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Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial.
Ophthalmology ( IF 13.7 ) Pub Date : 2018-01-19 , DOI: 10.1016/j.ophtha.2017.12.011 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
Ophthalmology ( IF 13.7 ) Pub Date : 2018-01-19 , DOI: 10.1016/j.ophtha.2017.12.011 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
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.
更新日期：2018-01-19
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