How to get more outdoor time in winter to manage myopia?

Spending more time outdoors cuts down the risk of myopia and its progression. Tips for more outdoor time in winter: form playgroups, expose to daylight through skyroof, schedule the time in, and more. 

Are you a parent of a child with myopia? Did you know that children’s myopia worsens faster during the winter?

Research has shown that myopia progression is faster in winter. A 2014 study in the US found that myopia progressed at a rate of -0.35D in the winter compared to -0.14D in the summer in children aged 6 to 12 with myopia. The researchers indicated that the slower myopia progression in the summer was likely related to spending more time outdoors and less time indoors doing near work.¹ This trend has also been observed in several other studies involving children from Asia and Europe.

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.²

So, today, let’s discuss how we can get more outdoor time in winter.

The benefit of outdoor time for myopia

Outdoor time has a beneficial impact on myopia, especially when it comes to reducing the risk of its onset. Multiple studies consistently demonstrate that increasing the amount of time children spend outdoors can lead to a decrease in the likelihood of developing myopia.

A meta-analysis that compiled data from five randomized control trials, involving more than 3,000 children, investigated the influence of outdoor time on myopia. The results were compelling – outdoor time reduced the risk of myopia and its progression. Children who spent more time outdoors exhibited a slower change in refractive error, up to a 26% reduction, and a 24% reduction in axial length. In simple terms, it means outdoor time is effective in controlling myopia.³

In a 2017 study that looked at 693 grade one students from 16 schools, those who spent at least 11 hours per week outdoors in the presence of ≥ 1000 - 3000 lux of light experienced decreased myopia progression and axial elongation.⁴

The Refractive Errors Preferred Practice Pattern 2022 by the American Academy of Ophthalmology emphasized the significance of increased outdoor time and summarized studies reviewed, "increasing time spent outdoors significantly decreased risk of myopic progression."⁵

The International Myopia Institute also recommended that school children engage in at least 80-120 minutes of outdoor activities daily to reduce the development of myopia. This underscores the important role that we, as a parent, can play in ensuring our child gets the outdoor time they need for the benefit of their eye health and myopia.⁶

So, how can we ensure our child can get more outdoor time in winter?

Practical strategies for more outdoor time in winter

In an online survey, parents reported several challenges in encouraging their children to spend more time outdoors, including weather, scheduling, and digital device preference.⁷ Some good news is that these challenges could be mitigated with effective strategies and by acknowledging that exposure to daylight exceeding 1000-3000 lux is an important driver.⁴ 

A. Environmental barriers

Weather and cold temperatures can deter outdoor activities in winter. As a parent, you can:

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• Help facilitate neighborhood children to play together consistently outdoor play after school.  
• Ensure your children are dressed warmly in jackets, sweaters, and pants. On snowy days, provide appropriate snow gear like snow jackets, pants, gloves, and boots.
• Go window shopping in a mall with a sky roof or visit a garden center with one.
• Take your children out in a car with a sunroof window during errands or for joyrides.
• Set up an activity room with large windows and good lighting, or potentially even a sunroom.

B. Conflicting schedules and activities after school

After-school schedules and activities can make outdoor time a challenge, but as a parent, you can overcome this by:

• Reserving outdoor time after school on schedule, especially considering that the winter days grow dark quickly.
• Walking to school (and back) or heading to the school bus stop a bit earlier to soak up some daylight before the school day begins.
• Encouraging your child to have their lunch break and recessive outdoor.
• Participating in outdoor after-school activities, such as soccer, baseball, or scout programs, as alternatives to indoor-based options.
• Planning family outdoor weekend activities, like countryside hikes or trips to botanical gardens and wildlife sanctuaries, to make the most of your time together.

C. Preference for digital device use

Digital devices and near-vision activities can compete with outdoor time. Some successful tips include:

• Fostering outdoor play with neighborhood children after school. Having fun with friends is just not the same. Some positive peer encouragement can help your child set aside their device.
• Setting limits on digital device usage, allowing 30 minutes to one hour of screen time per day or even no screen time on certain days.
• Using outdoor time as a reward for the right to use digital devices.

(Learn more about how to use an outdoor activity tracker to help.)

Conclusion

As a parent of a child with myopia, you play a vital role in managing your child's myopia and promoting their overall eye health. Spending more time outdoors during the winter months can make a difference. By implementing the practical strategies mentioned here, you can help your child get more outdoor time in winter. 

Plus, who knows, maybe while getting more outdoor time, you'll also discover who is the next snowball-throwing champion!

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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. 

3. Cao, Kai et al. “Significance of Outdoor Time for Myopia Prevention: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials.” Ophthalmic research vol. 63,2 (2020): 97-105. doi:10.1159/000501937.

4. Wu, Pei-Chang et al. “Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial.” Ophthalmology vol. 125,8 (2018): 1239-1250. 

5. Jacobs, Deborah S et al. “Refractive Errors Preferred Practice Pattern.” Ophthalmology vol. 130,3 (2023): P1-P60.

6. International Myopia Institute. 2021. IMI Prevention of Myopia and its Progression. Retrieved, Oct 15, 2023. https://myopiainstitute.org/imi-whitepaper/imi-prevention-of-myopia-and-its-progression/

7. Data on file. ClearSight Health 2023.