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• W2896473544 abstract "We read with interest the article on myopia and light exposure by Wu et al.1Wu P.C. Chen C.T. Lin K.K. et al.Myopia prevention and outdoor light intensity in a school-based cluster randomized trial.Ophthalmology. 2018; 125: 1239-1250Abstract Full Text Full Text PDF PubMed Scopus (242) Google Scholar Although the study evaluated the effect after 1 year of continuous intervention, measuring the change in spherical equivalent and axial length, outdoor time was evaluated objectively by means of a pendant light meter the children wore on their collars only for 7 consecutive days. In addition, it was not explained if the children wore the pendant for 1 week at the beginning of the study, to obtain the basal measurements, and again for 1 week at the end of the study, as Table 4 suggested. Undoubtedly, it would have been preferable to obtain the quantitative information from the light meters for a longer period (≥4 weeks). Furthermore, the light meters were used only to calculate the weekly in-school outdoor time, whereas afternoon out-of-school outdoor time and weekend outdoor time were obtained from a less reliable, nonquantitative, and more subject-dependent method (a diary log), because of compliance issues. No data on compliance of wearing the light meters out of the schools were provided. In Table 5 of the original article, which showed the analysis of myopic shift with outdoor times measured by different cutoff points of light intensity in all participants, it would be interesting to have the number of children in each category. It is indicated that those children with ≥200 minutes a week of exposure to both ≥1000 and ≥ 3000 lux showed a protective effect compared with those having <125 minutes of weekly light exposure (with a difference of 0.14 and 0.16 diopters [D], respectively). However, children also with ≥200 minutes a week of exposure to an even higher intensity of light (≥5000 lux) did not reach a significant protective effect compared with those with <125 minutes a week. Does it mean that those with <125 minutes of exposure to high levels of light also had the protective effect? In addition, was the myopic shift of those exposed to higher levels of light less than those with exposure to lower light levels, even if both groups had >200 minutes a week? The authors explained that participants who had ≥200 minutes of weekly outdoor time during school and were not myopic at baseline had significantly less myopic shift when exposed to ≥1000 lux (0.18 D), ≥3000 lux (0.22 D), or ≥5000 lux (0.24 D) environments than those with exposure <125 minutes per week. However, when assessing participants who had 125 to 199 minutes of outdoor time during school, only those who were exposed to a ≥10 000 lux environment had significantly less myopic shift (0.16 D) than the reference group. This finding suggested that, for schoolchildren with less outdoor time, a greater light intensity of light is necessary to reach the protective effects, whereas in those with longer durations of outdoor time, moderate levels of light (≥1000 lux or ≥3000 lux) may be sufficient to protect against myopia. We wonder if even lower light intensities, but for longer periods of times (i.e., 500 lux for 400 minutes per week) would also be protective. Currently, we are planning a study increasing lighting indoors in classrooms based on the study by Hua et al published in 2015.2Hua W.J. Jin J.X. Wu X.Y. et al.Elevated light levels in schools have a protective effect on myopia.Ophthalmic Physiol Opt. 2015; 35: 252-262Google Scholar The commented findings by Wu et al1Wu P.C. Chen C.T. Lin K.K. et al.Myopia prevention and outdoor light intensity in a school-based cluster randomized trial.Ophthalmology. 2018; 125: 1239-1250Abstract Full Text Full Text PDF PubMed Scopus (242) Google Scholar seem to correlate with this research, because the intensity was increased to a level of only ≥500 lux in the desk of the students. These results, as explained by the authors, are in contrast with animal studies, where it has been found that the increased protection occurs only at much higher light intensities.1Wu P.C. Chen C.T. Lin K.K. et al.Myopia prevention and outdoor light intensity in a school-based cluster randomized trial.Ophthalmology. 2018; 125: 1239-1250Abstract Full Text Full Text PDF PubMed Scopus (242) Google Scholar, 3Galvis V. Tello A. Camacho P.A. et al.Bio-environmental factors associated with myopia: An updated review.Arch Soc Esp Oftalmol. 2017; 92: 307-325Google Scholar, 4Stone R.A. Cohen Y. McGlinn A.M. et al.Development of experimental myopia in chicks in a natural environment.Invest Ophthalmol Vis Sci. 2016; 57: 4779-4789Google Scholar In contrast, Read et al5Read S.A. Collins M.J. Vincent S.J. Light exposure and physical activity in myopic and emmetropic children.Optom Vis Sci. 2014; 91: 330-341PubMed Google Scholar also found that emmetropic children spent significantly greater time exposed to moderate intensity light (>1000 lux) compared with the myopic children. As shown in the photograph 9 of Figure 2 of the original study by Wu et al,1Wu P.C. Chen C.T. Lin K.K. et al.Myopia prevention and outdoor light intensity in a school-based cluster randomized trial.Ophthalmology. 2018; 125: 1239-1250Abstract Full Text Full Text PDF PubMed Scopus (242) Google Scholar many classrooms have light levels below 500 lux; therefore, it seems a very plausible option to investigate. Furthermore, it is a measure very easy to implement if more studies confirm its advantages. Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized TrialOphthalmologyVol. 125Issue 8PreviewTo investigate the effectiveness of a school-based program promoting outdoor activities in Taiwan for myopia prevention and to identify protective light intensities. Full-Text PDF ReplyOphthalmologyVol. 125Issue 11PreviewWe thank Galvis et al for their letter. In our study, the schoolchildren wore light meters for 1 week and received baseline refraction measurements during the first month after beginning the study. Similarly, light meters were worn again for 1 week and refraction measurements were performed during the last month of the study. Full-Text PDF" @default.
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• W2896473544 title "Re: Wu et al.: Myopia prevention and outdoor light intensity in a school-based cluster randomized trial (Ophthalmology. 2018;125:1239-1250)" @default.
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