Children's myopia tends to worsen more rapidly in winter. To effectively manage myopia in winter, adhere to myopia control treatments, prioritize good eye habits, and adapt the lifestyle and environment.
Did you know that studies have found that for nearsighted children across different countries, their vision may worsen faster in winter?
In a 2014 study conducted in the US among ethnically diverse 6 to 12-year-old children with myopia, their myopia was associated with faster progression in winter. The mean spherical error progression was -0.35D (winter) vs. -0.14D (summer). The researchers indicated it was likely related to spending more time outdoors -- less time indoors doing near work -- in the summer.1 Similar results were reported in other studies conducted on Asian and European children.
The European Society of Ophthalmology and the International Myopia Institute highlighted in their 2021 guidance on myopia management that studies have revealed a faster progression of myopia during the darker winter months compared to the brighter summer months.2 This observation aligns with research results demonstrating that spending time outdoors can lower the risk of myopia, primarily because it leads to greater exposure to daylight.
Darker winter is concerning and is an obstacle to myopia control for our little ones.
Eight tips to effectively manage myopia in winter
The challenges during winter are it is cold outside, the day is shorter, and our homes may not be as well-lit. All of these may obstruct adherence to the myopia control intervention, ultimately impacting how well we can keep myopia from progressing for our children. Here are eight practical tips to manage myopia in winter:
1. Myopia control treatment
Over a year ago, my son started his treatment with a combination of atropine 0.05% and Ortho-K. Further, by ensuring he spent 80 to 120 minutes outdoors daily in conjunction with his combination treatment, we observed that his myopia did not progress when we had our check-up this spring.
According to meta-analysis studies, myopia control treatments, including atropine eye drops, specialized soft contact lenses, overnight contact lenses, and myopia control glasses, are among the most effective methods for preventing myopia from worsening. These options should serve as the cornerstone of treatment to manage myopia in winter.
2. Plan out outdoor time
Ensuring an adequate amount of outdoor time on weekdays can be challenging due to the shorter daylight hours in winter compared to summer. To tackle this challenge, my son and I use an outdoor activity tracker to help effectively manage and monitor of his outdoor activities. Through this tool, we've found that an effective approach involves encouraging my son to spend approximately 1.5 hours playing with his friends in our neighborhood immediately after school. Playing with friends in the community not only motivates regular outdoor play but also makes time pass quickly, even in chilly weather.
On days when it's rainy or my son's energy level is low, we have alternative strategies in place. He can sit under the porch or in front of the garage, where he can listen to audiobooks or engage in verbal games while ensuring he receives adequate daylight exposure -- more than 1000 - 3000 lux.3 Wearing a warm winter jacket with a hoodie also helps him stay comfortable in the cold weather.
3. Appropriate digital device use
Continue to maintain and limit recreational viewing on digital devices, encompassing smartphones, tablets, and computers. Additionally, ensure that these devices are held at a distance of approximately 12 inches (30 cm) from the eyes,2 which is roughly the span from the fist to the elbow.
If your child uses a computer with a small screen for school, you might want to explore the option of projecting the screen onto a TV, effectively shifting from near-vision to a more distant view.
4. Take reading breaks
While 20/20/20 rule suggests taking a 20-second break every 20 minutes, looking at an object 20 feet away can help reduce digital eye strain, recent research has questioned its benefit for children already affected by nearsightedness. A new recommendation proposes taking a 5-minute break every 30 to 60 minutes to allow the eyes to rest and minimize the risk associated with prolonged near work. (Note: See the recent publication on why 20/20/20 might not be enough)
5. Minimize dry eyes
If your child uses contact lenses, they may lead to symptoms of dry eyes. During winter, heated air leads to increased tear evaporation. Dry eyes are uncomfortable and may lead to itchiness or irritation; wearing contact lenses is challenging when having these symptoms.
To help, we turn on the humidifier for a few hours each day, turn down the heater, and always have some artificial tears around. Moreover, we use ones with a preservative-free formulation as preservatives may also lead to dry eyes.
6. Improve lighting at home
A study has shown that enhancing the illuminance of classroom desks to levels exceeding 500 lux has a beneficial impact on myopia in children.4 While there is still much to uncover about illuminance in home settings, I would hypothesize maintaining an illuminance level of >500 lux around my son's study desk at home, where he engages in schoolwork and near-work activities, may be beneficial.
7. Avoid staying up
Sleep cycle and circadian rhythm were identified to be involved in myopia development.5 Several research studies showed that staying up late is associated with a higher risk of developing myopia in children.5,6 In a large 2020 study with 6,295 school-aged children, myopia progression was shown to be faster in children who slept after 9:30 pm than in those who slept earlier – the later the bedtime, the faster the progression rates.6
As the day gets shorter and colder, I find it easier to put my son in bed by 9:00 pm. However, weekends and holidays are days to watch out for as there is less pressure to wake up on time, leading to staying up later than usual bedtime.
8. Go on an outdoor trip during the weekend
Weekends are fantastic opportunities for additional outdoor time. Consider planning winter outdoor activities like skiing, hiking, clearing snow from your driveway, taking a ferry ride, visiting a zoo, or embarking on a nature scavenger hunt.
Maintaining myopia control is more challenging during winter than in other seasons. The combination of darker, colder days limits daylight exposure and tempts us toward indoor, near-distance activities. To effectively manage myopia in winter, it's crucial to adhere to myopia control treatments, maintain good eye habits, and make lifestyle and environmental adjustments for the season ahead.
So, as we gear up for winter, let's not forget: it's not just about the cold; it's also about keeping our child's eyes focused on the sunny side of life!
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1. Gwiazda, Jane et al. “Seasonal variations in the progression of myopia in children enrolled in the correction of myopia evaluation trial.” Investigative ophthalmology & visual science vol. 55,2 752-8. 4 Feb. 2014, doi:10.1167/iovs.13-13029.
2. Németh, János et al. “Update and guidance on management of myopia. European Society of Ophthalmology in cooperation with International Myopia Institute.” European journal of ophthalmology vol. 31,3 (2021): 853-883. doi:10.1177/1120672121998960.
4. Hua, Wen-Juan et al. “Elevated light levels in schools have a protective effect on myopia.” Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists) vol. 35,3 (2015): 252-62. doi:10.1111/opo.12207
5. Hysi, Pirro G et al. “Meta-analysis of 542,934 subjects of European ancestry identifies new genes and mechanisms predisposing to refractive error and myopia.” Nature genetics vol. 52,4 (2020): 401-407. doi:10.1038/s41588-020-0599-0.
6. Liu, Xiao Nicole et al. “Sleeping late is a risk factor for myopia development amongst school-aged children in China.” Scientific reports vol. 10,1 17194. 14 Oct. 2020, doi:10.1038/s41598-020-74348-7.