School-age myopia is the most common vision disorder that usually begins in children. It is caused by abnormal eyeball elongation leading to refractive errors. Increased time indoors and decreased time outdoors, especially during the COVID-19 pandemic, are risk factors that may increase myopia. Environmental factors like increased education levels and decreased outdoor time have been linked to rising myopia rates. Maintaining good environmental sanitation through reducing light pollution and ensuring proper lighting can help prevent myopia.

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School-Age MYOPIA & Environmental Sanitation
Presentation · November 2022
DOI: 10.13140/RG.2.2.32595.45607
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Fatma Ibrahim Abdel-Latif Megahed
Suez Canal University
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2. Fatma Ibrahim Abdel-latif Megahed
Lecturer of Family and community health nursing at
Suez Canal University
School-Age MYOPIA & Environmental
Sanitation

5. The most common form of MYOPIA is school-age MYOPIA.
MYOPIA, also known as near- & short-sightedness, is the
most common vision disorder that usually begins in school-
age children which disturbs their distance vision. It
progresses slowly, and usually stabilizes by the age of 20. It is
characterized by blurring of objects viewed at a distance, and
is commonly the result of abnormal elongation of the eyeball
– which causes the refractive image formed by the cornea
and the lens to fall in front of the photoreceptors of the
retina.

6. According to the American Optometric Association,
more than 40% of Americans are myopic, a number that is
rapidly rising, especially among school-aged children. The
World Health Organization estimates that half of the
population of the world may be myopic by 2050. Insufficient
time spent in outdoor activities has been recognized in recent
years because of COVID-19 home confinement, which may
upsurge the sight-impairment damage little-a-bit.

7. The school-aged children were confined to their homes, and
online courses were offered. The duration and intensity of near
work activities are associated with MYOPIA such as reading or
using smartphones and computers.
Younger children are more vulnerable/susceptible to such
environmental changes than older ones. The onset of MYOPIA in
childhood increases the risks of high MYOPIA, and consequently,
macular degeneration, retinal detachment, cataracts, and
glaucoma in adulthood.

8. The underlying biological causes of MYOPIA is unknown,
and there is no widely-accepted-means of prevention or
cure. The optical error of MYOPIA can be corrected only
by using spectacle or contact lenses or corneal surgery. If
neglected/left-untreated, moderate MYOPIA is one of the
leading causes of visual impairment worldwide.

9. It is reasonable to assume that genes play a part in MYOPIA risk,
but they alone cannot account for the rapid changes in MYOPIA
prevalence that are being observed all over the world. In the study
by Mijie Li et al., the evidence supporting specific sleep factors
as independent risk factors for MYOPIA remains weak but
increased education and decreased time outdoors have been
identified as the two major environmental risk factors for
MYOPIA among school-aged children in Singapore.

10. Most of the identified risk factors for MYOPIA are correlated with
environmental influences, such as an increased socioeconomic status,
residing in an urban environment, higher education and IQ, increased
time spent performing near work, and increased time spent indoors.
According to Carr and Stell, the results have demonstrated that,
while genetics may determine MYOPIA susceptibility (e.g.: age of
onset, rate of progression, ultimate refractive error), environmental
factors are powerful modifiers of eye growth, and they may override
genetic predispositions.

11. Environmental sanitation was an instrumental concept in the founding
of the World Health Organization and was defined as the control of all
those factors in the physical environment which may exercise a
harmful effect on human beings’ physical development, health and
survival. It has been proven that a low or, on the contrary, an increased
level of illumination passing through the retina affects the working
processes of the brain and the state of the human body as a whole.
Insufficient illumination depresses, decreases work performance,
causes drowsiness. However; this is one of the main reasons for the
rapid deterioration of human vision.

13. Classification specifies the following hazardous and harmful working
factors associated with the light environment:
• Lack of necessary natural lighting;
• Lack of necessary artificial lighting;
• Increased brightness of light;
• Reduced light and color contrast;
• Direct and reflected glare;
• Increased pulsation of the light flux.

14. Light pollution, or photo pollution, is the presence of excess
artificial light and is a result of urbanization and industrialization.
It is only one of the many forms of pollution on Earth (e.g.
alongside plastic wastes, greenhouse gases and sewage, …).
Global light pollution has increased by at least 49% over the 25
years to 2017. Consequently, we need to limit usage of artificial
light, specially at night. Light pollution interferes with all biology
and biological natural cycles. This in human beings can result in
disturbed sleep, and likewise impact our immune system and
responses to stress.

15. Light pollution can also be amplified by other types of air pollution,
such as smoke and dust. The retina of the human eye can naturally
adjust its light-sensing cells to acclimate to very low-light conditions,
to allow some sort of night vision but because of light pollution, 37%
of people living in America don’t use their own night vision. Usage of
Light-emitting diodes (LEDs), is wide-spreading and will become
dominant in lighting in the future. However, strong and blue-rich
luminance makes LEDs potentially harmful to humans. Two types of
biological effects on humans are known: potential retinal toxicity and
biological clock disruption.

16. The International Dark-Sky Association has the following tips:
1. Reduce the use of light, installing it only where it’s really
needed and at the lowest brightness possible.
2. Use controls like dimmers, timers and motion sensors to
make the lights as efficient as possible.
3. Use shields to direct light toward the ground, reducing
glare.
4. Use warm color lights where possible and limit the use of
blue wavelength lights, which are thought to be the most
disruptive.

17. Exposure to potentially-harmful UV radiation can be
avoided by wearing UVA/UVB-blocking sunglasses and
sunscreen. Alternative light sources such as commercially
available SAD lights do not contain UV-radiation, and
have been shown to be nearly equally effective in
MYOPIA-prevention in animal models.

18. Prolonged exposure to natural-light-deficiency
leads to disruption of physiological balance in the
human body and the development of a pathological
condition called “light starvation”.

19. It is manifested by a disturbance in carbohydrate, protein, and
especially mineral metabolism, with a deterioration in the
state of the musculoskeletal system, weakening of immunity
to the effects of any pathogenic factors of a bacteriological
(viral, bacterial, fungal), chemical, radiation and other
nature, coupled with a decrease in the general tone of the
body, rapid fatigue, an increase in the number of defects in
work and a general deterioration in well-being.

20. Natural light is the most favorable for visual perception and
human health. In a natural light environment that is dynamic
during the day, there is daily circadian photoperiodism in
metabolism, in the release of sleep and wake hormones, in the
level of brain activity and other functions of the body of each
person. Many studies have noted the fact that both the
quantity and quality of lighting are also very important for
low accuracy and rough work. Decrease in injuries is
especially noted with favorable lighting.

21. Outdoor-light therapy may offer the ideal treatment for
MYOPIA. Not only does encouraging children to play
outside combat other major health concerns – such as
childhood obesity, juvenile diabetes, and depression – but
also, light therapy presents little to no serious health
concerns or side-effects compared to those of other
available MYOPIA-treatments.

22. Vitamin D is a fat soluble vitamin that also functions as a
hormone. There are 2 main forms of vitamin D: Vitamin D2
(ergocalciferol) and vitamin D3 (cholecalciferol).
Because it has less biological efficiency in mammals, it is
possible that vitamin D3 levels and its association with
MYOPIA is just a reflection of the effects of outdoor
activities itself and it is merely a confounding factor.

23. The most significant source of Vitamin D 3 is synthesis in the skin
on exposure to UV-B radiation. It comes mainly from animal
sources such as liver and oily fish including tuna, salmon,
mackerel and herring. Egg yolks are also an excellent source of
D3.
Most importantly parents need to ascertain that children get a
minimum of 90 minutes’ sunlight exposure every day as
deficiency in Vitamin D 3 can lead to visual impairment, less
immunity and other health complications.

24. To achieve and maintain a balanced diet, those children should
eat nutritious foods from all five food groups every day as
following:
1. Vegetables and legumes/beans — at least 5 serves daily.
Cabbage is high in beta-carotene, which helps improve vision and provides
protection against age-related cataracts.

26. 2. Fruit — 2 serves daily.
3. Lean meats, poultry, fish, eggs, nuts/seeds or
legumes/beans -— 1 to 3 serves a day, depending on age.

27. 4. Milk, yoghurt cheese and/or alternatives, mostly
reduced fat — at least 2-3 serves daily, with the
minimum amount varying based on age, sex and life
stage.
5. Grain (cereal) foods, mostly wholegrain and/or high
cereal fiber varieties — 4 serves daily for children.

28. Following is:
 A guide to sunshine-doses that are needed to
avoid vitamin D deficiency as influenced by the
season of the year.
Summer Spring/Autumn Winter
Fair skin 10 minutes 20 minutes 30 minutes
Dark skin 20 minutes 60 minutes 90 minutes

30. Topical atropine drops is considered to be the best
pharmaceutical treatment for MYOPIA but parents
should be aware of the most common side effects:
possible photophobia due to pupil dilation, impairment of
near-vision due to paralysis of the ciliary muscle, allergic
reactions, and rebound after cessation of treatment. It
should also be noted, that not all children will respond to
atropine-treatment.

31. Resources:
 https://my.clevelandclinic.org/health/diseases/8579-myopia-nearsightedness.
 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2774808.
 https://www.frontiersin.org/articles/10.3389/fpubh.2022.828298/full
 https://www.ncbi.nlm.nih.gov/books/NBK470669/
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8958826/
 file:///C:/Users/FOX/Downloads/Tepina_2022_IOP_Conf._Ser.__Earth_Environ._Sci._988_022069.pdf
 https://www.weforum.org/agenda/2022/06/light-pollution-health-climate/
 https://www.livescience.com/light-pollution
 https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/pandemic-impact-low-vitamin-d-levels-noted-in-children-
with-new-onset-of-progressive-myopia/articleshow/94221872.cms
 https://actascientific.com/ASOP/pdf/ASOP-04-0334.pdf
 https://www.alarabiya.net/medicine-and-health/2016/05/17/%D8%AA%D9%86%D8%A7%D9%88%D9%84-
%D8%A7%D9%84%D9%85%D9%84%D9%81%D9%88%D9%81-%D9%85%D8%B1%D8%AA%D9%8A%D9%86-
%D8%A8%D8%A7%D9%84%D8%A3%D8%B3%D8%A8%D9%88%D8%B9-%D9%84%D8%AA%D8%AD%D8%B5%D9%84-
%D8%B9%D9%84%D9%89-8-%D9%81%D9%88%D8%A7%D8%A6%D8%AF-%D8%B5%D8%AD%D9%8A%D8%A9
 https://www.healthdirect.gov.au/foods-high-in-vitamin-d
 https://www.sciencedirect.com/science/article/abs/pii/S0013935120308379

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