Lifestyle change could slow down or stop myopia from getting worse. Find out how my son and I put together an actionable plan and the tools that we use.
Why treat myopia?
The obvious reason to treat myopia is to improve vision so your kid could see distant objects better. Not being able to see well may lead to low school grades, poor sports performance, or shortened attention span.
Furthermore, it is also important to control the progression of myopia. Myopia may appear between 6 and 12 years of age when your kid’s body grows quickly with a progression rate of 0.50-0.80 diopters (D) per year. Then, it slows down and levels off after the age of 20. (Learn more about optical diopter strength)
If the condition progresses to high myopia (more than -6.00D in refractive error), it may also put your kid at higher risk for other serious conditions later in life, such as cataracts, retina detachment, glaucoma, or degenerative myopia (a type of macular degeneration).
Furthermore, I have a family history of high myopia, and I am worried that my son’s eyes may progress to high myopia in a few years.
Our first step to managing myopia
Lifestyle change, contact lens, and medication are three promising ways of slowing or stopping myopia from worsening in the US. Until we find an optometrist with extensive experience in myopia management to work with, this article focused on managing his lifestyle modification.
After researching the latest ophthalmology guidelines and several review papers, I arrived at three areas to work on to manage his condition.
- Go outdoor in the daylight. Get two (2) hours of daylight every day. Research indicated that the brightness of sunlight led to the release of a hormone, dopamine, which controls the growth of the eye. Some appropriate activities include sports, gardening, a walk around the neighborhood, trail hiking, or even a picnic.
- Take a break. Myopia worsens if your kid keeps near focus for too long. For every 20 minutes looking at a screen or near work/reading, relax for 20 seconds by looking at an object 20 feet away. This is also known as the 20-20-20 rule. (You could also simply have him close his eyes for 20 seconds)
- Use digital devices appropriately. Limit device screen time to less than two (2) hours, including smartphones, tablets, or computers. Furthermore, hand-held devices viewing distance should be about 12” (30 cm) from the eyes.
Putting plans into actions
Even with clear aims of what to do, I knew it was only a matter of time before my son returned to his old habits – not enough outdoor activities and worrisome screen time. He would need some help getting used to and sticking to his new routines.
An outdoor activity tracker
I searched online for a while; surprisingly, I couldn’t find an outdoor activity tracker that is simple to use. Even though there were smart device apps, using them would add to his screen time. It just doesn’t make sense to me to increase his screen time so he could limit it. So I modified an exercise tracking sheet into a monthly outdoor activity tracking sheet.
After discussing and getting my son’s commitment to two hours of outdoor activities daily, I sweetened the plan with some incentives – one outdoor point for each 30 min completed. And, he could exchange these points for things he likes, excluding handheld video game consoles and similar items of course.
On the other hand, if he didn’t complete more than 75 minutes of outdoor activities for any particular day, his 30 minutes of iPad game time the next day would be replaced with outdoor activities. However, he could still tally the outdoor points for that day. After all, the aim was to encourage him outside as much as possible, even when he can’t complete the planned amount.
We have used the tracker for a week now; it seems to be working. He has been on top of spending time outdoors, tallying in his activities every night, and asking the points he would need to get his rewards.
[Outdoor activities are beneficial to controlling myopia progression. Make sure getting sufficient sun protection. See CDC recommendation on Sun safety.]
Timer set for every 20 minutes
Taking screen breaks at fixed time intervals consistently is not easy. For the longest time, I was told I should take a five-minute break for each hour of near work or reading activities. Closing my eyes or looking at objects afar for five minutes throughout the day and every day takes a lot of determination. I confess I could only stick to it for a couple of days, even until now.
I asked my son to try it. And it didn’t work for him too. Five minutes were too long and boring.
So I searched and found that the latest recommendation from National Eye Institute suggests for every 20 minutes of screen time, relax for 20 seconds by looking at an object 20 feet away. (or simply close your eyes for 20 seconds) It is also known as the 20-20-20 rule.
After some discussion, we believed that it could work.
My son was comfortable looking far away or closing his eye for 20 seconds in school. And, at home, when doing near work or reading activities, including reading books, doing homework, watching TV, or playing on iphone/ipad, he sets a repeating alarm for 20 min.
At home, he likes to use smart speakers for this since they are easy to set the alarm and snooze; they are convenient since they are already available in all of the rooms in our house; they are fun to use.
Digital device use
On a typical school day, my son usually spent less than two hours in front of a TV or digital device at home, especially if he went out playing with the neighbors after school. And to our delight, his outdoor time seemed to eat into his digital device time.
During the weekend or when he had a day off from school, my wife and I had to put in more effort. We found that his screen time depended on what we planned for him.
We kept an eye on his screen time across the different devices, limiting it to under two hours each day. We also found having enough outside activities planned during the day made it easier to minimalize his screen time.
As for viewing distance, we used a 12-inch ruler and tried different postures that were comfortable for him while still maintaining a good viewing distance. We also identified some postures to avoid that may be comfortable but would consistently put him at less than 12 inches of viewing distance. So instead of constantly measuring and keeping the distance in mind, he could just remember to get into one of the comfortable but good postures. It seems to work for him after some testing and getting used.
I am thinking of letting him try a smart app called vision.app. It could remind him to take a break every 20 min and notify him when he is too close to the device.
What next?
Now we have a lifestyle modification plan with incentives. It’s summer now; timing is on our side to help him get into good habits and routines. We’ve got a good start.
However, I anticipate it will get more challenging during the winter months ahead. His outdoor times may be reduced when daylight gets shorter and the cold weather sets in.
It makes sense to work with an optometrist for treatment options to augment the lifestyle modification plan, and also to have a look at how to improve the plan.
Off to make some calls and an appointment now, more to come.
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