My wife is co-authoring a review paper on this topic with the group from Zhongshan. The rise in myopia prevalence is really quite staggering, especially among asians.
It's a long article, but the essential point is that insufficient time spent in bright light >10k lux (roughly corresponding to being in shade on a bright day) during early childhood increases the risk of developing myopia.
Normal eye growth requires dopamine which is released in a circadian fashion, which requires exposure to bright/daylight. Absence of this dopamine cycle may cause the eyeball to be more elongated, leading to refractive errors.
The precise number of hours needed to prevent myopia is difficult to say, but studies in schools with even 40-mins extra have shown benefit, and there's some evidence supporting 3+ hours/day.
Importantly, it doesn't seem to matter how much close-focal work kids do, such as computer use/studying, as long as they spend sufficient time in bright light. I'd consider setting up a study desk in front of a large window, and taking breaks at school outdoors instead of inside.
Did anyone compare the data from this paper with the development of myopia in northern countries (e.g. Finland), where winters are dark and kids (and adults as well) would probably get only a few hours of sunlight per day (in contrast, summers are very bright)?
While myopia was not associated with the month of birth, there was a trend towards a higher prevalence of myopia among conscripts living above the Arctic Circle, consistent with the hypothesis that ambient lighting might influence
refractive development.
Do we know if it's related to the UV spectrum of the light(e.g. is this equivalent to sunlight's properties w/r to vitamin D), or is the eye exposure mostly about the visible spectrum?
What about distant focal work (focusing your eyes on clouds, etc)? It's weird that illumination should have an effect and training focus variation doesn't?
I don't know, I'm looking at the other side of my room right now and I can definitively see a lot of difference (additional blur) by trying to extend my depth of field. Maybe I'm focusing past infinity though.
Would the rise of wearing sunglasses during the last 50 or so years might have any effect as well, I wonder? After all, the eye presumably responds the same whether it's getting insufficient light because someone is indoors or because that person is outside but shielding it from >10k lux light with tinted shades.
Cecil Adams, of 'The Straight Dope' fame, once answered a question related to perceived vision of sitting close to TV inducing myopia [1]. Although, he plainly refuted this as a possible cause, but he cites a study where the correlation suggests that it might be the "product of our civilization".
> 'The most striking demonstration of this was a study in the late 60s of eyesight among Eskimoes in Barrow, Alaska. These people had been introduced to the joys of civilization around World War II. The incidence of myopia in those age 56 and up was zero percent; in parents age 30 and up, 8 percent; in their children, 59 percent.'
Because this is still a new, and somewhat controversial idea, and the article spent a lot of time considering the alternatives and explaining why their proposed idea seemed to fit the data best. Without it there would be no reason to take their idea as more credible.
Now I dislike pointlessly long articles, and certainly this article could have used with an abstract to put forward the main thesis before delving into alternatives, but I don't think your criticism is entirely fair. It certainly didn't fit the pattern of the really long articles where the writer invariably talks about their childhood or some other barely relevant events before actually talking about the issue at hand.
Haha no. If the article was written to be maximally useful then it would have mentioned the conclusion in the first two sentences rather than buried somewhere near the end. Clearly the incentives of the writer and magazine are not aligned with those of the reader.
Oh boy. Go on scholar.google.com and search for "lens-induced myopia", "axial elongation eyeball", "near induced transient myopia", "pseudo myopia". How myopia happens has already been figured out, hundreds of times over, over the past 4 decades. It's in the major ophthalmology journals at least a few times a year. Researching what caused myopia, low light, just plain silly in 2015. ;-)
See gettingstronger.org, frauenfeldclinic.com, myopia.org, etc. Absolutely reversible. No economic benefit. How is it going to be popular if there's nothing to sell? :) Pills, more pills, that's how most non-acute conditions are dealt with.
Not all cases of myopia are caused by misshapen eyeballs. There are a few other conditions which can cause nearsightedness. Some will correct on its own, others can be corrected by some eye exercises. This would explain why some people have success with these methods.
However, if myopia is caused by misshapen eyeballs (the usual cause), then none of those exercises have been observed to be effective in any way.
And don't use argument of no economic benefit. There is always something to sell. See the middle link you have posted which is selling a $150/mo subscription to "reverse myopia"
Heh. Yea no offense taken. I made the account specifically to comment on this topic.
Myopia.org is not pretty, but scammy, I dunno. And gettingstronger.org, look around there. It's not even a site about myopia, but he has some very relevant insights. Forum with a zillion posts discussing the topic. Also he sells nothing on there. So where's the scam potential? And Frauenfeld on "about myopia" has a ton of clinical research references. There is a giant PDF on that page with just about everything worth knowing about myopia.
If it matters most what the sites "look" like, sure. Not Apple.com, no quick fix answers. This topic does require some reading to find meaningful insights.
myopia.org:
first impressions, timecube. Second impressions: wait, myopia isn't inherited? There are 18 loci on 15 chromosomes that are associated with myopia. Carriers of these genes are 10x as likely to have myopia. Bullshit meter for the site is off the scale. Does the same person who writes that site write homeopathic guides? Wait, let's see what else is linked to. Oh, some bullshit cholesterol pills! And on all cholesterol products, "We are currently not supplying this item due to quality issues at the supplier's factory."
And cataract drops! "Carnosine (β-alanyl-L-hystidine), and its topical prodrug formulation N-acetylcarnosine (NAC), is advertised (especially on the internet) to treat a range of ophthalmic disorders associated with oxidative stress, including age-related and diabetic cataracts. No convincing animal studies or masked clinical trials have been reported"
This dude is a snakeoil salesman. The myopia.org site is just the bait.
gettingstronger.org: it has some, hm, interesting opinions that's for sure. He's a chemical engineer and philosopher, though, so not .. quite .. sure about his clinical expertise, especially with regard to myopia. No ads, not selling anything (on the surface) except his slightly-out-there ideas.
Frauenfeld Clinic: with clinic in the name, you immediately think it's run by a doctor -- right? Welllllll.... it was launched seven years ago by a "holistic ophthalmology practitioner" that signs his posts only with "Alex;" The current curator is "Jake Steiner," who claims to have fixed his own myopia with "this amazing program." His training in the area is self proclaimed as, "[...] tak[ing] dozens of classes in ophthalmology, stud[ying] optometry, and read[ing] tens of thousands of pages of myopia studies" His consults start at $10k.
Did you read the PDF with a whole lot of the interesting research on the subject? Pretty brilliant stuff there, and not related to selling of anything. Can't comment on Steiner consults, didn't see any way to actually buy or pay - looked to me more like a way to say "go ask somebody else", if I remember.
Also gettingstronger isn't very much out there on the myopia topic at all. Check out scholar.google.com and just type in the keywords that Todd talks about. That's some pretty established premises, that hardly anybody is arguing against.
My point was to suggest some ways to work out the myopia problem. I for one used to depend on -3.00 glasses that I haven't needed in a few years, thanks to the ideas on those and other sites like it. It is fascinating how often it's more about being right, than looking into options (which can't really point at you there, you clearly looked at the sites). Pseudo myopia, near-induced transient myopia, lens-induced myopia, those are all very key pieces to the puzzle. The concept of the "dynamic eye", which changes specifically based on sight and focal plane, is another.
Put it all together, and you aren't necessarily stuck with glasses forever. :)
>There are 18 loci on 15 chromosomes that are associated with myopia. Carriers of these genes are 10x as likely to have myopia.
That is pathological myopia. Most myopia is not pathological myopia and is not inherited. (did you even read the article?) The site is bullshit, but so is your comment.
Mentioned in the article, too: Sitting in the shadow with sunglasses on a sunny day: >10000 lux, typical indoor/office: 500 lux.
So, while much brighter than a candle, this can not be compared at all to sunlight.
I was paid for the word once and let me tell you, if they said 1500-2000 words, you can guess which end of the range I took.
But that situation was very rare and in the other five or six jobs I've had in the journalism world, it hasn't been the case. And in fact journalistic style is to pack as much into the first sentence as you can. This is a long, analytical feature piece by a major journal's news department. If you want the brief version, find a rewrite by AP or a blog.
Is this actually true? It's pretty hard to believe, I honestly feel like you pulled it out of your ass, but it's also possible I'm totally out of touch.
This article is a "feature" (not entirely sure what that implies) in a scientific journal (targeted towards a relatively general audience, compared to other scientific journals). Is this particular publication, or this type of publication, known to pay by the word?
Which other publications pay by the word?
Is it more common in some areas of publication than others?
How could such an incentive-perverting mechanism not have died off by now?
Do any companies still pay/evaluate their developers by lines of code written?
I used to work in newspapers and it's still pretty common in that industry. But they also usually give you a word count to hit, so it's not like you can just write yourself a Mercedes.
In my experience, big sites that crank out short articles like the Atlantic online, Slate, and Vice pay a set rate per piece, but longer-form outlets like Aeon and Nautilus pay per word. I've never written for a print-only magazine but I've heard that they still pay per word by and large. And I should add, the academic journals I've written for pay nothing at all!
All right. What you don't want to do is increase artificial light intensity. A big part of the issue is the light spectrum and distribution of it. There is a pretty easy way to test / verify this, if you have an eye chart handy. Compare your acuity in outdoor, shaded light, to a solely fluorescent lit environment. Once you get to where you can barely make out the line, note the difference in acuity natural vs. artificial light.
Also, the minus lens creates focal plane stimulus inside the eye that prompts axial elongation. Lots of studies on this subject, it's basically uncontested. What you really don't want to be doing is wear a lens that gives you sharp distance vision, while working up close. You want to have a specific reduced prescription for close-up, that just gives you correction to the distance you need.
Breaks, also. Initial myopia is a ciliary (focusing muscle) spasm. Lots of studies there too, look for pseudo myopia or NITM (near induced transient myopia). Part of your current deficiency is ciliary, part is axial elongation. Take an hour break every three hours. Get outside. Focus at a distance. Your ciliary muscle isn't meant to be all tensed up (close-up use) all day.
For more on the subject, take a look at www.frauenfeldclinic.com, those guys are fairly awesome.
> Compare your acuity in outdoor, shaded light, to a solely fluorescent lit environment
The amount of light in the shade outdoors, or on an overcast day, is around 12 EV [1]. A bright indoors office with fluorescent lights is around 8EV. This means that the human eye will be receiving 16 times more light in the outdoor shade, compared to even a bright indoors room. That's a big difference that has nothing to do with the source of the light.
Common sense also dictates that fluorescent lights did not get popular in homes until the last 10 years due to the rise of CFLs, and yet kids grown up in the 1970s have increased myopia rates- the source of the myopia therefore cannot be due to the indoor lights.
> About one-fifth of university-aged people in East Asia now have this extreme form of myopia, and half of them are expected to develop irreversible vision loss.
Which means that 10% of university-aged people in East Asia are going to develop irreversible vision loss. This sounds too terrible to be true. Am I missing something here? I interpret vision loss as blindness, but maybe it is used to describe degraded vision instead?
I have wondered why the eye stays elongated. My quest for answers has been from dubious sources on the internet and so everything said below is suspect. It is all based on reasoning and thoughts from potentially bad information.
I read that the eyeball is a sack filled with a viscous fluid, and therefore, its shape is determined by the eye muscles. I determined the viscosity of the eye fluid is thicker than water, but less than motor oil. The idea behind the eye muscles is that near work puts tension on the muscles and they stiffen up and thus elongate the eyeball. So now I wonder why the eye muscles don't relax. Surely, a good night’s sleep or two would do the trick. Could the eye muscles return to their proper position by not wearing my glasses and spending more time focusing on distant objects? After about 3 years of experimenting with this thought, my vision has not improved. But I work indoors in front a computer everyday with glasses on. I have read the eyes muscles lack any counter force to pull the eyeball back into shape. Perhaps the eyeball shell has grown deformed and it is stiff enough to hold the shape. Maybe the eye socket determines the shape. Maybe the eye muscles have nothing to do with the shape. I would like to think that there is some corrective measure built into the eye system. Otherwise, it would seem everybody's eyes are on a one-way trip to becoming myopic and only the speed of this transition can be affected. I know that for me, I wore my glasses all the time, even when I was reading. Looking back, when I was first diagnosed, I really only needed them to play baseball at night under the lights. I sort of wished that was the only time I wore them. I wonder if my eyes could have corrected themselves. Now it seems too late, because I need to wear them just to read a computer screen 18" away. I have also read that wearing glasses forces your eyes to focus at a close up distance. So wearing glasses is like doing near work all the time and thus puts you on the fast track to becoming more myopic. After all this rambling, I guess the real question is what is keeping the eyeball in the wrong shape? If this were known, then maybe one could figure out how to fix the condition. As a final note, I have also read that maybe the eye ball is not elongated, but that the cornea is not shaped correctly.
I have thought about this myself, but I thought that elongation being permanent or difficult to reverse was intuitive. If you stretch a piece of a plastic it stays that way.
I believe the prevailing theory is when you focus near, your lenses expand pushing on the aqueous humor, causing expansion of the eyeball. When you focus far, they shrink, but these lenses don't pull the eyeball back in because they aren't connected to the front or back of the eyeball. This is why people with myopia often have increased intraocular pressure. I don't understand how this fits in with the findings in this article though.
I have never heard of anyone becoming less nearsighted. And even presbyopia is simply when your lens cannot change anymore, it doesn't actually shrink your eyeballs.
It seems like the optical industry is content with making a lot of money constantly prescribing stronger glasses every year or lasik which has significant risks and doesn't stop the elongation.
Whoever cracks this problem will make a lot of money. But shrinking eyeballs is probably a very difficult task and easier and very profitable to just fix the symptoms. And most people don't become blind from this so it doesn't seem like a priority.
> I have thought about this myself, but I thought that elongation being permanent or difficult to reverse was intuitive. If you stretch a piece of a plastic it stays that way.
May be different for living tissue. I wonder if there might be some brace developed to reshape the eye ball, that could be eventually removed. Of course the implant procedure might be incredibly, prohibitively invasive.
I can add my anecdotal experience as well. On Windows XP, the default refresh rate for CRT monitors was set low, to avoid burning out those that couldn't handle more.
It took me two years to figure this out. My screen was a fuzzy mess for those two years. Had progressing myopia during that period.
Myopia stabilized after that.
Edit: Found the support doc for this. Ah, 60hz default.
Between the ages of 13 and 27 years old I spent hours every night in a dark room in front of a monitor. I started with really bad 14" CRTs and these days I have shiny LCDs.
I've been wearing glasses since I was 7 years old and my prescription hasn't changed since I was about 16. But my doctor said that it was going to keep progressing while I'm still developing then stop until I start hitting age problems.
Your timing seems to correlate well with growth spurts that people have in high school. I didn't have mine, still short. So your myopia might be less because of the bad screen and more because a lot of people first develop bad eyes when they go through puberty.
I would agree that puberty has a big effect on eyesight. I had terrible vision as a child, glasses from about 6 years old on. At 12, about the time my growth spurt kicked in and I shot from 5'5" to 6', I suddenly realized I could see fine without my glasses (which was fantastic, since that was when I started playing basketball a lot, and gah, RecSpecs...) I've had roughly 20/20 vision since.
Did you also not spend time outside? The article says that time spent at low light reading or using a computer doesn't affect myopia if you also spend time outside in high light conditions.
Same thing, around the same age. A somewhat famous ophthalmologist who did a decent amount of research insisted to my mother, at the time, that there was no statistical correlation between CRT use and myopia. Interesting to see the consensus move since then...
I was never much of an outdoors-type kid. I spent much of my early childhood basking in the warm, green glow of an Apple ][ monochrome display (had to be torn away from it periodically and forced to go outside), and so I had to start wearing glasses in the 2nd grade. Today, my eyeglass prescription is -8.50D. Though it's at least been stable for the last 10 years or so.
My mother is also a programmer and has horrible eyesight as well, but she grew up on a farm and had never even seen a computer prior to college, so maybe my myopia is mostly inherited.
I was using a good CRT the Apple eMac. At one point it stopped showing colors properly, red of RGB came and went. Started using another CFL monitor more often.
I was 18 so around that time I started college and used iMacs and those gray standalone screens that matched G4 towers. All the lighting in computer labs came from fluorescent lights. And all those screens were CFL backlit.
This is when I started having pain in my eyes and became nearsighted. Only needed 0.5 correction at first, progressed to 3.5 since then.
I became curious about this when I became significantly less short-sighted during each of my years of maternity leave. A few more kids and I won't need glasses any longer :-) Indeed, I spent much more time outside while on maternity leave than when I was working.
I've always thought eyes work remarkably well for something hacked together out of meat and jelly. I guess part of that is probably a feedback mechanism where the growth of tissue is effected by where the image is focused. Presumably staring at books throws off the mechanism that evolved for gazing at the scenery. Guess it needs bright light to work?
10000 lux is something achievable with 100W of LED light.
Why not, instead of limiting children exposure to computers and kicking them outside, just paint the wall behind their computer white and point 100W worth of LEDs at it?
I'm sure (s)he will spend at least 3 hours per day in that environment without trauma associated with forcefully exposing the child to boredom of outside.
EDIT: Yes, yes. I know. Being outside and kicking ball has lots of other benefits. But still... People are not doing it today despite potential obesity that predictably can kill you and they won't start doing it due to potential myopia that will force you to wear glasses. So why not go with pragmatic solution?
I feel like there should be some other correlates if light is a dominating factor, such as between geography and myopia (should see some trends around super-cloudy vs. super-sunny areas).
I was home schooled through fourth grade. Lots of time spent outdoors, even on school related things (setting up little rubber army men in the sandbox when studying the revolutionary war, for example). My eyesight was quite good, despite spending quite some time on the computer (balanced, of course, with out-door activities).
Half-way through my first year in public school, I needed glasses. My eyesight went from 20/20 to ~20/80 in less than five months. 20 years later, it's around 20/300 - though fairly stable for the last ten years.
If you don't wear glasses (or contact lenses) then you are in a minority. I am in this minority and I find it worrying. Who would have thought that all of those long walks home would be beneficial?
I think that cycling helps my eyesight. If I cycle in to town then, for survival reasons, I am fully testing out my eyes. It does not matter what time of day this is, going through traffic or rolling home late at night on empty roads, I am really working those eyes. I get to look to the far horizon as well as those quick glances over the shoulder. Thinking about it, I cannot think of a better eye exercise!
As well as the normal light I also get enhanced levels of UV reflected from the road during the summer months.Normally we try to bar UV with glazing so I am just rebalancing the spectrum if non-visible light is bouncing off the tarmac.
So, if I was calling the shots here on planet earth I would mandate that all children cycle to school. For comedy value I would make the punishment for those that drove their kids in be harsh - eyes scooped out and donated to medical science. For now, in the run up to the introduction of that I would want public information campaigns that just tell parents that driving their kids to school makes them go blind, which is totally true.
It's a good question, but it seems unlikely to be feasible given that "a well-lit office or classroom is usually no more than 500 lux."
I have a hard time believing that it's 20 times brighter outside than inside, but then again I have no issues seeing my phone's or laptop's screen indoors, while it's almost impossible outside (even in the shade) to see anything.
Let your eyes fully adapt to the dark every evening before you go to sleep. (takes about half an hour) You may need to get thicker curtains, depending on where you live.
What difference will the darkness make? I only read about this 10000 lux of natural light exposure scarcity. Don't we get the needed darkness by sleeping?
I was diagnosed with myopia at around 7 years of age. I had -1. I went and got prescription glasses. The guys there fudged it up and gave me +1. I wore those for more than a year, but I could not, for the love of me, see with them. My parents were FURIOUS I did not wear them. I kept telling them I couldn't actually see anything with them. They made things worse. But no dice, they thought I was just being stubborn. Anyways, I get another checkup after a year, they realized the error.
On the second checkup, I had -1,75. Either the +1 glasses exacerbated my myopia, did nothing for it, or actually helped curve it, I could not say. I think it made things worse. And it was a pain in the ass having to wear something that made things worse and have people lash on me because they thought I was just being stubborn by not wearing them.
With plus lens therapy, you only wear the plus lens while doing close work. If you were wearing the plus lenses while looking more than a few feet away, you wouldn't be doing plus lens therapy.
I laughed to myself after reading the first few paragraphs. When I saw the image of young Chinese students I immediately thought of the literary use of myopia, not the medical condition. Given the source of the article was “Nature”, I assumed it was an article about the Chinese exploitation of natural resources for the sake of short term profits and the destructive effect on the environment; hence, myopia. Is that irony?
Kaisu. She's a bit nutty perhaps, but knows what she is talking about. Only works before you start to get into more than pseudo myopia (since at that point you just can't see anything with a plus lens).
Since a lot of people are chiming in with anecdotal evidence I'll add some of my own.
There's circumstantial evidence to suggest that eating white rice can exacerbate myopia. And asians eat lots of white rice. I found my eyesight deteriorating and cut white rice out of my diet. I think it's stopped now.
Not to mention, myopia in Asia is the prevalent in dense populated areas such as Singapore, South Korea or Japan where rice consumption per capita is lower than anywhere else in south-east Asia since they can afford more variety of food when compared to Vietnam, Thailand or Philippines.
You could almost make an opposite case that rice consumption decreases myopia but most likely there is no link whatsoever.
I think I got lots of sunlight as a kid but I don't think I slept properly so my circadian rhythm was disrupted all the time. I blame it on getting up early for school and sleeping late because of David Letterman.
One could easily find a correlation between my need for glasses and the time at which I (and a lot of others) began using computers heavily, like being on a computer for more than 8 hours a day.
I, on the other hand, started using a computer heavily about 5 years after getting my first pair of glasses. Some of it is just genetic and not all myopia is preventable with just more time outside.
More time with computers is less time spent outside. Also, it might be a certain age when people start using computers (like when they have learned to read).
I always wondered why I had an entire childhood of obsessive close work (computer, Lego, drawing, etc.) yet have better vision than my parents had at my age. I don't know if computer screens are bright enough to have a protective effect, but I did grow up in a culture insistent on kicking kids out of the classroom for breaks no matter the weather.
It's a long article, but the essential point is that insufficient time spent in bright light >10k lux (roughly corresponding to being in shade on a bright day) during early childhood increases the risk of developing myopia.
Normal eye growth requires dopamine which is released in a circadian fashion, which requires exposure to bright/daylight. Absence of this dopamine cycle may cause the eyeball to be more elongated, leading to refractive errors.
The precise number of hours needed to prevent myopia is difficult to say, but studies in schools with even 40-mins extra have shown benefit, and there's some evidence supporting 3+ hours/day.
Importantly, it doesn't seem to matter how much close-focal work kids do, such as computer use/studying, as long as they spend sufficient time in bright light. I'd consider setting up a study desk in front of a large window, and taking breaks at school outdoors instead of inside.