Every patient who comes to pediatric ophthalmologist Noha Ekdawi, MD, gets the same prescription: Spend more time outdoors. Sunlight is the best way to prevent myopia, or nearsightedness, in children.
It’s a deceptively simple response to a growing public health crisis, but it works, and not enough people know about it.
Childhood nearsightedness is on the rise
Nearsightedness in children has increased at an alarming rate over the past 30 years. It is estimated that about 40% of children ages 6 to 19 years are nearsighted; in Asia, the rate is nearly double. If nothing is done to help slow the increase, half the world’s population may be nearsighted by the year 2050.
Nearsightedness happens when the eye grows too long from front to back. As a result, people with myopia have good near vision but poor distance vision. While glasses or contact lenses can correct a child’s vision, research shows that having severe myopia puts children at risk of potentially blinding eye problems down the road, including retinal detachment, glaucoma, early cataracts and myopic maculopathy, a leading cause of blindness worldwide.
Spending time outdoors is good for the eyes
Although genetics play a role in who develops myopia, the sharp increase suggests that environmental factors may be at play. Many experts point to the combination of increased screen time and less time outdoors as factors that may put children at higher risk for developing myopia.
Why would outdoor time protect against myopia, or closeup work make it worse? It’s unclear. One idea is that sunlight increases dopamine levels in the eye, which controls the growth rate of the eye. Another theory suggests that shorter viewing distances may promote abnormal growth of the eye. Think of long periods of intense near work, whether in front of computer screen or a book, without breaks.
Whatever the cause, Dr. Ekdawi is already seeing the impact on her patients. “I’m seeing too many kids with retinal detachment,” she said. “That shouldn’t be happening.”
“The time to intervene is in early childhood because the earlier a child develops myopia, the more likely they are to develop severe myopia later in life. So, the goal is to delay the start of myopia and to slow the rate of progression so the child can avoid the worst complications of myopia, like retinal problems.”
Solutions for slowing myopia
Among the options for slowing myopia are atropine eye drops and special multifocal contact lenses.
Atropine drops dilate the pupil. It’s unclear how they work, but multiple studies worldwide have shown that low doses of atropine eye drops can slow the increase in myopia. Studies also show that a new, special contact lens can slow myopia progression. These are a daily disposable contact lens that must be fit by a specialty-trained optometrist or ophthalmologist.
Dr. Ekdawi prescribes these treatments based on a child’s age and how fast they’re progressing. But all her patients get the same prescription for sunlight. Dr. Ekdawi encourages at least one to two hours of outdoor time each day and reducing screen time to one to two hours a day.
As a mother to two middle school-aged daughters, Elizabeth and Magdalena, Dr. Ekdawi knows it’s a challenging goal. But she also knows it can be done – even in Illinois, in winter!
“You don’t have to radically change your life,” she said. “There were maybe only two to three weeks last year where we couldn’t be outside. I just got snow pants so I could be outside with them.”
Outdoor reading, screen-free zones and other strategies
Dr. Ekdawi also has her children read outside so they’ll get both the dopamine hit from the sun exposure and more opportunities to break their focus on near work. Instead of reminding them to obey the 20-20-20 rule (every 20 minutes, look 20 feet away for 20 seconds) they do it instinctively as they naturally look up at birds flying by or squirrels scurrying across the lawn. Try it, it’s kind of genius.
Inside the home, she and her husband set up screen-free zones that kids and adults alike obey. She has found that modeling healthy habits is key to getting her own children on board. “The biggest thing I’ve learned: They are watching. So I had to change my behavior, too.”
It’s a message that more parents need to hear. A recent national study found that just half of parents recognize that screen time can impact their child’s eye health.
There is increasing concern that the COVID-19 pandemic could drive myopia rates higher with the increased use of electronic devices due to remote learning. Since the pandemic, Dr. Ekdawi says she has seen more cases of dry eye, strabismus, as well as myopia.
“I know, sometimes, we don’t have a choice. It’s so easy to put your kid in front of a screen. I don’t think the TV is the devil, you just need to be more aware,” she said, noting that she let her husband put a TV in their outdoor entertainment center.
“You don’t have to be 100 percent perfect,” she said. “Just be pretty good.”