The DOI matches its Crossref record; 27 of the 27 references it cites were found in a registry or an index.
Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial
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.
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Citations
Cites
Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050
Holden, B. A., Fricke, T. R., Wilson, D. A., Jong, M., Naidoo, K. S., Sankaridurg, P., Wong, T. Y., Naduvilath, T. J., & Resnikoff, S. (2016) · Ophthalmology · doi:10.1016/j.ophtha.2016.01.006 · Cited by 5,500
Outdoor Activity Reduces the Prevalence of Myopia in Children
Rose, K. A., Morgan, I. G., Ip, J., Kifley, A., Huynh, S., Smith, W., & Mitchell, P. (2008) · Ophthalmology · doi:10.1016/j.ophtha.2007.12.019 · Cited by 1,335
Myopia and associated pathological complications
Saw, S., Gazzard, G., Shih‐Yen, E. C., & Chua, W. (2005) · Ophthalmic and Physiological Optics · doi:10.1111/j.1475-1313.2005.00298.x · Cited by 1,098
He, M., Xiang, F., Zeng, Y., Mai, J., Chen, Q., Zhang, J., Smith, W., Rose, K., & Morgan, I. G. (2015) · JAMA · doi:10.1001/jama.2015.10803 · Cited by 1,076
Parental History of Myopia, Sports and Outdoor Activities, and Future Myopia
Jones, L. A., Sinnott, L. T., Mutti, D. O., Mitchell, G. L., Moeschberger, M. L., & Zadnik, K. (2007) · Investigative Opthalmology & Visual Science · doi:10.1167/iovs.06-1118 · Cited by 769
Efficacy Comparison of 16 Interventions for Myopia Control in Children
Huang, J., Wen, D., Wang, Q., McAlinden, C., Flitcroft, I., Chen, H., Saw, S. M., Chen, H., Bao, F., Zhao, Y., et al. (2016) · Ophthalmology · doi:10.1016/j.ophtha.2015.11.010 · Cited by 752
Self-citationOutdoor Activity during Class Recess Reduces Myopia Onset and Progression in School Children
Wu, P.-C., Tsai, C.-L., Wu, H.-L., Yang, Y.-H., & Kuo, H.-K. (2013) · Ophthalmology · doi:10.1016/j.ophtha.2012.11.009 · Cited by 688
Self-citationHuang, H.-M., Chang, D. S.-T., & Wu, P.-C. (2015) · PLOS ONE · doi:10.1371/journal.pone.0140419 · Cited by 617
Self-citationCauses of Blindness and Visual Impairment in Urban and Rural Areas in Beijing
Xu, L., Wang, Y., Li, Y., Wang, Y., Cui, T., Li, J., & Jonas, J. B. (2006) · Ophthalmology · doi:10.1016/j.ophtha.2006.01.035 · Cited by 608
Role of Near Work in Myopia: Findings in a Sample of Australian School Children
Ip, J. M., Saw, S.-M., Rose, K. A., Morgan, I. G., Kifley, A., Wang, J. J., & Mitchell, P. (2008) · Investigative Opthalmology & Visual Science · doi:10.1167/iovs.07-0804 · Cited by 595
Cited by
Prousali, E., Haidich, A.-B., Fontalis, A., Ziakas, N., Brazitikos, P., & Mataftsi, A. (2019) · BMC Ophthalmology · doi:10.1186/s12886-019-1112-3 · Cited by 75
Metadata
- Authors
- Wu, P.-C., Chen, C.-T., Lin, K.-K., Sun, C.-C., Kuo, C.-N., Huang, H.-M., Poon, Y.-C., Yang, M.-L., Chen, C.-Y., Huang, J.-C., Wu, P.-C., Yang, I.-H., Yu, H.-J., Fang, P.-C., Tsai, C.-L., Chiou, S.-T., & Yang, Y.-H.
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2018-08
- Volume
- 125
- Issue
- 8
- Pages
- 1239-1250
- ISSN
- 0161-6420 (ISSN-L)
- OpenAlex
- W2782805558
- Cited by
- 574
- References
- 27
- FWCI
- 33.75
- Type
- journal article
- Language
- en
- Open access
- closed
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- Wu, P.-C., Chen, C.-T., Lin, K.-K., Sun, C.-C., Kuo, C.-N., Huang, H.-M., Poon, Y.-C., Yang, M.-L., Chen, C.-Y., Huang, J.-C., Wu, P.-C., Yang, I.-H., Yu, H.-J., Fang, P.-C., Tsai, C.-L., Chiou, S.-T., & Yang, Y.-H. (2018). Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. Ophthalmology. https://doi.org/10.1016/j.ophtha.2017.12.011
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