Light exposure from spending time outdoors has been proven to prevent and slow down myopia. There is now an evidence-based medical device delivering low-level red light therapy that can help children reduce and even reverse myopia, without them having to step outside.
Myopia is a major public health concern in East and Southeast Asia, including mainland China, Hong Kong, Taiwan, South Korea, Japan, and Singapore.
In these regions, around 80 per cent of students who complete secondary school have myopia which requires correction, while 10 to 20 per cent of them have high myopia with a refractive error of above -6.00 diopters.
Axial length elongation, the fundamental pathologic change of myopia, is at its most exponential when children’s eyes are rapidly growing before the age of 10 and slows down in the pre-teen and teen years.
Hence, to effectively slow down myopia, it is essential to detect the condition and intervene as early as possible.
Developing high myopia increases the child’s risk of developing sight-threatening conditions, such as retinal degeneration, glaucoma, retinal detachment, and cataract. This poses a considerable burden not only on the individual, but also on the health care system and economy, as not only is treating severe vision impairments costly, sight-threatening disorders can lead to a loss in productivity.
According to the World Health Organization (WHO), annual global costs of productivity losses associated with vision impairment from uncorrected myopia was US$244 billion in 2015.
The annual direct cost of myopia correction for Asian adults has been estimated at US$328 billion per annum, with cost of care increasing significantly with the prevalence of high myopia.
The same study also shows that myopes, especially high myopes, tend to have reduced quality of life due to adverse psychological, cosmetic, practical, and financial factors that affect productivity, mobility, and activities of daily living.
In young school-going children, myopia may not only negatively impact academic performance, but also lower self-esteem, and as a result reduce their social interaction and participation in activities outside the classroom.
Outdoor Time Effective In Preventing Myopia
Effective myopia management typically requires a combination of evidence-based therapies and lifestyle modifications, and spending time outdoors is one of the simplest lifestyle changes to incorporate into a child’s day-to-day schedule.
The WHO says that children who spend more than two hours a day outdoors have a lower risk of myopia than children who spend less than two hours, even if they continue to do near work or have two myopic parents.
In a 2015 study of six-year-olds in Guangzhou, China, an additional 40 minutes per day of outdoor activity at school resulted in a reduced incidence rate of myopia over the next three years.
Unfortunately, urban Asian children spend only about 30 minutes outdoors on a typical weekday.
This is usually due to the parents’ high expectations for their children to excel academically, which has led them to allocate more time to intensive study indoors, in and out of school.
These parents may be less inclined to allow their children to spend extended periods of times outdoors, even if they are aware that this could help to manage myopia.
Limitations In The Current Treatment Landscape
There are several evidence-based treatment options to manage myopia such as atropine eye drops, spectacles, and contact lenses. Many Asian parents tend to opt for spectacles to control myopia as they tend to be well-tolerated in children.
However, studies show that not only does spectacle-related ocular trauma make up three to 7 per cent of all ocular injuries in children, but some myopic children will need to upgrade their lens prescription every year to keep up with their progressing myopia, which can be costly.
Contact lenses are more convenient for children who are active in sport and exercise, especially if spectacles are not required during the day. Hard contact lenses such as orthokeratology (ortho-k) lenses, which are worn overnight, have been shown to slow down myopia progression by over 50 per cent.
The main advantage of these lenses is that the child can expect to go without spectacles or contact lenses the following day. Disposable dual-focus contact lenses have also been found to slow down myopia progression by over -2.00 diopters for children between the ages of eight and 18 years.
However, in addition to the high cost of contact lenses, a significant barrier that discourages parents from enabling their children to adopt contact lenses is their apprehensions with regards to contact lens safety and the risk of developing eye infections from improper use.
Parents may also find fitting contact lenses for their child inconvenient, especially in young children who would need daily assistance for at least the first few years upon fitting the contact lenses.
Atropine eyedrops in low-dose concentrations (0.01%), have been proven to be effective in managing myopia and is widely prescribed by ophthalmologists in countries such as Singapore and Taiwan.
However, atropine has not been approved as a myopia control drug in many countries such as China, which poses some limitations to its use. Atropine, especially in higher doses, have also been linked to adverse effects such as photophobia or sensitivity to bright light, poor near visual acuity, and allergy.
The promising emerging data on low-level red-light therapy (RLRL) and the convenient and non-invasive nature of treatment make it an exciting new addition to the eye care professionals’ (ECPs) toolkit in the fight against myopia, especially in younger children, and children who are not suitable candidates for the other treatments.
Red Light Therapy In Treating Myopia
There is a growing body of research into the benefits of red light therapy, or low-level light therapy, in eye health and vision restoration. Red light therapy is a therapeutic technique in which light-emitting diodes (LED) diffuse red and near-infrared (NIR) light at specific wavelengths through the skin and into the cells, activating the body’s own mitochondrial response to create energy and boost the functioning of tissues and organs.
While investigating its efficacy in treating myopia, my colleagues and I found that children who underwent RLRL therapy for three minutes twice a day, five days a week, significantly reduced their myopia progression over a period of six months.
The primary outcomes show RLRL therapy had 69.4 per cent efficacy in controlling axial length elongation, and 76.6 per cent efficacy in controlling myopia progression.
A post-trial follow-up study also found that the treatment effect was sustained for up to two years after the treatment was stopped, with only a modest rebound effect.
Additionally, according to a study published in 2023, nearly a quarter of children benefited from at least 0.05mm axial length shortening following 12 months of RLRL therapy – the first treatment for myopia to achieve such results.
The recent launch of the Eyerising Myopia Management Device in the Asia-Pacific region is a positive development for ECPs in the region, as the desktop device enables children with myopia to undergo RLRL therapy in the comfort of their own homes under the supervision of a parent or guardian, potentially transforming the treatment landscape for myopia in this region.
Widely available in China and approved by its National Medical Products Administration (NMPA), the technology has also received regulatory clearance from the Conformité Européene (CE) in the European Union,
Medicines and Healthcare Products Regulatory Agency (MHRA) in the United Kingdom, Medsafe in New Zealand, and is currently preparing for Food and Drug Administration (FDA) approval in the United States.
Prof He Mingguang is Head of Ophthalmic Epidemiology at the Centre for Eye Research Australia, and Professor of Ophthalmic Epidemiology, University of Melbourne, Australia.