ABSTRACT

Objective : To assess the

relationship of near, midworking
distance and outdoor activities with
the prevalence of myopia in schoolaged children
Design : Cross-sectional study of 2
age samples from 51 Sydney
schools,
Participants : 1765 six yrs old (Yr
#
1) and 2367 12-yrs old (Yr 7)

INTRODUCTION
In the latter part of the 20th century
in highly urbanized East Asian
regions, the prevalence of myopia
>> dramatically
In parallel with the >> in overall
myopia, theres been a rise in the
prev. of high myopia
Myopia is appearing with greater
prev. in young children, which places
#
these children at >> risk of

INTRODUCTION
Due to these trends, theres been a
research focus on factors >> risk of
myopia
Example: family history, ethnicity (East
Asian) both genetic factors
Myopia is believed to have a
multifactorial etiology
Rapid rise in the prev. suggests that
rapidly changing environmental factors
#
are predominant current patterns of

Materials & Methods

The Sydney Myopia Study populationbased survey of refraction & other eye
conditions
Samples : School children (Yr1 & Yr7)
resident in the area of Sydney, Australia
Methods : the study area was stratified
by sosioecon. Status using Australian
Bureau of Statistics 96-01
34 primary & 21 secondary school
#
selected

Materials & Methods

Obtain informed consent from at least 1
parent & verbal consent of each child
Then, the children had a comprehensive
eye exam. Including cycloplegic
autorefraction to determine
refractive status
Parents complete questionnaire
( periods during which children engaged
in near work [<50 cm working dist],
midworking distance [watching TV, #

Materials & Methods

The children is classified into different
ethnic communities. [European
caucasian, East Asian, African, South
American etc]
The questionnaire was translated into 3
languages (Chinese, Vietnamese,
Arabic)
Assessment of parental refractive error
prescription for glasses
#

Data Handling &

Statistical Analysis
Data were entered into an Access
database (Microsoft, Redmond)
Statistical analysis were performed
using Statistical Analysis System (SASV9.1, SAS Inc)

Results

Characteristic
All children

Year 1 Sample

% Myopic

SER

1735

1.5

+1.26

1105

0.7

+1.40

298

3.4

+0.91

857
878

1.6
1.4

+1.34
+1.19

778
398
95

0.8
2.5
3.2

+1.37
+1.23
+0.98
#

Ethnic background
European
Caucasian
East Asian
Gender
Girls
Boys
Parental Myopia
No myopic parents
One myopic parent
Two myopic parents

Characteristic
All children

Year 7 Sample

% Myopic

SER

2353

12.8

+0.49

1406

5.1

+0.81

352

41.6

- 0.50

1163
1190

15.0
10.7

+0.41
+0.56

1120
542
126

7.6
14.8
43.6

+0.67
+0.33
- 0.55
#

Ethnic background
European
Caucasian
East Asian
Gender
Girls
Boys
Parental Myopia
No myopic parents
One myopic parent
Two myopic parents

Results
( Outdoor
Activity)

Average
hours /
day

Year 1 Sample (SER)

Low
(0- 1.7)

Moderat
e
(1.7-2.7)

High
(2.7+)

P value

+1.24*

+1.31*

+1.41

0.009

+1.37
+1.10*

+1.37
+1.26

+1.52
+1.29

0.09
0.01

+1.36
+1.06*

+1.41
+1.15*

+1.44
+1.40

0.4
0.000
5

+1.34

+1.38

+1.49

#
0.15

(outdoor activity)

All children
Gender
Girls
Boys
Parental myopia
None
Any
Ethnicity
European Caucasian

Average
hours /
day

Year 7 Sample (SER)

Low
(0- 1.59)

Moderat
e
(1.6-2.8)

High
(2.8+)

P value

+0.32*

+0.50

+0.54

<0.00
03

+0.14*
+0.54*

+0.50
+0.48*

+0.37
+0.68

0.052
0.003

+0.56*

+0.67

+0.79

- 0.05

+0.18

+0.18

0.000
3
0.2

(outdoor activity)

All children
Gender
Girls
Boys
Parental myopia
None
Any
Ethnicity
European Caucasian

+0.70*

+0.80

+0.89

0.002

Results
( Near-work
Activity)

Average
hours /
day

Year 1 Sample (SER)

Low
(0- 1.5)

Moderat
e
(1.6-2.5)

High
(2.6+)

P value

+1.35

+1.32

+1.28

0.08

+1.43
+1.28

+1.45
+1.20

+1.37
+1.19

0.3
0.07

+1.47*
+1.14

+1.43*
+1.15

+1.32
+1.26

0.004
0.3

+1.45
+0.71

+1.41
+0.92

+1.37
+1.02

0.14
#
0.3

(near-work activity)

All children
Gender
Girls
Boys
Parental myopia
None
Any
Ethnicity
European Caucasian
East Asian

Average
hours /
day

Year 7 Sample (SER)

Low
(0- <2)

Moderat
e
(2.0-3.1)

High
(3.1+)

P value

+0.48

+0.48

+0.42

0.8

+0.29
+0.63

+0.38
+0.56

+0.32
+0.53

0.9
0.6

+0.78*
+0.05

+0.66
+0.20

+0.60
+0.11

0.1
0.4

+0.91*
-1.18

+0.82
- 0.69

+0.69
- 0.82

0.01
#
0.06

(near-work activity)

All children
Gender
Girls
Boys
Parental myopia
None
Any
Ethnicity
European Caucasian
East Asian

Results
( Midworking
Distance
Activity)

Midworking distance
Activity
Average hour spent
Year1

Year7

1.89hrs

2.89hrs

Pvalue:0.7

Pvalue:0.8

Therefore, midworking distance activities were not

associated with mean SER in either the Year 1 or
Year 7 samples.

Discussion
Parssinen and Lyyra reported genderspecific association of outdoor activity.
with myopia :
- No association in girls
- An association between increased time
spent with outdoor activity and less myopia in
boys

Study of myopia, lifestyle and schooling

in Chinese students in Singapore and
Sydney also reported there was a
#
significant association between time

Discussion
In this study there was no significant
influence of near work on refractive
error
There was a significant trend for the
European Caucasian children alone.
Midworking distance activities also
showed no significant association with
SER
#

Discussion
One possible hypothesis for the effect
of outdoor activities on refraction
related to the low accommodative
demand in distance vision
Light intensity may be an important
factor, which higher outdoors than
indoors. So, pupils constricted more
outdoors.
this will result in a greater depth of field
#
and less image blur

Discussion
Release of dopamine from retina is
known to be stimulated by light
Dopamine can acts as inhibitor of eye
growth
These hypotheses need to be
systematically tested as they may
provide an explanation of the
particularly low prev. of myopia reported
for both children & adults in Australia
#

Discussion
If the hypotheses were successfully
proven, public health could aim at
preventing development of myopia by
increasing engagement of children in
outdoor activity
Ways of promoting outdoor activity :
-more outdoors activity in curricula
-encourage family to have more outdoor
activities such picnics and family
#
vacation

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