Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial

Pei Chang Wu, Chueh Tan Chen, Ken Kuo Lin, Chi Chin Sun, Chien Neng Kuo, Hsiu Mei Huang, Yi Chieh Poon, Meng Ling Yang, Chau Yin Chen, Jou Chen Huang, Pei Chen Wu, I. Hui Yang, Hun Ju Yu, Po Chiung Fang, Chia Ling Tsai, Shu Ti Chiou, Yi Hsin Yang

Research output: Contribution to journalArticle

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Abstract

Purpose: To investigate the effectiveness of a school-based program promoting outdoor activities in Taiwan for myopia prevention and to identify protective light intensities. Design: Multi-area, cluster-randomized intervention controlled trial. Participants: A total 693 grade 1 schoolchildren in 16 schools participated. Two hundred sixty-seven schoolchildren were in the intervention group and 426 were in the control group. Methods: Initially, 24 schools were randomized into the intervention and control groups, but 5 and 3 schools in the intervention and control groups, respectively, withdrew before enrollment. A school-based Recess Outside Classroom Trial was implemented in the intervention group, in which schoolchildren were encouraged to go outdoors for up to 11 hours weekly. Data collection included eye examinations, cycloplegic refraction, noncontact axial length measurements, light meter recorders, diary logs, and questionnaires. Main Outcome Measures: Change in spherical equivalent and axial length after 1 year and the intensity and duration of outdoor light exposures. Results: The intervention group showed significantly less myopic shift and axial elongation compared with the control group (0.35 diopter [D] vs. 0.47 D; 0.28 vs. 0.33 mm; P = 0.002 and P = 0.003) and a 54% lower risk of rapid myopia progression (odds ratio, 0.46; 95% confidence interval [CI], 0.28–0.77; P = 0.003). The myopic protective effects were significant in both nonmyopic and myopic children compared with controls. Regarding spending outdoor time of at least 11 hours weekly with exposure to 1000 lux or more of light, the intervention group had significantly more participants compared with the control group (49.79% vs. 22.73%; P < 0.001). Schoolchildren with longer outdoor time in school (≥200 minutes) showed significantly less myopic shift (measured by light meters; ≥1000 lux: 0.14 D; 95% CI, 0.02–0.27; P = 0.02; ≥3000 lux: 0.16 D; 95% CI, 0.002–0.32; P = 0.048). Conclusions: The school-based outdoor promotion program effectively reduced the myopia change in both nonmyopic and myopic children. Outdoor activities with strong sunlight exposure may not be necessary for myopia prevention. Relatively lower outdoor light intensity activity with longer time outdoors, such as in hallways or under trees, also can be considered.

Original languageEnglish
Pages (from-to)1239-1250
Number of pages12
JournalOphthalmology
Volume125
Issue number8
DOIs
Publication statusPublished - Aug 1 2018
Externally publishedYes

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Myopia
Light
Control Groups
Confidence Intervals
Mydriatics
Sunlight
Taiwan
Randomized Controlled Trials
Odds Ratio
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Wu, P. C., Chen, C. T., Lin, K. K., Sun, C. C., Kuo, C. N., Huang, H. M., ... Yang, Y. H. (2018). Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Ophthalmology, 125(8), 1239-1250. https://doi.org/10.1016/j.ophtha.2017.12.011

Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. / Wu, Pei Chang; Chen, Chueh Tan; Lin, Ken Kuo; Sun, Chi Chin; Kuo, Chien Neng; Huang, Hsiu Mei; Poon, Yi Chieh; Yang, Meng Ling; Chen, Chau Yin; Huang, Jou Chen; Wu, Pei Chen; Yang, I. Hui; Yu, Hun Ju; Fang, Po Chiung; Tsai, Chia Ling; Chiou, Shu Ti; Yang, Yi Hsin.

In: Ophthalmology, Vol. 125, No. 8, 01.08.2018, p. 1239-1250.

Research output: Contribution to journalArticle

Wu, PC, Chen, CT, Lin, KK, Sun, CC, Kuo, CN, Huang, HM, Poon, YC, Yang, ML, Chen, CY, Huang, JC, Wu, PC, Yang, IH, Yu, HJ, Fang, PC, Tsai, CL, Chiou, ST & Yang, YH 2018, 'Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial', Ophthalmology, vol. 125, no. 8, pp. 1239-1250. https://doi.org/10.1016/j.ophtha.2017.12.011
Wu, Pei Chang ; Chen, Chueh Tan ; Lin, Ken Kuo ; Sun, Chi Chin ; Kuo, Chien Neng ; Huang, Hsiu Mei ; Poon, Yi Chieh ; Yang, Meng Ling ; Chen, Chau Yin ; Huang, Jou Chen ; Wu, Pei Chen ; Yang, I. Hui ; Yu, Hun Ju ; Fang, Po Chiung ; Tsai, Chia Ling ; Chiou, Shu Ti ; Yang, Yi Hsin. / Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. In: Ophthalmology. 2018 ; Vol. 125, No. 8. pp. 1239-1250.
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AU - Chen, Chueh Tan

AU - Lin, Ken Kuo

AU - Sun, Chi Chin

AU - Kuo, Chien Neng

AU - Huang, Hsiu Mei

AU - Poon, Yi Chieh

AU - Yang, Meng Ling

AU - Chen, Chau Yin

AU - Huang, Jou Chen

AU - Wu, Pei Chen

AU - Yang, I. Hui

AU - Yu, Hun Ju

AU - Fang, Po Chiung

AU - Tsai, Chia Ling

AU - Chiou, Shu Ti

AU - Yang, Yi Hsin

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N2 - Purpose: To investigate the effectiveness of a school-based program promoting outdoor activities in Taiwan for myopia prevention and to identify protective light intensities. Design: Multi-area, cluster-randomized intervention controlled trial. Participants: A total 693 grade 1 schoolchildren in 16 schools participated. Two hundred sixty-seven schoolchildren were in the intervention group and 426 were in the control group. Methods: Initially, 24 schools were randomized into the intervention and control groups, but 5 and 3 schools in the intervention and control groups, respectively, withdrew before enrollment. A school-based Recess Outside Classroom Trial was implemented in the intervention group, in which schoolchildren were encouraged to go outdoors for up to 11 hours weekly. Data collection included eye examinations, cycloplegic refraction, noncontact axial length measurements, light meter recorders, diary logs, and questionnaires. Main Outcome Measures: Change in spherical equivalent and axial length after 1 year and the intensity and duration of outdoor light exposures. Results: The intervention group showed significantly less myopic shift and axial elongation compared with the control group (0.35 diopter [D] vs. 0.47 D; 0.28 vs. 0.33 mm; P = 0.002 and P = 0.003) and a 54% lower risk of rapid myopia progression (odds ratio, 0.46; 95% confidence interval [CI], 0.28–0.77; P = 0.003). The myopic protective effects were significant in both nonmyopic and myopic children compared with controls. Regarding spending outdoor time of at least 11 hours weekly with exposure to 1000 lux or more of light, the intervention group had significantly more participants compared with the control group (49.79% vs. 22.73%; P < 0.001). Schoolchildren with longer outdoor time in school (≥200 minutes) showed significantly less myopic shift (measured by light meters; ≥1000 lux: 0.14 D; 95% CI, 0.02–0.27; P = 0.02; ≥3000 lux: 0.16 D; 95% CI, 0.002–0.32; P = 0.048). Conclusions: The school-based outdoor promotion program effectively reduced the myopia change in both nonmyopic and myopic children. Outdoor activities with strong sunlight exposure may not be necessary for myopia prevention. Relatively lower outdoor light intensity activity with longer time outdoors, such as in hallways or under trees, also can be considered.

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