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Scott A. Read, Michael J. Collins, Stephen J. Purpose : The purpose of this study was to examine the relationship between objectively measured ambient light exposure and longitudinal changes in axial eye growth in childhood. Methods : A total of children 41 myopes and 60 nonmyopes10 to 15 years of age participated in this prospective longitudinal observational study.

Axial eye growth was determined from measurements of ocular optical biometry collected at four study visits over an month period.

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Each child's mean daily light exposure was derived from two periods each 14 days long of objective light exposure measurements from a wrist-worn light sensor. Conclusions : In this population of children, greater daily light exposure was associated with less axial eye growth over an month period. These findings support the role of light exposure in the documented association between time spent outdoors and childhood myopia.

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Purchase this article with an. Jump To Read ; Michael J. Collins ; Stephen J. Correspondence: Scott A. Alerts User Alerts. You will receive an whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My. This feature is available to authenticated users only. Get Citation Citation. Get Permissions. There is growing evidence from both human and animal studies of refractive error showing that ambient light exposure is an important environmental factor involved in the regulation of eye growth.

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Documented seasonal variations in eye growth and refractive error progression in childhood with slower eye growth seen in summer months and faster rates of eye growth in winter months support a potential role for ambient light exposure in the control of human eye growth. Interventions aimed at increasing children's time spent outdoors have also been reported to reduce the development of myopia in childhood 23 Morgan IG, et al.

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Although most studies report a ificant relationship between less time outdoors and myopia, some studies have found no ificant relationship between outdoor time and the presence, 2425 progression, 26 or stabilization of myopia. Although it has been postulated that the association between less myopia and more time outdoors is due to increased light exposure when outdoors, 12 most studies examining the relationship between outdoor activity and myopia have used questionnaires to estimate outdoor activity.

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These questionnaires rely upon the accurate recall and perception of activities, and there is evidence that questionnaire-derived outdoor time does not correlate strongly with objectively measured light exposure. We recently reported objectively measured light exposure and physical activity patterns of a pediatric population and found a ificantly lower average light exposure in myopic children than in nonmyopic children.

Although these recent studies have provided detailed cross-sectional analyses of the typical environmental light exposure of children and young adults, to date there have been no longitudinal studies examining the influence of objectively measured light exposure upon eye growth in humans.

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In this longitudinal study, we aimed to examine the relationship between objectively measured ambient light exposure and axial eye growth over 18 months, in a population of myopic and nonmyopic children. This prospective, observational longitudinal examination of axial eye growth and objectively measured light exposure involved children between 10 and 15 years of age enrolled in the Role of Outdoor Activity in Myopia ROAM study.

Approval from the Queensland University of Technology human research ethics committee was obtained before commencement of the study, and all parents provided written informed consent, and children written assent prior to participation. All children were treated in accordance with the tenets of the Declaration of Helsinki.

All children enrolled in the study exhibited best corrected visual acuity of logMAR 0. Myopic children all wore conventional single-vision spectacle correction although four children also wore spherical soft disposable contact lenses and were excluded if they were under any optical or pharmacologic treatments to slow myopia progression.

One of the nonmyopic participants developed s of a retinal dystrophy at the second study visit and was therefore excluded from all analyses. Myopic and nonmyopic children were well matched for both age mean age: Baseline ocular biometric measurements were collected between May and November Each child then had ocular measurements made every 6 months over an month period i. Questionnaires detailing each child's typical nearwork and outdoor activities performed in the preceding 6 month period were also completed at each follow-up visit, using a ly validated questionnaire.

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At each 6-month ocular measurement visit, axial length AxL was measured using an optical biometer, which is based on the principles of optical low coherence reflectometry Lenstar LS ; Haag Streit AG, Koeniz, Switzerland and provides highly precise measures. All ocular biometry measurement visits were scheduled between 3 PM and 5 PM, to limit the potential confounding influence of diurnal variations in AxL 35 upon the data.

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This is a light weight, waterproof up to 30 minutes in water wristwatch device that contains a silicone photodiode light sensor that measures visible light the sensor measures over a wavelength range from to nm, has a peak sensitivity of nm, and a dynamic range from 5 tolux. The first period of light measurements was conducted between July and December i. Each child had one measurement period in each category and wore the light sensor on the nondominant wrist, for 24 hours a day over each day period during the school academic term i.

All devices were programmed to instantaneously record light exposure every 30 seconds i. Measurement protocol and data screening procedures used for the light exposure measurements have been ly described in detail. Following data collection at each visit, the AxL data of right and left eyes were averaged. Light exposure data were then analyzed to calculate the mean daily light exposure between 6 AM and 6 PM for each subject, for each of the two day periods of light sensor wear.

These light exposure values for each subject were derived from an average of An intraclass correlation of the between-session reliability of the average daily light exposure measurements was 0.

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The mean light exposure between 6 AM and 6 PM was used as our primary light exposure measure in the study, as this encompassed the period during the day where the vast majority of light exposure occurred for all subjects in the study across all measurement times. The average minutes per day of nearwork and outdoor activities were also calculated based upon the questionnaire responses at each visit, using the criteria described by Rose et al.

The longitudinal changes in AxL and their association with a range of predictor variables over the 18 months of the study were then examined using linear mixed model LMM analyses, with restricted maximum likelihood estimation.

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Linear mixed model analyses examined the effect of study visit time in years from baseline visit, as a continuous variable upon AxL, assuming a first-order autoregressive covariance structure this assumes the correlation between measurements is lower for measurements taken farther apart in time.

Individual subject's slopes and intercepts were included as random effects in the model assuming an unstructured covariance type.

Categorical predictor variables refractive error group, parental myopia, and sex were included in the model as fixed factors; and continuous predictor variables age at baseline visit, average daily light exposure, average minutes of nearwork per day, average minutes of self-reported outdoor time per day and average daily physical activity per day were included as covariates. Because the human eye typically exhibits a logarithmic response to light, analyses regarding eye growth and light exposure were performed on the log of the average daily light exposure data.

Additional mixed models were also carried out, including quadratic and cubic time terms, but because the inclusion of these terms did not alter the overall statistical outcomes nor improve Akaike's information criteria associated with the model, only the linear models are presented.

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To provide further insight into the influence of light exposure upon eye growth, an additional LMM analysis was conducted that categorized the children according to their average daily light exposure. Additionally, this model also used baseline AxL as the variable describing refractive error given that AxL is the major biometric correlate of refractive errorin order to provide an analysis that did not rely upon the noncycloplegic refractive error grouping.

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Changes in AxL over the course of the study were then examined, including categorical predictor variables light exposure group, parental myopia, and sex in the model as fixed factors, and continuous predictor variables AxL at baseline, age at baseline visit, average minutes of nearwork per day, average minutes of questionnaire-derived outdoor time per day, and average daily physical activity per day as covariates.

The average environmental climate and day length i. Table 1 View Table. The average objectively measured light exposure for this population of children is summarized in Table 2.

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Table 2 View Table. Figure 1. View Original Download Slide. Solid lines indicate best fit regression line for myopic red and nonmyopic blue children, and dashed black line is the line of equality between the warmer days and the cooler days.

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At the baseline visit, the mean AxL in the myopic children was Over the course of the study, a mean axial eye growth i. Linear mixed model analysis examining the longitudinal changes in AxL Table 3 revealed a ificant main effect of refractive group and sex, consistent with a ificantly smaller baseline AxL in the nonmyopic children compared to the myopic children the myopic children were estimated to have a 1.

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ificantly greater AxL change was also observed in boys than in girls boys were found to exhibit an AxL growth of 0. Figure 2.

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Mean change in axial length AxL from baseline to 18 months for the myopic red linenonmyopic blue line and all green line children in the study. Vertical error bars represent the standard error of the mean change in axial length, and horizontal error bars represent the standard error of the study visit time.

Vertical black lines indicate mean timing of the first and second light exposure measurements in the study gray shading around the vertical lines illustrates the standard deviation of the mean timing of light exposure measurements. Figure 2 Mean change in axial length AxL from baseline to 18 months for the myopic red linenonmyopic blue line and all green line children in the study.

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Table 3 View Table. To further explore the relationship between light exposure and axial eye growth, we performed LMM analyses that included mean daily times exposed to the various bright light levels i.

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Additional analyses were carried out after categorizing the children based upon their average daily light exposure regardless of refractive status. Table 4 View Table.

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Figure 3. Data for all children amyopic children only band nonmyopic children only c are shown. Vertical error bars represent standard error of the mean change in AxL, and horizontal error bars represent standard error of the study visit time. This study, examining the longitudinal changes in AxL of children, demonstrates a modest but statistically ificant relationship between objectively measured daily light exposure and axial eye growth adjusting for potential confoundersindicating that greater average daily light exposure in less axial growth of the eye in childhood. Children habitually experiencing low average daily light exposure were found to exhibit statistically ificantly faster axial eye growth compared to children habitually experiencing moderate and high average daily light exposure.

Although studies have reported a ificant association between time spent outdoors, derived by questionnaires, and the prevalence, 11 — 14 development, 15 — 18 and progression 1920 of myopia, our study provides the first evidence of a ificant influence of objectively measured daily ambient light exposure upon eye growth in childhood.

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Our findings are consistent with the hypothesis 12 that the documented association between less outdoor activity and more myopia is driven by differences in light intensity levels between indoor and outdoor environments. The lack of a ificant relationship between physical activity and eye growth also suggests that differences in physical activity associated with being outdoors are not a major factor in the relationship between myopia and time outdoors. Taken together, these suggest that the mechanisms controlling eye growth may be sensitive to the intensity of light outdoors, and brighter light intensities of more than lux may have a greater influence on eye growth than intensities of to lux.

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Although our indicate that the magnitude of daily light exposure appears to contribute to the apparent protective effects of outdoor activities, it does not rule out the potential involvement of other factors. We found evidence of ificantly faster axial eye growth in children habitually experiencing low daily light exposure but no ificant difference in the rate of eye growth between children experiencing moderate and high daily light exposure. This finding supports the notion that there may be a threshold of daily light exposure required in childhood in order to slow axial eye growth.

This suggests that less than 40 minutes per day of bright light exposure may predispose children to faster axial eye growth. Our support the potential for interventions aimed at increasing average daily light exposure in order to reduce the progression of childhood myopia, and also help to improve our understanding of the potential magnitude of the effects of such interventions.

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Although increased daily light exposure could be achieved through a variety of means e. from a small of such interventions do appear to suggest a positive effect in reducing myopia progression 23 Morgan IG, et al. Although only a small of studies have examined the relationship between myopia progression and outdoor activities in childhood, these reports have presented some conflicting. ZIP: 39428

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