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The association between time spent outdoors and myopia in children and adolescents: A systematic review and meta-analysis


Sherwin, JC and Reacher, MH and Keogh, RH and Khawaja, AP and Mackey, DA and Foster, PJ, The association between time spent outdoors and myopia in children and adolescents: A systematic review and meta-analysis, Ophthalmology, 119, (10) pp. 2141-2151. ISSN 0161-6420 (2012) [Refereed Article]

Copyright Statement

Copyright 2012 by the American Academy of Ophthalmology

DOI: doi:10.1016/j.ophtha.2012.04.020


Objective: To summarize relevant evidence investigating the association between time spent outdoors and myopia in children and adolescents (up to 20 years).

Design: Systematic review and meta-analysis.

Participants: Results from 7 cross-sectional studies were pooled in a meta-analysis. A further 16 studies (8 cross-sectional not meeting criteria for meta-analysis; 7 prospective cohort studies; 1 randomized, controlled trial [RCT]) were reported in the systematic review.

Methods: The literature search included 4 databases (Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials [CENTRAL]), and reference lists of retrieved studies. Estimates of association were pooled using random effects meta-analysis. We summarized data examining the association between time spent outdoors and prevalent myopia, incident myopia, and myopic progression.

Main Outcome Measures: Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for myopia for each additional hour spent outdoors per week from a meta-analysis.

Results: The pooled OR for myopia indicated a 2% reduced odds of myopia per additional hour of time spent outdoors per week, after adjustment for covariates (OR, 0.981; 95% CI, 0.973-0.990; P<0.001; I2, 44.3%). This is equivalent to an OR of 0.87 for an additional hour of time spent outdoors each day. Three prospective cohort studies provided estimates of risk of incident myopia according to time spent outdoors, adjusted for possible confounders, although estimates could not be pooled, and the quality of studies and length of follow-up times varied. Three studies (2 prospective cohort and 1 RCT) investigated time spent outdoors and myopic progression and found increasing time spent outdoors significantly reduced myopic progression.

Conclusions: The overall findings indicate that increasing time spent outdoors may be a simple strategy by which to reduce the risk of developing myopia and its progression in children and adolescents. Therefore, further RCTs are warranted to investigate the efficacy of increasing time outdoors as a possible intervention to prevent myopia and its progression.

Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Ophthalmology and optometry
Research Field:Ophthalmology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Mackey, DA (Professor David Mackey)
ID Code:83028
Year Published:2012
Web of Science® Times Cited:250
Deposited By:Medicine
Deposited On:2013-02-27
Last Modified:2017-11-07
Downloads:1 View Download Statistics

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