25360635 PMCID: PMC4216005 DOI: 10.1371/journal.pone.0110906] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Bright light has been shown a powerful inhibitor of myopia development in animal models. We studied which temporal patterns of bright light are the most potent in suppressing deprivation myopia in chickens. METHODS Eight-day-old chickens wore diffusers over one eye to induce deprivation myopia. A reference group (n = 8) was kept under office-like illuminance (500 lux) at a 10:14 light:dark cycle. Episodes of bright light (15 000 lux) were super-imposed on this background as follows. Paradigm I: exposure to constant bright light for either 1 hour (n = 5), 2 hours (n = 5), 5 hours (n = 4) or 10 hours (n = 4). Paradigm II: exposure to repeated cycles of bright light with 50% duty cycle and either 60 minutes (n = 7), 30 minutes (n = 8), 15 minutes (n = 6), 7 minutes (n = 7) or 1 minute (n = 7) periods, provided for 10 hours. Refraction and axial length were measured prior to and immediately after the 5-day experiment. Relative changes were analyzed by paired t-tests, and differences among groups were tested by one-way ANOVA. RESULTS Compared with the reference group, exposure to continuous bright light for 1 or 2 hours every day had no significant protective effect against deprivation myopia. Inhibition of myopia became significant after 5 hours of bright light exposure but extending the duration to 10 hours did not offer an additional benefit. In comparison, repeated cycles of 1:1 or 7:7 minutes of bright light enhanced the protective effect against myopia and could fully suppress its development. CONCLUSIONS The protective effect of bright light depends on the exposure duration and, to the intermittent form, the frequency cycle. Compared to the saturation effect of continuous bright light, low frequency cycles of bright light (1:1 min) provided the strongest inhibition effect. However, our quantitative results probably might not be directly translated into humans, but rather need further amendments in clinical studies.
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Affiliation(s)
- Weizhong Lan
- Section of Neurobiology of the Eye, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
- Graduate School of Cellular & Molecular Neuroscience, University of Tuebingen, Tuebingen, Germany
- * E-mail:
| | - Marita Feldkaemper
- Section of Neurobiology of the Eye, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Frank Schaeffel
- Section of Neurobiology of the Eye, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
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363
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McMonnies CW. Clinical prediction of the need for interventions for the control of myopia. Clin Exp Optom 2014; 98:518-26. [PMID: 25346495 DOI: 10.1111/cxo.12212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/23/2014] [Accepted: 07/27/2014] [Indexed: 11/27/2022] Open
Abstract
The prevalence of myopia is increasing in Western populations but in East Asian countries, it is increasing to epidemic levels, where there are also markedly increased rates of progression to pathological myopia. Measures to more effectively control the development and progression of myopia are urgently needed. Notwithstanding a large volume of research, especially regarding the different mechanisms for the development of myopia and the efficacy of particular methods of intervention, there is still a great need and scope for improvements in clinical efforts to prevent and/or control myopic progression. Too often clinical efforts may involve only one method of intervention; however, the heterogenous nature of myopia suggests that clinical intervention may be more successful when interventions are employed in combination. The decision to prescribe interventions for the control of myopia in children, especially prior to onset, may be better framed by a comprehensive estimation of the degree of risk for the development and/or progression of myopia. For example, rather than ascribing equal weight to any degree of parental myopia, more accurate estimates may be obtained, if risk is judged to increase with the degree of parental myopia and the extent of any associated degenerative pathology. Risk estimates may be limited to broad mild, moderate and severe classifications due to lack of accurate weighting of risk factors. Nevertheless, comprehensive assessment of risk factors appears likely to better inform a prognosis and discussions with parents. Consideration of numerous environmental influences, for example, such as continuity and intensity of near work and time spent outdoors, may contribute to better risk estimation. Family-based practice appears to be ideally suited for risk estimation and the clinical application of approaches to control myopia. A proactive approach to estimating risk of developing myopia prior to its onset may be beneficial. Earlier implementation of interventions to control myopia could significantly reduce the chance of progression to pathological myopia.
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Affiliation(s)
- Charles W McMonnies
- School of Optometry and Vision Science, University of New South Wales, Kensington, Australia.
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365
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Galvis V, Tello A, Castellanos YA, Camacho PA, Prada AM, Rangel CM. Re: Wu et al.: Outdoor Activity during Class Recess Reduces Myopia Onset and Progression in School Children (Ophthalmology 2013;120:1080-1085). Ophthalmology 2014; 121:e20. [DOI: 10.1016/j.ophtha.2013.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 11/05/2013] [Indexed: 10/25/2022] Open
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367
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Ngo CS, Pan CW, Finkelstein EA, Lee CF, Wong IB, Ong J, Ang M, Wong TY, Saw SM. A cluster randomised controlled trial evaluating an incentive-based outdoor physical activity programme to increase outdoor time and prevent myopia in children. Ophthalmic Physiol Opt 2014; 34:362-8. [PMID: 24460536 DOI: 10.1111/opo.12112] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 11/20/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate an incentive-based intervention to increase time spent outdoors among children in a 9-month cluster randomised controlled trial. METHODS Two hundred and eighty-five children aged 6-12 years of age were randomised to the intervention (n = 147) or control arm (n = 138) in the Family incentive trial (FIT). The FIT intervention comprised of targeted education on myopia and good eye care habits, structured weekend outdoor activities and incentives for children to increase their daily steps via pedometers. The main outcome measure was outdoor time, measured by the WHO questionnaire and a 1-week diary. RESULTS Interim analysis at 6 months showed a significant increase in mean outdoor time per week in the intervention arm (14.75 h week(-1) ) compared to the control arm (12.40 h week(-1) ) as measured by the questionnaire (p = 0.04). However, greater outdoor time was not statistically significant at the end of the trial (15.95 h week(-1) vs 14.34 h in the control group (p = 0.29). CONCLUSIONS There was an increase in outdoor time for children in the incentive-based physical activity outdoor program after 6 months but not at the end of the trial. Further larger school trials with better compliance with the intervention and longer duration could be conducted to evaluate clinical outcomes such as myopic shifts.
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Affiliation(s)
- Cheryl S Ngo
- Department of Ophthalmology, National University Hospital, Singapore
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368
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Lougheed T. Myopia: the evidence for environmental factors. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:A12-9. [PMID: 24380886 PMCID: PMC3888556 DOI: 10.1289/ehp.122-a12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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369
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Wu PC, Yang YH. Author reply: To PMID 23462271. Ophthalmology 2013; 121:e20-1. [PMID: 24359626 DOI: 10.1016/j.ophtha.2013.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/05/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Hsin Yang
- School of Pharmacy, Kaohsiung Medical University, Taiwan
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370
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Scheiman M, Zhang Q, Gwiazda J, Hyman L, Harb E, Weissberg E, Weise KK, Dias L. Visual activity and its association with myopia stabilisation. Ophthalmic Physiol Opt 2013; 34:353-61. [PMID: 24345071 DOI: 10.1111/opo.12111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the association between outdoor and nearwork activities at baseline and myopia stabilisation by age 15 in the Correction of Myopia Evaluation Trial (COMET). METHODS Correction of Myopia Evaluation Trial enrolled 469 children (ages: 6-11 years) with spherical equivalent myopia between -1.25 and -4.50 D, who were randomised to progressive addition or single vision lenses and followed for 5 years in their original lenses. At baseline, families recorded the child's outdoor and nearwork activities for 3 days within a week. Weekly hours spent in nearwork and outdoor activities were calculated for each participant. Refractions collected over 11 years were fit using the Gompertz function to determine each participant's myopia stabilisation age. Myopia for each child was then categorized as stable/not stable by age 15. RESULTS Half (233/469) of participants had usable baseline activity diaries and refraction data that could be fit with the Gompertz function, 59.7% (139/233) had stable myopia by age 15 and 40.3% had myopia that was not yet stable. The frequency of stable myopia was similar for the two categories (median split) of outdoor activities: 60% (71/118) for ≤9.0 hours/week(-1) and 59% (68/115) for >9.0 hours/week(-1) . 56% (64/114) of children reporting >21.0 h of baseline weekly nearwork activity had stable myopia by age 15 compared to 63% (75/119) with ≤21.0 h of near work (adjusted OR = 0.74; 95% CI: 0.43-1.29). Using baseline nearwork as a continuous variable, the multivariable odds ratio for the association between baseline nearwork hours and stabilisation by age 15 is 0.98: 95% CI: 0.96-1.00, a result trending towards significance. CONCLUSION While time spent in outdoor activities in childhood does not appear to be related to myopia stabilisation by age 15, less near work activity might potentially be associated with myopia stabilisation by that age.
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Affiliation(s)
- Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Philadelphia, USA
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371
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Practical applications to modify and control the development of ametropia. Eye (Lond) 2013; 28:134-41. [PMID: 24310242 DOI: 10.1038/eye.2013.255] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/10/2013] [Indexed: 11/09/2022] Open
Abstract
For many individuals, the developmental trend of lessening hyperopia from birth continues past emmetropia towards myopia during childhood. The global pattern for prevalence of refractive errors indicates that the prevalence of hyperopia is low; in contrast, the burden of myopia is on the rise because of rising prevalence and magnitude of myopia. This review highlights the need to lessen the global burden of myopia by intervening with the development and/or slowing the progression of myopia. Further, outcomes from human clinical trials of pharmaceutical, optical, and environmental approaches to control myopia will be summarised. Pharmaceutical treatments are effective in controlling eye growth but are associated with deleterious side effects. Optical strategies that induce myopic defocus at the retina such as peripheral defocus reducing lenses, simultaneous defocus lenses, bifocals, and orthokeratology as well as environmental influences such as increased outdoor activity show promise and provide a substantially risk-free environment in which to control eye growth.
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Guo Y, Liu LJ, Xu L, Tang P, Lv YY, Feng Y, Meng M, Jonas JB. Myopic shift and outdoor activity among primary school children: one-year follow-up study in Beijing. PLoS One 2013; 8:e75260. [PMID: 24086484 PMCID: PMC3782472 DOI: 10.1371/journal.pone.0075260] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose To assess whether a change in myopia related oculometric parameters of primary school children in Beijing was associated with indoors and outdoors activity. Methods The longitudinal school-based study included school children who were examined in 2011 and who were re-examined in 2012. The children underwent a comprehensive eye examination including ocular biometry by optical low-coherence reflectometry and non-cycloplegic refractometry. Parents and children had a detailed interview including questions on time spent indoors and outdoors. Results Out of 681 students examined at baseline, 643 (94.4%) returned for follow-up examination. Within the one-year period, mean time spent daily outdoors increased by 0.4±0.9 hours, mean axial length by 0.26±0.49 mm, the ratio of axial length divided by anterior corneal curvature (AL/CC) by 0.03±0.06, and myopic refractive error by −0.06±0.89 diopters. In multivariate analysis, elongation of axial length was significantly associated with less total time spent outdoors (P = 0.02; standardized coefficient beta −0.12) and more time spent indoors with studying (P = 0.007; beta: 0.14) after adjustment for maternal myopia (P = 0.02; beta: 0.12). An increase in AL/CC was significantly associated with less time spent outdoors (P = 0.01; beta:−0.12) after adjustment for paternal myopia (P = 0.003; beta: 0.15) and if region of habitation was excludedors for leisure (P = 0.006; beta:−0.13), with less total time spent outdoors (P = 0.04; beta:−0.10), or with more time spent i. An increase in myopic refractive error, after adjustment for age, was significantly associated with less time spent outdo ndoors with studying (P = 0.005; beta: 0.13). Conclusions A change in oculometric parameters indicating an increase in myopia was significantly associated with less time spent outdoors and more time spent indoors in school children in Greater Beijing within a study period of one year. Our study provides additional information on the potentially helpful role of outdoors activity in the prevention of myopia. Public health care measures such as school agendas may potentially take it into account.
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Affiliation(s)
- Yin Guo
- Tongren Eye Care Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Li Juan Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- * E-mail:
| | - Ping Tang
- Tongren Eye Care Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yan Yun Lv
- Tongren Eye Care Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yi Feng
- Tongren Eye Care Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meng Meng
- Tongren Eye Care Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Germany
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373
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Norton TT, Siegwart JT. Light levels, refractive development, and myopia--a speculative review. Exp Eye Res 2013; 114:48-57. [PMID: 23680160 PMCID: PMC3742693 DOI: 10.1016/j.exer.2013.05.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 04/30/2013] [Accepted: 05/02/2013] [Indexed: 11/18/2022]
Abstract
Recent epidemiological evidence in children indicates that time spent outdoors is protective against myopia. Studies in animal models (chick, macaque, tree shrew) have found that light levels (similar to being in the shade outdoors) that are mildly elevated compared to indoor levels, slow form-deprivation myopia and (in chick and tree shrew) lens-induced myopia. Normal chicks raised in low light levels (50 lux) with a circadian light on/off cycle often develop spontaneous myopia. We propose a model in which the ambient illuminance levels produce a continuum of effects on normal refractive development and the response to myopiagenic stimuli such that low light levels favor myopia development and elevated levels are protective. Among possible mechanisms, elevation of retinal dopamine activity seems the most likely. Inputs from intrinsically-photosensitive retinal ganglion cells (ipRGCs) at elevated light levels may be involved, providing additional activation of retinal dopaminergic pathways.
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Affiliation(s)
- Thomas T Norton
- Department of Vision Sciences, School of Optometry, University of Alabama at Birmingham, USA.
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374
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French AN, Ashby RS, Morgan IG, Rose KA. Time outdoors and the prevention of myopia. Exp Eye Res 2013; 114:58-68. [PMID: 23644222 DOI: 10.1016/j.exer.2013.04.018] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/20/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
Recent epidemiological evidence suggests that children who spend more time outdoors are less likely to be, or to become myopic, irrespective of how much near work they do, or whether their parents are myopic. It is currently uncertain if time outdoors also blocks progression of myopia. It has been suggested that the mechanism of the protective effect of time outdoors involves light-stimulated release of dopamine from the retina, since increased dopamine release appears to inhibit increased axial elongation, which is the structural basis of myopia. This hypothesis has been supported by animal experiments which have replicated the protective effects of bright light against the development of myopia under laboratory conditions, and have shown that the effect is, at least in part, mediated by dopamine, since the D2-dopamine antagonist spiperone reduces the protective effect. There are some inconsistencies in the evidence, most notably the limited inhibition by bright light under laboratory conditions of lens-induced myopia in monkeys, but other proposed mechanisms possibly associated with time outdoors such as relaxed accommodation, more uniform dioptric space, increased pupil constriction, exposure to UV light, changes in the spectral composition of visible light, or increased physical activity have little epidemiological or experimental support. Irrespective of the mechanisms involved, clinical trials are now underway to reduce the development of myopia in children by increasing the amount of time they spend outdoors. These trials would benefit from more precise definition of thresholds for protection in terms of intensity and duration of light exposures. These can be investigated in animal experiments in appropriate models, and can also be determined in epidemiological studies, although more precise measurement of exposures than those currently provided by questionnaires is desirable.
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Affiliation(s)
- Amanda N French
- Discipline of Orthoptics, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW 2011, Australia
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