Variation of ambient illumination across different locations winter and summer: An

impact on anti-myopia strategy

By

Mr. Rishiraj

(Optometry Intern)

Under the guidance of

Mr. Ritesh Kumar, PhD scholar

Assistant Professor & Optometrist

Submitted in partial fulfillment for the degree of

Bachelor of Optometry (B. Optometry)

Submitted to

Department of Optometry

C L Gupta Eye Institute, Moradabad

Date: August 30, 2023 Page 1

 DECLARATION

I hereby declare that the contents in this dissertation titled “Variation of ambient illumination
across different locations winter and summer: An impact on anti-myopia strategy” is the
outcome of study conducted by me. I further affirm that it’s entirely my effort and not been
copied. The project/dissertation has been conducted with the purpose of submission in partial
fulfillment of the certificate for internship in Clinical Optometry in C L Gupta Eye Institute,
Moradabad, UP.

The above mentioned information is authentic to the best of my understanding.

The project/dissertation was undertaken and carried out by me under the guidance of Mr.
Ritesh Kumar

Name: Mr. Rishiraj Mentor Name: Mr. Ritesh Kumar

Enrollment No: Signature:

Signature: Date:

Date:

Date: August 30, 2023 Page 2

 CERTIFICATE

This is to certify that the work which is presented in the project/dissertation titled “Variation
of ambient illumination across different locations winter and summer: An impact on anti-
myopia strategy” is in partial fulfillment of the certificate for internship in Clinical
Optometry and submitted to the Department of Optometry, C L Gupta Eye Institute,
Moradabad, U.P, is an authentic record of Mr.Rishiraj, a final year student of Bachelor of
Optometry, Sushant University carried out during the period from 2019 to 2023 under the
supervision of Department of Optometry, C L Gupta Eye Institute, Moradabad, U.P.

_____________________________

Mr. Samir Sutar,

HOD, Optometry Education & Services

C L Gupta Eye Institute

Moradabad, U.P, India

Date: August 30, 2023 Page 3

 ACKNOWLEDGEMENT

I have been working on this topic for a long time. Initially it was difficult to visualize what I
was doing but with time and process I eventually made it. Foremost I would like to express
my deep and sincere gratitude to C. L. Gupta Eye Institute who gave me the golden
opportunity to do this wonderful project and provide invaluable guidance throughout this
research.

I extend my heartiest gratitude to my supervisor Mr. Ritesh Kumar, Assistant professor of

Optometry Education and Services, C. L. Gupta Eye Institute for giving me the critical
comments to think more and delve more in my research work. His dynamism, vision,
sincerity and motivation have deeply inspired me. He has taught me the methodology to
carry out the research and to present the research works as clearly as possible. He has always
given me different perspectives around seeing things from different lenses. It was a great
privilege and honor to work and study under his guidance. I am extremely grateful for what
he has offered me.

Besides my mentor, I would like to express my special thanks of gratitude to my thesis

committee Dr. Sanjay Chanda, Dr. Piyush Kohli, Mr. Lokesh Chauhan, Mr. Ritesh
Kumar, Mr. Suraj Chaurasiya, Ms. Uzma Rafeeq and Ms. Alaknanda Sharma for their
encouragement, insightful comments and hard questions.

My sincere thanks also goes to my research partner Mr. Rishabh Chaudhary for his role in
making me understand different principles and different judgment variables that made this
project works a success.

Last but not the least I would like to thanks my parents and my family members who were
also a backbone of this research work.

Thank You

Date: August 30, 2023 Page 4

 CONTENT

ABSTRACT………………………………………………………………………………….6
CHAPTER: 01……………………………………………………………………………….8
INTRODUCTION…………………………………………………………………………….8
CHAPTER: 02……………………………………………………………………………....11
LITERATURE REVIEW………………………………………..…………………………..11
CHAPTER: 03………………………………………………………………………….......13
METHODOLOGY…………………………………………………………………………..13
CHAPTER: 04……………………………………………………………………………....16
DATA ANALYSIS…………………………………………………………………………..16
CHAPTER: 05………………………………………………………………………………17
RESULTS……………………………………………………………………………………17
CHAPTER: 06………………………………………………………………………………25
DISCUSSION………………………………………………………………………………..25
CHAPTER: 07………………………………………………………………………………29
CONCLUSION………………………………………………………………………………29
REFERENCES……………………………………………………………………………...30

Date: August 30, 2023 Page 5

 ABSTRACT

Purpose: Variation of ambient illumination across different locations winter and summer:
An impact on anti-myopia strategy.

Methods: An experimental study was conducted between first week of December, 2022 and
first week of January, 2023 in Moradabad, which is the northern region of India. The study
was approved by Institutional Review Board of the Institute. Illuminance level in “lux” was
measured using factory calibrated digital lux meter (HTC LX-101 A, Hatco Industries,
Mumbai, Maharashtra, India). The range of the measurement for lux meter was between 0
and 200000 lux. The measurement was done by single examiner in 6 outdoors and 5 indoor
locations. To ensure the accuracy of the measurements at each locations, the display screen
was set to zero by switching off the lux meter and the cap of light sensor was covered as
recommended in the manual provided by manufacturer.[22] The measurement of light
intensities were obtained by keeping the light sensor close to the examiner’s eye to obtain the
closer value of illuminance level entering the eye. The mean of three readings obtained at
each locations was noted and was used for further analysis.

Results: The overall median illumination level across 6 outdoor locations and 5 indoor
locations were 3400 lux (1537 – 7500 lux) and 326 lux (190 – 626 lux). The overall median
illuminance level for outdoors locations was 10.4 times more than indoor locations. The
overall median illuminance level recorded in summer and winter season were 4500 lux (2400
– 9600 lux) and 1900 (810 – 4305 lux). The overall illuminance noted for winter season was
2.3 times less than the illuminance level of summer season. All the outdoor locations that
recorded illuminance level ≥ 1000 lux under direct source of light for all the timings of the
day in summer season. Similarly, all the outdoor locations except “between three building”
recorded illuminance level ≥ 1000 irrespective of all measurement conditions (time of the
day and sun protection) in summer days. Similarly, The overall median illuminance level
recorded in sunny days and foggy days were 2600 lux (1200 – 5500 lux) and 1400 (620 –
3300 lux). The overall illuminated noted for foggy days of winter season was almost half of
the illuminance level of sunny days

Date: August 30, 2023 Page 6

Conclusion: In order to encourage children to spend time outside with sun protection at a
specific time of day at a specific place, it is important to emphasise that the illuminance
levels reported in the study vary with sun protection, season, weather, and time of day. It
should be highlighted that the present oversimplified recommendations for children and
parents to spend time outdoors as an anti-myopia therapy should be carefully considered in
light of the variance in lighting conditions in various regions as well as other environmental
factors.

Keywords: Ambient light, Illumination, Anti-myopia, India, 1000 lux.

Date: August 30, 2023 Page 7

 CHAPTER: 01

INTRODUCTION

Myopia: a condition in which the spherical equivalent refractive error of an eye is ≤ −0.5 D
when ocular accommodation is relaxed.[1-2]It is the most prevalent refractive error and a
significant contributor to ocular morbidity, particularly for young people who are in school.
Myopia has serious social, economic, psychological, and developmental repercussions when
left untreated.[3] India is the second most populated country in the world, with around 41% of
its population (492 million) being less than 18 year age group.[4]Progression of myopia
in kids is expounded to genetic factors, pollution, life style, living, small outdoors activity,
and increased time spent on electronic devices in the style of laptop and phone (i.e. indoor
activities).
The overall crude prevalence of myopia over last four decades is 7.5% (95% CI, 6.5–8.5%)
in 5-15-year age group. The prevalence of myopia is 8.5% (95% CI, 7.1–9.9%) in urban and
6.1% (95% CI, 4.5–7.7%) in rural children, with highest prevalence in urban 11-15-year age
group [15.0% in last decade]. A significant increment in prevalence is noted in the last
decade in rural children from 4.6% to 6.8%, reflecting changing rural environment.[5]
A systemic review and meta-analysis predicted that by 2050 there will be 4758 million
people with myopia (49.8% of the world population; 3620-6056 million [95% CI, 43.4% –
55.7%]) and 938 million people with high myopia (9.8% of the world population; 479-2104
million [95% CI, 5.7% – 19.4%]).[6] The proof suggests that not solely genetic, however
conjointly environmental factors similar to time spent outdoors to be protective for myopia or
to delay the onset of myopia. A number of studies have reported a correlation between an
increased amount of time spent outdoors and a lower risk for myopia development.[7-10]
Studies that quantified the sunshine exposure pattern by estimating luminosity by a light
tracker reported that myopic kids spent most of their time in an indoor environment where
illuminance level is less than 1000lux.[11-12] A recent study reported reduction in myopia
progression when once exposed to associate degree illuminance level of >3000 lux each
day.[13]

Date: August 30, 2023 Page 8

Outdoor activities with strong sunlight exposure may not be necessary for myopia
prevention. Relatively lower outdoor light intensity activity with longer time outdoors, such
as in hallways, under trees, under porch, in open playground and other conditions where
children’s used to play where amount of light is >1000lux also can be considered.[14]The
odds of developing myopia can be decreased by 2% with an additional hour of outdoor
activity every week, according to Sherwin et al. Ho et al. recommended 120 minutes of daily
outdoor exposure while in school as the most effective way to prevent myopia.[15-16]
Children at school spend the majority of their time in indoors, for example in the classroom,
and only a less amount of time in outdoors, for example on the playground.

Environments that are indoors or outdoors might vary widely. For instance, a playground
may be open to the sky, or it may be shaded by a large tree or have a roof over it, or covered
by tall buildings. Similar to this, a typical interior setting, like a classroom, can have no
windows, one window, several windows, and one or more light sources. Other factors that
might influence the illuminance level in various locations include the weather (sunny or
cloudy), geographic locations, elevations, seasons (summer or winter), and time of day
(morning, noon, afternoon, or evening).

The amount of light reaching eye level might also vary depending on direction the sun is
shining when kids are playing outside. For instance, illuminance measurements taken when
facing the sun may be higher than those taken when facing the opposite way. The practise of
wearing hats or caps outside to prevent sunburn and other UV-related eye damage may
reduce the quantity of light that reaches the eyes.
Bhandary et al.[17] conducted a experimental study with a lux meter under weather conditions
(sunny or cloudy), hours of the day (7:00, 11:00, 13:30, and 16:00), seasons
(summer/winter), and sun protection (hat and cap) in both outdoor and indoor locations. The
illuminance level in the outdoor locations was eight times higher than that in all indoor
locations (1175;197–5400 lux vs. 179;50–333 lux). The "open playground" (9300; 4100–
16825 lux) had the highest outdoor illumination, followed by "under a translucent artificial
shade" (8180; 4200–13300 lux) and "within four buildings" (11; 6–20 lux). Under the
"Canopy,""between three buildings," and "within four buildings," the illumination was
comparable to that of indoor locations (1000 lux). The illuminance did not change from high

Date: August 30, 2023 Page 9

to low level (>1000 to 1000 lux) regardless of the time of day, weather, season, sensor
position, or whether or not sun protection was used. On both sunny and cloudy days, the
"room with multiple large windows" was the only indoor location where the illuminance
exceeded 1000 lux at specific times.

There can be several variation of light intensities in outdoor and indoor environment. For
example, children playing in open playground can have big trees or open-top. Similarly,
children playing in indoor environment can have rooms without window or with single or
multiple windows. Consequently, the level of illumination in outdoor can also be affected by
weather (Cloudy/Sunny) or seasons (Summer/Spring/Winter). Lanca et al[18] found greater
differences between outdoor (11,080 – 18,176 lux) and indoor (112-156 lux) locations.
Additionally, Lanca et al.[18] also reported that use of sunglasses/hat still provided
illuminance (at the eye level) 11–43 times higher than that of indoors. Bhandary et al17 found
changes in illuminance level under different conditions during winter and summer in India.
However, the measurements were done in southern part of India where the effect of winter do
not remain same as northern India.

With regard to myopia, previous literatures[19, 20] have reported that the myopia progression
was slower in summer season than winter season due to greater time spent outdoor in
[21]
summer than winter. Additionally, Nioi et al have reported that duration of bright light
was over 1000 lux for 46 minutes in summer and 3 minutes in winter which further suggested
greater variation in the light intensities between two seasons.

Considering the fact that the level of optimum illumination and myopia progression varies
with seasons (summer/winter), the present study aimed to evaluate changes in the level of
ambient illumination between summer and winter at different locations, time of a day, sun
protection (Hat/Cap) and source position in Northern India.

Date: August 30, 2023 Page 10

 CHAPTER: 02

LITERATURE REVIEW

Year Author/s Title Methodology Summary/Result

2021 Bhandary et.al Ambient light It is an experimental study Variation in

level varies conducted in week of June illuminance in different
with different and November in 2019 at locations and impact it
locations and Hyderabad. may have on myopia
environmental Illumination level at 9 control, appropriate
conditions: outdoor and 5 indoor detailed
Potential to locations at different time recommendation seems
impact zone were recorded. necessary while
myopia. Lux meter is used for the suggesting outdoor
illuminance level. time as an Anti-
myopia strategy to
ensure desired
outcomes.

2020 Wen et.al Objectively The Clouclip device has a The authors reported that
measured near built-in infrared distance an increase in exposure
work, outdoor sensor and a light time to 70 min per week
exposure and intensity sensor for to a light intensity of
myopia in detecting the working approximately >1000 lux
children distance and ambient light can reduce the risk of
intensity in real time. myopia development by
The participants were 35%.
required to wear Clouclip
throughout the day

Date: August 30, 2023 Page 11

 Year Author/s Title Methodology
2019 Lanca et.al The Effects of A child-sized mannequin
Different head was developed to
Outdoor measure light illuminance
Environments, levels with and without
Sunglasses and sun-protective
Hats on Light equipment.
Levels: 3 outdoor( open park,
Implications for under a tree and street )
Myopia and 2 indoor (under a
Prevention. fluorescent illumination
with window, under
white LED-based lighting
without window) location
was taken
2015 He et.al Effect of Time For 6 intervention
Spent Outdoors schools, 1 additional 40-
at School on the minute class of outdoor
Development of activities was added to
Myopia Among each school day, and
Children in parents were encouraged
China to engage their children
in outdoor activities after
school hours
Children and parents in
the 6 control schools
(n = 951 students)
continued their usual
pattern of activity.
Date: August 30, 2023
Summary/Result
Exposure to light
levels outdoors was
considerably higher
than indoors even
while wearing
sunglasses, a hat or
being in the shade
The addition of 40
minutes of outdoor
activity at school
compared with usual
activity resulted in a
reduced incidence rate
of myopia over the
next 3 years
.
Page 12
 CHAPTER: 03

METHODOLOGY

An experimental study was conducted between first week of December, 2022 and first week
of January, 2023 in Moradabad, which is the northern region of India. The study was
approved by Institutional Review Board of the Institute. Illuminance level in “lux” was
measured using factory calibrated digital lux meter (HTC LX-101 A, Hatco Industries,
Mumbai, Maharashtra, India). The range of the measurement for lux meter was between 0
and 200000 lux. The measurement was done by single examiner in 6 outdoors and 5 indoor
locations. To ensure the accuracy of the measurements at each locations, the display screen
was set to zero by switching off the lux meter and the cap of light sensor was covered as
recommended in the manual provided by manufacturer.[22] The measurement of light
intensities were obtained by keeping the light sensor close to the examiner’s eye to obtain the
closer value of illuminance level entering the eye. The mean of three readings obtained at
each locations was noted and was used for further analysis. The methodology of the present
study was adopted from previous literature.[17]

Outdoor and Indoor Locations

A total of 11 locations were selected for study purpose and was based on the study done in
southern India.[17] There were 6 outdoor locations and 5 indoor locations. Outdoor locations
included open playground, between two buildings, between three buildings, under a porch
facing east, under a big tree and under a porch facing west. Similarly, indoor locations
included rooms with multiple large windows, rooms with combination of light sources, room
with single artificial light, room with multiple artificial lights, canopy covering the buildings.
The locations were selected thinking the children likely to spend their time for the day. The
description of the locations are represented in Table 1.

Date: August 30, 2023 Page 13

Table 1: List of 6 outdoor and 5 indoor locations with their descriptions.
Locations Description
Outdoor locations
Open playground An open area of land where children’s used to play.
Between 2 buildings A hallway covered with 2 tall buildings from 2 sides.
Between 3 buildings An open space covered with 3 tall buildings from three sides.

Under a porch facing Small covered area from one side with a tall building facing
east towards west.
Under a big tree Big tree in playground.
Under a porch facing Small covered area from one side with a tall building facing
west towards west.
Indoor locations
Room with multiple A large room with two large glass windows facing towards
large windows East and North. (Dimensions in feet- 36×25×11.5)
Room with combination A room with two large glass windows facing towards east and
of light sources north with ceiling LED lights. (Dimensions in feet-
36×25×11.5)
Room with single A closed room with single ceiling LED source. No natural
artificial light light source. (Dimensions in feet- 17×10×9.5)
Room with multiple Large room with multiple ceiling LED sources. No natural
artificial lights light source. (Dimensions in feet- 41×42×10)
Under a canopy covered An area covered with four tall buildings on 4 sides with
by 4 buildings. translucent artificial shade.

Time of the day, Source positions, Weather and Sun protection

The illuminance level was measured along four different time points in a day (7:00 – 8:00,
10:00 – 11:00, 13:00 – 14:00, and 16:00 – 17:00) on foggy and sunny days. The forecast of
the day (as sunny, cloudy or foggy) was recorded from the default weather application on an

Date: August 30, 2023 Page 14

IOS smartphone (AccuWeather application,
https://www.accuweather.com/en/in/moradabad/191056/weather-forecast/191056). Similarly,
The measurements in outdoor locations were obtained by positioning the sensor of the lux
meter in three different directions relative to the source of light, i.e. i) facing towards the
source (TS), ii) opposite from source (OS) and iii) Intermediate to the source (IS) which is 90
degree midway from TS and OS. Additionally, the measurement of illumination level for
indoor locations were done in two different scenario, i.e i) Under the source (the sensor of the
lux meter facing toward the ceiling where artificial light was placed) and ii) Away from the
source (measurement usually 1-2 meter away from the source). For outdoor measurements,
the illuminance levels were also measured using sun protection (Hat and Cap) to evaluate the
influence of illuminance level reaching the eye.

Date: August 30, 2023 Page 15

 CHAPTER: 04

DATA ANALYSIS

Statistical analysis was performed using SPSS software (IBM SPSS, version 25; IBM Corp.,
Armonk, NY, USA). The term “overall” was defined for the illuminance level recorded for
all conditions (time of the day, with and without sun protection, position of sensor relative to
source and weathers) for each locations. Data were represented in mean and IQR (Inter-
Quartile Range) for different outdoor and indoor locations

Date: August 30, 2023 Page 16

 CHAPTER: 05

RESULTS

Overall illuminance level for outdoor and indoor locations

The overall median illumination level across 6 outdoor locations and 5 indoor locations were
3400 lux (1537 – 7500 lux) and 326 lux (190 – 626 lux). The overall median illuminance
level for outdoors locations was 10.4 times more than indoor locations. Considering each
location for outdoor, the highest overall illumination was recorded in “open playground”
(median: 8000; 4100-18300 lux) followed by “between two buildings” (median: 3400; 1600-
7500 lux) and “under a porch facing west” (median: 2500; 1300 – 4800 lux). Similarly, the
lowest overall illumination level was recorded in “under a porch facing east” (Median: 1500;
900 – 3800 lux) followed by “Under a big tree” (median: 1800; 1200 - 3500) and “under a
porch facing east” (median: 1500; 900 – 3800 lux). However, the median illuminance level
for “between three buildings” and “under a big tree” were four times less than the
illuminance level for “open playground”. Though all the outdoor locations had recorded
optimum illumination (≥ 1000 lux), the three locations (under a porch facing east, between
three buildings and under a big tree) had recorded median value very close to optimum level
of illumination [Table 2].

Indoor locations showed an overall low median illuminance level (< 1000 lux) irrespective of
the locations and source positions. However, the overall illuminance level more than 1000
lux was recorded for “Room with multiple large windows” (median: 1200; 690 – 3800) and
“room with combination of light sources” (median: 1100; 560 – 2345) [Table 2].

Date: August 30, 2023 Page 17

Table 2: Overall illuminance level for 6 outdoor and 5 indoor locations.
Locations Overall illuminance level (Lux)
Median (IQR) Range
Outdoor locations
Open playground 8000 (4100 – 18300) 270 – 129500
Between two buildings 3400 (1600 – 7500) 99 – 14500
Between three buildings 1800 (785 – 4900) 26 – 10740
Under a porch facing east 1500 (900 – 3800) 71 – 94000
Under a big tree 1800 (1200 – 3500) 103 – 71400
Under a porch facing west 2500 (1300 – 4800) 110 – 34700
Indoor locations
Room with multiple large windows 1200 (690 – 3800) 160 – 30800
Room with combination of lights sources 1100 (560 – 2345) 12 – 31000
Room with single artificial lights 102 (24 – 220) 10 – 490
Room with multiple artificial lights 320 (195 – 430) 50 – 710
Canopy with four buildings 628 (345 – 1615) 117 - 3300

Illuminance level for summer and winter season

The overall median illuminance level recorded in summer and winter season were 4500 lux
(2400 – 9600 lux) and 1900 (810 – 4305 lux). The overall illuminance noted for winter
season was 2.3 times less than the illuminance level of summer season. All the outdoor
locations that recorded illuminance level ≥ 1000 lux under direct source of light for all the
timings of the day in summer season. Similarly, all the outdoor locations except “between
three building” recorded illuminance level ≥ 1000 irrespective of all measurement conditions
(time of the day and sun protection) in summer days [Figure 1]. During winter season, only
three outdoor locations, “open playground” (median: 11450; IQR 8000 – 22150 lux),
“between two buildings” (median: 5800; IQR 2600- 12075 lux) and “between three
buildings” (median: 3800; IQR 2000 – 7175 lux) recorded optimum illuminance level under
direct source for all time of the day. Additionally, all the outdoor locations recorded greater
Date: August 30, 2023 Page 18
than optimum illumination for three point of time (10:00–11:00, 13:00–14:00 and 16:00–
17:00 hours). Additionally, all the outdoor locations recorded optimum illuminance (≥ 1000
lux) between 13:00 – 14:00 hours of the day irrespective of all the measurement conditions in
winter season [Figure 2]. However, there was no effect of weather in indoor location’s
illuminance level.

All the indoor locations recorded the illuminance level < 1000 lux irrespective of all
measurement conditions except two indoor locations (room with multiple large windows and
room with combinations of light sources) that had recorded > 1000 lux between 10:00 –
14:00 hours in both winter and summer season [Figure 3].

Figure 1: Median illuminance level recorded under direct source, hat, and with a cap on 30
summer days. TS, IS and OS sensor source positions recorded in four different time points of
a day (07:00–08:00, 10:00–11:00, 13:00–14:00 and 16:00– 17:00 hours). The downward-
facing arrows in red colour represent illuminance levels < 1000 lux.

Date: August 30, 2023 Page 19

Figure 2: Median illuminance level recorded under direct source, hat, and with a cap on 20
winter days. TS, IS and OS sensor source positions recorded in four different time points of a
day (07:00–08:00, 10:00–11:00, 13:00–14:00 and 16:00– 17:00 hours). The downward-
facing arrows in red colour represent illuminance levels < 1000 lux.

Date: August 30, 2023 Page 20

Figure 3: Median illuminance level recorded in five indoor locations on 20 winter and 30
summer days. US and AS sensor source positions recorded in four different time points of a
day (07:00–08:00, 10:00–11:00, 13:00–14:00 and 16:00– 17:00 hours). The upward-facing
arrows in black colour represent illuminance levels > 1000 lux.

Illuminance level in sunny and foggy days of winter season

The overall median illuminance level recorded in sunny days and foggy days were 2600 lux
(1200 – 5500 lux) and 1400 (620 – 3300 lux). The overall illuminated noted for foggy days
of winter season was almost half of the illuminance level of sunny days. Only one outdoor
location (open playground) showed illuminance level greater than 1000 lux irrespective of
the conditions (time of the day, sun protections and relative position of sensor). Additionally,
the outdoor locations that recorded illuminance level ≥ 1000 lux under direct source of light
for all the timings of the day were “open playground” (median: 10500; IQR 10000 – 11200
lux), “between two buildings” (median: 7500; IQR 3500 – 15000 lux), “between three
buildings” (median: 4200; IQR 2300 – 7500 lux), “under a porch facing east” (median: 3650;
IQR 1800 – 5850 lux) and “under a porch facing west” (median: 4350; IQR 2700 – 7000 lux)
in sunny days [Figure 4] while only three outdoor locations recorded illuminance level ≥

Date: August 30, 2023 Page 21

1000 lux in foggy days that included “open playground” (median: 9250; IQR 5300 – 10600
lux), “Between two buildings” (median: 4650; IQR 2125 – 7575 lux), and “Between three
buildings” (median: 3150; IQR 1700 – 6275 lux) irrespective of all conditions [Figure 5].
Additionally, all the outdoor locations showed illuminance level ≥ 1000 lux between 13:00 –
14:00 hours of the day irrespective of all the measurement conditions in sunny and foggy
weathers. However, there was no effect of weather in indoor location’s illuminance level. All
the indoor locations recorded the illuminance level < 1000 lux irrespective of all
measurement conditions except two indoor locations (room with multiple large windows and
room with combinations of light sources) that had recorded > 1000 lux between 13:00 –
14:00 hours [Figure 3].

Figure 4: Median illuminance level recorded under direct source, hat, and with a cap on 9
sunny days of winter season. TS, IS and OS sensor source positions recorded in four different

Date: August 30, 2023 Page 22

time points of a day (07:00–08:00, 10:00–11:00, 13:00–14:00 and 16:00– 17:00 hours). The
downward-facing arrows in red colour represent illuminance levels < 1000 lux.

Figure 5: Median illuminance level recorded under direct source, hat, and with a cap on 11
foggy days of winter season. TS, IS and OS sensor source positions recorded in four different
time points of a day (07:00–08:00, 10:00–11:00, 13:00–14:00 and 16:00– 17:00 hours). The
downward-facing arrows in red colour represent illuminance levels < 1000 lux.

Date: August 30, 2023 Page 23

Illumination level at different point of time for the day

The median illuminance level of all outdoor locations were ≥ 1000 lux during 13:00 – 14:00
hours (median: 2900; IQR 1400 – 5800 lux) followed by 10:00 – 11:00 hours (median: 1650;
IQR 1100 – 5625 lux). Similarly, “room with multiple large windows” (median: 5500 IQR
1670 – 11350 lux ) and “ Room with combination of light sources” (median: 5200; IQR 3075
– 9000 lux) were the two indoor locations that had recorded the illuminance level ≥ 1000 lux
between 13:00 – 14:00 hours for both sunny and foggy weathers for measurement under
direct source [Figure 3].

Date: August 30, 2023 Page 24

 CHAPTER: 06

DISCUSSION

The median (IQR) illuminance levels in 6 separate outdoor and 5 different indoor locations
under diverse situations of winter and summer season were described in this study. No matter
the time of day, weather, sun protection, or type of day, the overall meridian illuminance
level of all the outdoor locations was recorded (>1000 lux). Highest overall illumination level
was recorded in “open playground” which is supported by previous literatures[12,17,18]
followed by “under a big tree” and “under a porch facing west” and lowest overall
illumination level was recorded in “under a porch facing east” followed by “under a big tree”
and “between three buildings”.Indoor locations had overall median illuminance levels that
were 10.4 times lower than those of outdoor locations and under 1000 lux except “Room
with multiple large windows” and “room with combination of light sources”. In this study we
found greater difference between overall median illuminance level in 6 outdoor locations
(median 3400; 1537-7500) and 5 indoor locations (median 326; 190-626) which is also
supported by the previous literature[12,17,18] who also found greater difference in the
overall median illumination level for outdoor and indoor locations irrespective of several
measurements conditions.

In the current investigation, overall low illuminance levels were observed in all indoor
locations irrespective of all measurements conditions except “Room with multiple large
windows” and “Room with combination of light sources”, with the overall median
illuminance levels being <1000 lux, which may support previously reported studies[11-12]
that myopic kids spent most of their time in an indoor environment where illuminance level
is less than 1000lux. Bhandary et al.[17] conducted a experimental study with a lux meter
under weather conditions (sunny or cloudy), hours of the day (7:00, 11:00, 13:30, and 16:00),
seasons (summer/winter), and sun protection (hat and cap) in both outdoor and indoor
locations. The overall median illuminance level in the outdoor locations was eight times
higher than that in all indoor locations (1175;197–5400 lux vs. 179;50–333 lux). The "open
playground" (9300; 4100–16825 lux) had the highest outdoor illumination, followed by
"under a translucent artificial shade" (8180; 4200–13300 lux). Lanca et al[18] found greater

Date: August 30, 2023 Page 25

differences between outdoor (11,080 – 18,176 lux) and indoor (112-156 lux) locations. Wu et
al.[12] through a portable light tracker sensor reported overall median highest illumination
level in “open playground” (>100000 lux) followed by “under a tree shade”(7480 lux) and in
“a hallway”(7600 lux).The highest overall median illuminance level recorded in current
study was in “open playground” (median: 8000; 4100-18300 lux) followed by “between two
buildings” (median: 3400; 1600-7500 lux) and “under a porch facing west” (median: 2500;
1300 – 4800 lux)and lowest overall illumination level was recorded in “under a porch facing
east” (median: 1500; 900-3800) followed by “under a big tree” (median: 1800; 1200-3500)
and “between three buildings” (median: 1800; 785-4900) which is lower to that reported in
Hyderabad[17] which could be due to difference in weather, season and temperature as the
weather and temperature of Hyderabad is tropical wet and dry climate bordering on a
hot semi-arid climate. During winters the temperature of Hyderabad is usually ranges
between 28*C to 14.5*C [22] while the temperature of Moradabad during winters ranges from
25*C to 5*C [22].

The overall median illuminance level recorded in this study is much higher than that reported
by Lanca et al[18] which could be due to difference in weather as Lanca et al[18] recorded the
overall median illuminance level only on cloudy days while we recorded in sunny, cloudy
and foggy days of season summer and winter.

We place the sensor in three distinct positions with sensors facing the source, opposite to the
source, and an intermediate to source, we measured the amount of light in 6 different outdoor
locations. The placement of the sensor in relation to where the eye is could be another reason
why greater values were found in the current investigation. We manually positioned the
sensor in front of the eye, as opposed to Lanca et al.[18] who did so to restrict the sensor's
exposure to light from the periphery by placing the sensor inside the mannequin's eye.

The overall median illuminance level recorded in summer and winter season were 4500 lux
(2400 – 9600 lux) and 1900 (810 – 4305 lux). The overall illuminance noted for winter
season was 2.3 times less than the illuminance level of summer season. All the outdoor
locations except “between three building” recorded illuminance level ≥ 1000 irrespective of
all measurement conditions (time of the day and sun protection) in summer days. During
winter season, only three outdoor locations, “open playground” (median: 11450; IQR 8000 –

Date: August 30, 2023 Page 26

22150 lux), “between two buildings” (median: 5800; IQR 2600- 12075 lux) and “between
three buildings” (median: 3800; IQR 2000 – 7175 lux) recorded optimum illuminance level
under direct source for all time of the day which solemly supports previous literatures[19, 20]
that have reported that the myopia progression was slower in summer season than winter
season due to greater time spent outdoor in summer than winter.

All the indoor locations recorded the illuminance level < 1000 lux irrespective of all
measurement conditions except two indoor locations (room with multiple large windows and
room with combinations of light sources) that had recorded > 1000 lux between 10:00 –
14:00 hours in both winter and summer season.

The overall median illuminance level recorded in sunny days and foggy days were 2600 lux
(1200 – 5500 lux) and 1400 (620 – 3300 lux). The overall illuminated noted for foggy days
of winter season was almost half of the illuminance level of sunny days. Only one outdoor
location (open playground) showed illuminance level greater than 1000 lux irrespective of
the conditions (time of the day, sun protections and relative position of sensor). The outdoor
locations that recorded illuminance level ≥ 1000 lux under direct source of light for all the
timings of the day were “open playground”, “between two buildings”, “between three
buildings”, “under a porch facing east” and “under a porch facing west” in sunny days. while
only three outdoor locations recorded illuminance level ≥ 1000 lux in foggy days that
included “open playground”, “Between two buildings”,and “Between three buildings”
irrespective of all conditions. Additionally, all the outdoor locations showed illuminance
level ≥ 1000 lux between 13:00 – 14:00 hours of the day irrespective of all the measurement
conditions in sunny and foggy weathers.

All the indoor locations recorded the illuminance level < 1000 lux irrespective of all
measurement conditions except two indoor locations (room with multiple large windows and
room with combinations of light sources) that had recorded > 1000 lux between 13:00 –
14:00 hours.

The median illuminance level of all outdoor locations were ≥ 1000 lux during 13:00 – 14:00
hours followed by 10:00 – 11:00 hours. Similarly, “room with multiple large windows” and
“ Room with combination of light sources” were the two indoor locations that had recorded

Date: August 30, 2023 Page 27

the illuminance level ≥ 1000 lux between 13:00 – 14:00 hours for both sunny and foggy
weathers for measurement under direct source.

According to Lanca et al., wearing a hat and sunglasses in the evening could lower light
levels at the eye and result in values that are similar to those found indoors. For this reason,
one should choose an outdoor location carefully so that the impact of wearing sun protection
gear (a hat or cap with sunglasses) will have the least amount of an impact on illumination as
also seen in current study that illuminance level vary with sun protection and timing of the in
winter season. Only 13-14 hours of the day have illuminance level >1000 lux irrespective of
all measurements conditions.

Only the two indoor locations “Room with multiple large windows” and “Room with
combination of light sources” have illuminance level>1000 lux irrespesctive of all
measurements conditions considering the evidence in favor of a bright classroom design with
high illumination as a myopia prevention measure. Since childrens spend the majority of
their schooldays in classrooms, alterations to those spaces may be worthwhile to improve
ambient lighting and prevent myopia. Elevated light intensities and spectra that are closer to
those seen outside can be exposed in the adapted classroom. To ensure that students are
exposed to ambient light levels of >1000 lux, an interior classroom with several huge
windows may be a better solution while taking into account the cost of actually erecting a
glass classroom.

The most advantageous aspect of this study is that we looked at the lighting conditions in six
outdoor and five indoor areas that are frequently visited by kids. Illuminance levels were
recorded under a variety of circumstances (four time points during the day, sun protection,
summer and winter seasons, sunny and cloudy weather, etc.) to help understand how outdoor
and inside surroundings differ with regard to ambient lighting. Childrens may face different
directions in relation to light sources while doing daily activities, hence three relative sensor
positions (lux meters) were used to capture the illumination levels at these places.

Date: August 30, 2023 Page 28

 CHAPTER: 07

CONCLUSION

As a last point, it should be remembered that not all outdoor locations may offer sufficient
exposure to light to prevent myopia. The researched outdoor locations can be classified as
adequate illuminance regions since they consistently recorded illuminance >1000 lux based
on the illuminance levels measured under all conditions.

Only one outdoor location “Open playground” considered as adequate outdoor location
which received illuminance level>1000 lux irrespective of all measurements conditions
(Season,weather, sun protection and time of the day). In summer all outdoor locations
irrespective of all measurements conditions have Illuminance level >1000 lux except
“between three buildings”. In winter only three outdoor locations “Open playground”,
“Between 2 buildings” and “between three buildings” have illuminance level>1000 lux under
direct source of light for all time of the day. All outdoor locations have illuminance level
>1000 lux at particular time of the day 13-14 hours irrespective of all measurements
conditions (season: summer or winter, weather: suuny or foggy, sun protection: hat or cap).

However there is no effect of season, weather and time of the day on the illuminance level of
inddor locations. All the indoor locations have illumanace level < 1000 lux except “room
with multiple large windows” and “Room with combination of light sources” which have
illuminance level >1000 lux at 13-14 hours of the day under direct source of light
irrespective of season(summer and winter) and weather(sunny and foggy).

In order to encourage children to spend time outside with sun protection at a specific time of
day at a specific place, it is important to emphasise that the illuminance levels reported in the
study vary with sun protection, season, weather, and time of day. It should be highlighted
that the present oversimplified recommendations for children and parents to spend time
outdoors as an anti-myopia therapy should be carefully considered in light of the variance in
lighting conditions in various regions as well as other environmental factors.

Date: August 30, 2023 Page 29

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