Outdoor activity and myopia progression in children: A follow-up study using mixed-effects model
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Updated: Oct 12, 2025
Binocular Dynamic Visual Acuity in Eyeglass-Corrected Myopic Patients
Published on: March 29, 2022
Saroj Gupta1, Ankur Joshi2, Harsha Saxena3
1Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Insights
Increased outdoor activity in children is linked to slower myopia progression. This study found a significant inverse relationship, suggesting more time outdoors may help control myopia development.
Area of Science:
- Ophthalmology
- Pediatric Health
- Public Health
Background:
- Myopia, or nearsightedness, is a growing global health concern, particularly in children.
- Understanding factors influencing myopia progression is crucial for developing effective interventions.
- Limited outdoor activity has been anecdotally linked to increased myopia risk.
Purpose of the Study:
- To investigate the impact of daily outdoor activity on the progression of myopia in children.
- To quantify the relationship between time spent outdoors and changes in refractive error.
Main Methods:
- A hospital-based, prospective observational study involving 495 children aged 7-14 with myopia.
- Myopia progression was tracked via cycloplegic refraction every six months over 18 months.
- Parent-reported daily outdoor activity was recorded and used to calculate a standardized score.
Main Results:
- A statistically significant inverse association was observed between outdoor activity and myopia progression (spherical equivalent change).
- Each unit increase in outdoor activity was associated with a -0.01 D change in SE (Model 1) and a -0.06 D change (Model 2).
- These findings indicate that greater time spent outdoors correlates with slower myopia progression.
Conclusions:
- The study provides robust evidence for a significant inverse relationship between outdoor activity and myopia progression in children.
- Encouraging increased outdoor activity may be a viable strategy for myopia management and prevention.
Purpose:
The purpose of this study was to determine the influence of outdoor activity on myopia progression.
Methods:
It was a hospital-based longitudinal prospective observational study. Children between 7 and 14 years of age with a myopia of - 0.5 D or worse were included. Myopia progression was evaluated by cycloplegic refraction, every 6 months for 18 months. Parents were asked to record the daily outdoor activity of the child in hours per day at school and at home during weekdays and at weekends separately, based on which the daily outdoor activity score was calculated. The independent variables measured included age and gender of the participant, degree of myopia, and the daily outdoor activity score. Progression of myopia was defined as an increase in the spherical equivalent (SE) over 18 months. The magnitude of the association was determined by two mixed-effects models.
Results:
A total of 495 participants (250 males and 245 females) completed three visits during the study period. On taking age groups and paired observations as a random effect and adding SE at the last visit as the random slope in Model 1, each unit increase in outdoor activity had a negative effect on change in SE of - 0.01 (-0.02 to 0.00; P = 0.045). The same inverse relationship between outdoor activity and absolute SE as - 0.06 (-0.07 to - 0.03; P < 0.001) is estimated in Model 2.
Conclusion:
The study demonstrates a statistically significant inverse relationship between outdoor activity and myopia.
