A New AMA Policy – More Time Spent Outdoors May Reduce the Risk of Kids’ Nearsightedness

This resolution called for the American Medical Association to limit screen time and increase outdoor activity to prevent childhood myopia, authored by Shannon Tai, medical student at Saint Louis University, and Ingrid Hsiung, pathology resident physician at the Rush University Medical Center in Chicago. It was adopted as AMA policy by the House of Delegates at the 2017 Annual Meeting in Chicago.

In the 21^st century, children are leaving the playground behind to become digital consumers. From the time they can first grasp an object, children begin to play with their parents’ phones or iPads and soon grow comfortable using tablets, TVs, laptops, and gaming systems. A national Kaiser Family Foundation survey found that 8-18-year-olds today devote an average of 7 hours and 38 minutes to using entertainment media across a typical day.¹ Furthermore, the post-millennial generation spends about half as much time outside as children did 20 years ago. This concurrent shift towards increased screen time and decreased outdoor play may raise the likelihood of developing myopia. It has long been thought that nearsightedness is mostly a hereditary problem, but researchers led by the Journal of the American Medical Association² (JAMA) and Ophthalmology³ suggest that children’s environment exerts a significant influence.

Myopia is the leading cause of visual impairment globally and will likely affect 50% of the world’s population by the year 2050.⁴ See Figure 1. It already affects 90% of children in Eastern Asia, predominantly in China, Korea, and Taiwan. Myopia’s prevalence is an important healthcare concern, as afflicted patients report a lower quality of life and hefty financial consequences associated with a lifetime of refractive correction.⁵ Growing up, we carried this burden and struggled constantly to get new contact lenses that could keep up with our ever-worsening myopia. Now, as grade schools begin implementing iPads as learning tools in class and require children to have a laptop for homework assignments, we worry that the educational system is inadvertently failing to address the health care consequences children may suffer.

Figure 1.

Figure 1 shows the number of people in millions estimated to have myopia and high myopia globally for each decade from 2000 through 2050. Myopia is projected to reach 4758 million people by 2050, 49.8% of the global population. High myopia is projected to reach 938 million by 2050, 9.8% of the global population.

Source: Franchi C, Longo A, Meslin D. High Myopia: the specificities of refraction and optical equipment. Points de Vue, International Review of Ophthalmic Optics. 2016; 73. Available at http://www.pointsdevue.com/article/high-myopia-specificities-refraction-and-optical-equipment#

This concern, in tandem with my interest in ophthalmology and intellectual attraction to medical advocacy sparked my initiative to combat childhood myopia. This then inspired us to write a medical policy to improve public health outcomes for children with nearsightedness.

During the research process for writing this policy, it was found that numerous studies showed increasing time spent outdoors may be a simple strategy to reduce the risk of developing myopia and its progression in children. These evidence-based guidelines had seen success and were already implemented in Chinese, Taiwanese, and Australian schools. For example, a randomized controlled trial published by JAMA showed that in six schools with children from grades 1–2, the addition of just 40 minutes of outdoor activity resulted in a reduced incidence rate of myopia by 9.1%.²

Our policy was titled, “Decreasing screen time and increasing outdoor activity to offset myopia onset and progression in school children.” Myriad problems arise when screen time stymies physical activity and face-to-face social interaction outdoors. To those points, the American Academy of Pediatrics (AAP) recommends that parents limit the amount of screen time their children spend on electronic devices every day and ensure a minimum of 1 hour of physical activity.^6,7 Screen time can also potentially lead to eyestrain and problems as grave as myopia. Fortunately, our policy can build upon the foundation laid by the AAP and sharpen the scope to help reduce the prevalence and onset of childhood myopia.

It was truly an emotional and gratifying experience to help navigate this policy through the city, state, and national levels by way of the St. Louis Metropolitan Medical Society, Kansas City Medical Society, Missouri State Medical Association House of Delegates, and, finally, the American Medical Association House of Delegates. We would like to humbly thank Dr. Charles Van Way and the American Academy of Ophthalmology for their mentorship and guidance. Without the aforementioned parties, our dream of helping children avoid the burdens of myopia would not have become a reality. Ours has been a long journey, but thanks to the long hours we put into researching and writing this policy, we may help protect subsequent generations in a new, digital age. The final resolved clause is stated below:

“RESOLVED, That our American Medical Association support efforts to increase outdoor time and promote other activities that have been demonstrated to reduce the progression of myopia in children.”

Medical students at the AMA meeting, from left : Drew Garrone, Elliot Voss, Ariel Carpenter, Jared Lammert, David Barbe, MD, Scott Bernt, and Junaid Yasin.

Biography

Shannon Tai, MSMA Member since 2016, is a Medical Student at Saint Louis University School of Medicine and a Missouri Alternate Delegate to the American Medical Association.

Contact: stai@slu.edu