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Advertisement Advertisement Eye * View all journals * Search * Log in * Explore content * About the journal * Publish with us * Subscribe * Sign up for alerts * RSS feed 1. nature 2. eye 3. review articles 4. article * Review Article * Published: 22 September 2023 Eye exercises for myopia prevention and control: a comprehensive systematic review and meta-analysis of controlled trials * Zhicheng Lin ORCID: orcid.org/0000-0002-6864-6559^1, * Feng Xiao ORCID: orcid.org/0000-0002-5704-6427^1^ na1 & * Weiye Cheng^1^ na1 Eye volume 38, pages 473-480 (2024)Cite this article * 404 Accesses * 1 Citations * 91 Altmetric * Metrics details Subjects * Epidemiology * Vision disorders Abstract Objectives To evaluate the efficacy of eye exercises in preventing and controlling myopia. Methods We searched studies on eye exercises from nine Chinese and English databases from their inception to December 15, 2022. Using random-effect models and sensitivity/subgroup analyses, we estimated the effects of eye exercises compared to control on changes in three measures: visual acuity, refractive error (both quantified using standardized mean differences, SMDs), and protective/mitigating effects (assessed through risk ratios, RRs). Results Eleven studies were included in the meta-analysis, with 921 participants. Nine studies had some concerns of bias in at least two domains, and two studies had a high risk of bias in two domains. Seven studies used visual acuity to measure myopia; visual acuity declined after eye-exercise interventions (SMD = -0.67, 95% CI -1.28 to -0.07, Z = 2.17, P = 0.03) and the effect was not better than control (SMD = -0.50, 95% CI -1.16 to 0.16, Z = 1.49, P = 0.14). Two studies used refractive error to measure myopia; the effect of eye-exercise interventions did not differ from control (SMD = -1.74, 95% CI -6.27 to 2.79, Z = 0.75, P = 0.45). Seven studies reported on protective/mitigating effects; eye exercises exhibited a greater protective/mitigating effect than control (RR = 0.40, 95% CI 0.23-0.71, Z = 3.13, P < 0.01). Conclusions Overall, the results suggest that eye exercises have limited to no efficacy in preventing or controlling myopia progression. Until robust evidence supports their efficacy, available evidence suggests retiring the eye-exercise policy. Zhai Yao Fang Fa : Zai Jiu Ge Zhu Yao Zhong Wen He Ying Wen Shu Ju Ku Li Sou Suo Yu Yan Bao Jian Cao Xiang Guan De Dui Zhao Shi Yan Yan Jiu , Ri Qi Wei Cong Shu Ju Ku Jian Li Qi Zhi 2022Nian 12Yue 15Ri , Bing Shi Yong Hui Cui Fen Xi (Sui Ji Xiao Ying Mo Xing He Min Gan Xing Fen Xi ) Gu Ji Yan Bao Jian Cao Xiang Dui Dui Zhao Zu Zai San Ge Jin Shi Zhi Biao Shang De Xiao Guo , Ji Shi Min Du , Qu Guang Wu Chai (Jun Shi Yong Biao Zhun Hua Jun Shu Chai , SMD), Yi Ji Bao Hu /Huan Jie Xiao Guo (Feng Xian Bi , RR) . Jie Guo : Gong You 11Xiang Yan Jiu Na Ru Liao Zhe Ge Hui Cui Fen Xi , She Ji 921Ming Can Yu Zhe ----You Jiu Xiang Yan Jiu Zai Zhi Shao Liang Ge Fang Mian You Pian Yi Wen Ti , Er You Liang Xiang Yan Jiu Zai Liang Ge Fang Mian You Gao Pian Yi Feng Xian . Qi Zhong Qi Xiang Yan Jiu Shi Yong Shi Min Du Lai Ping Gu Jin Shi : Yan Bao Jian Cao Gan Yu Hou , Shi Li Xia Jiang Liao (SMD = -0.67, 95% CI -1.28 to -0.07, Z = 2.17, P = 0.03), Qie Qi Xiao Guo Bing Bu You Yu Dui Zhao Zu (SMD = -0.50, 95% CI -1.16 to 0.16, Z = 1.49, P = 0.14) . Liang Xiang Yan Jiu Shi Yong Qu Guang Wu Chai Lai Ping Gu Jin Shi : Yan Bao Jian Cao Gan Yu De Xiao Guo Yu Dui Zhao Zu Wu Yi (SMD = -1.74, 95% CI -6.27 to 2.79, Z = 0.75, P = 0.45) . Qi Xiang Yan Jiu Bao Gao Liao Bao Hu /Huan Jie Xiao Guo : Yan Bao Jian Cao De Bao Hu /Huan Jie Xiao Guo You Yu Dui Zhao Zu (RR = 0.40, 95% CI 0.23-0.71, Z = 3.13, P < 0.01) . Jie Lun : Hui Cui Fen Xi Biao Ming , Yan Bao Jian Cao Zai Yu Fang Huo Kong Zhi Jin Shi Jin Zhan Fang Mian De Liao Xiao You Xian Huo Wu Xiao . Yin Ci , Zai You Chong Fen Zheng Ju Zhi Chi Qi Liao Xiao Zhi Qian , Jian Yi Ting Zhi Ji Xu Shi Shi Yan Bao Jian Cao Zheng Ce . Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution Access options Access through your institution Access through your institution Change institution Buy or subscribe Subscribe to this journal Receive 18 print issues and online access $259.00 per year only $14.39 per issue Learn more Buy this article * Purchase on Springer Link * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout Additional access options: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer support Fig. 1: PRISMA Flowchart for the Study Selection Process. [41433_2023_2739_Fig1_HTML] Fig. 2: Forest Plots for the Four Comparisons. [41433_2023_2739_Fig2_HTML] Similar content being viewed by others [41433_2021] What colour are your eyes? Teaching the genetics of eye colour & colour vision. Edridge Green Lecture RCOphth Annual Congress Glasgow May 2019 Article Open access 23 August 2021 [placeholde] How do I recognise and manage visual snow syndrome? Article Open access 16 April 2024 [41572_2020] Myopia Article 17 December 2020 Data availability This study is registered on the Open Science Framework. Extracted data and code are available online (https://osf.io/dr5jk/); additional requests may be made to the corresponding author. References 1. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123:1036-42. Article PubMed Google Scholar 2. Morgan IG, Rose KA. Myopia: is the nature-nurture debate finally over? Clin Exp Optom. 2019;102:3-17. Article PubMed Google Scholar 3. Morgan IG, French AN, Ashby RS, Guo X, Ding X, He M, et al. The epidemics of myopia: aetiology and prevention. Prog Retin Eye Res. 2018;62:134-49. Article PubMed Google Scholar 4. Chua SY, Sabanayagam C, Cheung YB, Chia A, Valenzuela RK, Tan D, et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016;36:388-94. Article PubMed Google Scholar 5. Hu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of age at myopia onset with risk of high myopia in adulthood in a 12-year follow-up of a Chinese cohort. JAMA Ophthalmol. 2020;138:1129-34. Article PubMed Google Scholar 6. Ikuno Y. Overview of the complications of high myopia. Retina. 2017;37:2347-51. Article PubMed Google Scholar 7. Naidoo KS, Fricke TR, Frick KD, Jong M, Naduvilath TJ, Resnikoff S, et al. Potential lost productivity resulting from the global burden of myopia: systematic review, meta-analysis, and modeling. Ophthalmology. 2019;126:338-46. Article PubMed Google Scholar 8. Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet global health commission on global eye health: vision beyond 2020. Lancet Glob Health. 2021;9:e489-551. Article CAS PubMed PubMed Central Google Scholar 9. National Health Commission of the People's Republic of China: The 2020 national survey on myopia among children and adolescents. Available at: http://www.gov.cn/xinwen/2021-07/13/ content_5624709.htm. Accessed 21 Jan 2023. 10. He M, Huang W, Zheng Y, Huang L, Ellwein LB. Refractive error and visual impairment in school children in rural southern China. Ophthalmology. 2007;114:374-82. Article PubMed Google Scholar 11. Wang H, Li Y, Qiu K, Zhang R, Lu X, Luo L et al. Prevalence of myopia and uncorrected myopia among 721 032 schoolchildren in a city-wide vision screening in southern China: the Shantou myopia study. Br J Ophthalmol. 2022. https://doi.org/10.1136/ bjo-2021-320940. 12. Ma X, Zhou Z, Yi H, Pang X, Shi Y, Chen Q, et al. Effect of providing free glasses on children's educational outcomes in China: cluster randomized controlled trial. BMJ. 2014;349:g5740. Article PubMed PubMed Central Google Scholar 13. Wang XQ, Yi HM, Lu LN, Zhang LX, Ma XC, Jin L, et al. Population prevalence of need for spectacles and spectacle ownership among urban migrant children in eastern China. JAMA Ophthalmol. 2015; 133:1399-406. Article PubMed Google Scholar 14. Zhu Z, Chen Y, Tan Z, Xiong R, McGuinness MB, Muller A. Interventions recommended for myopia prevention and control among children and adolescents in China: a systematic review. Br J Ophthalmol. 2023;107:160-66. Article PubMed Google Scholar 15. Jan C, Li L, Keay L, Stafford RS, Congdon N, Morgan I. Prevention of myopia, China. Bull World Health Org. 2020;98:435-37. Article PubMed PubMed Central Google Scholar 16. Rawstron JA, Burley CD, Elder MJ. A systematic review of the applicability and efficacy of eye exercises. J Pediatr Ophthalmol Strabismus. 2005;42:82-8. Article PubMed Google Scholar 17. Morgan IG, Jan CL. China turns to school reform to control the myopia epidemic: a narrative review. Asia Pac J Ophthalmol. 2022; 11:27-35. Article Google Scholar 18. Li M, Xu L, Tan CS, Lanca C, Foo LL, Sabanayagam C, et al. Systematic review and meta-analysis on the impact of COVID-19 pandemic-related lifestyle on myopia. Asia Pac J Ophthalmol. 2022;11:470-80. Article Google Scholar 19. Wang J, Li Y, Musch DC, Wei N, Qi X, Ding G, et al. Progression of myopia in school-aged children after COVID-19 home confinement. JAMA Ophthalmol. 2021;139:293-300. Article PubMed PubMed Central Google Scholar 20. Hu Y, Zhao F, Ding X, Zhang S, Li Z, Guo Y, et al. Rates of myopia development in young Chinese schoolchildren during the outbreak of COVID-19. JAMA Ophthalmol. 2021;139:1115-21. Article PubMed PubMed Central Google Scholar 21. Wang J, Han Y, Musch DC, Li Y, Wei N, Qi X, et al. Evaluation and follow-up of myopia prevalence among school-aged children subsequent to the COVID-19 home confinement in Feicheng, China. JAMA Ophthalmol. 2023;141:333-40. Article PubMed PubMed Central Google Scholar 22. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097. Article PubMed PubMed Central Google Scholar 23. Luo X, Liu X, Chen Z, Huang X, Chen H. Application research of 3D visual training combined with ciliary muscle exercise training for juvenile myopia rectification. Nurs Pract Res. 2018;15:90-1. Google Scholar 24. Wu L. Clinical observation on treating juvenile myopia by Dazhui vibrating manipulation plus point massage. thesis, Fujian University of Traditional Chinese Medicine, 2013. Available from: https://kns.cnki.net/kcms/detail/detail.aspx?dbcode=CMFD&dbname= CMFD201302&filename=1013186311.nh&uniplatform=NZKPT&v= xv-P_wO5R9tNyPd-g0H6KtdkdB4AAgfwuM6GsPvN4L3__bL3mip2XnUTo_8glVZv. Accessed 3 Feb 2023. 25. Sun J. The clinical research of applying tonifying spleen Qi Tuina method in treating spleen Qi deficiency type of pediatric myopia. thesis, Shandong University of Traditional Chinese Medicine, 2011. Available from: https://kns.cnki.net/kcms/detail/ detail.aspx?dbcode=CMFD&dbname=CMFD2012&filename=1011204980.nh& uniplatform=NZKPT&v= BRxh8Ytmbk4bWBgfeDdAiIMxdl7ooRxfa538LkIz_g9sMyFkLerxGfVu3FSX8Ctp. Accessed 3 Feb 2023. 26. Lv Y, Dou S, Chen Y, Hong M, Ke M. Juvenile myopia treatment by four combined methods for 105 eyes. Chin Med Mod Distance Edu. 2014;12:10-11. Google Scholar 27. Zhang L. Observation of the influence of eye exercise on visual functions of pupils. Guangxi Med. 1974;04:37-8. Google Scholar 28. Han B, Mu T. Observation on the effect of badminton training on adolescent pseudomyopia. Chin J Conval Med. 2015;24:174-75. Google Scholar 29. He J, Hao Y, Peng Q, Chen J. Efficacy of yoga eye exercise on juvenile pseudomyopia. J Beihua Univ (Natural Sci Edit). 2014; 15:85-7. Google Scholar 30. Ma Z. Research on the creation and compilation of gymnastic exercise for sports health care and prevention and treatment of myopia in teenagers thesis, Harbin Sport University, 2017. Available from: https://kns.cnki.net/kcms/detail/detail.aspx? dbcode=CMFD&dbname=CMFD201801&filename=1017070627.nh&uniplatform= NZKPT&v= 2rKcXhWX2PxuHzkadJ4HdPBphBb2RIcooEH8Zg9f0eMDoF7sSAWMRVoVhLm59jhO. Accessed 3 Feb 2023. 31. Wang Y, Bao X, Shi Y, Wang Z. Clinical study of muscle massage around eyes combined with scraping of head and neck in the treatment of adolescent pseudomyopia. J Heibei Trad Chin Med Pharmacol. 2019;34:35-8. CAS Google Scholar 32. Wang Y-Q. Effect of eye exercises in combination with auricular plaster therapy on adolescent pseudomyopia patients. In Proceedings of the 3rd AASRI Conference on CIB, 2015. ISBN:978-1-60595-308-3. 33. Hayashi N, Du L. Acute and chronic periocular massage for ocular blood flow and vision: a randomized controlled trial. Int J Ther Massage Bodywork. 2021;14:5-13. PubMed PubMed Central Google Scholar 34. Tang J, Pei Y, Wang J, Yan N, Luo Y, Zhou W, et al. The association between Chinese eye exercises and myopia in children and adolescents: a systematic review and meta-analysis. Frontiers in Public Health. 2023;11:950700. Article PubMed PubMed Central Google Scholar 35. He MG, Zheng YF, Xiang F. Prevalence of myopia in urban and rural children in Mainland China. Optometry Vision Sci. 2009;86:40-4. Article Google Scholar 36. Lin Z, Vasudevan B, Jhanji V, Gao TY, Wang NL, Wang Q, et al. Eye exercises of acupoints: their impact on refractive error and visual symptoms in Chinese urban children. BMC Complement Altern Med. 2013;13:306. Article PubMed PubMed Central Google Scholar 37. Lin Z, Vasudevan B, Fang SJ, Jhanji V, Mao GY, Han W, et al. Eye exercises of acupoints: their impact on myopia and visual symptoms in Chinese rural children. BMC Complement Altern Med. 2016;16:349. Article CAS PubMed PubMed Central Google Scholar 38. Lu Z-P, Ouyang M-Z, Zhang R, Tang X, Zhong H-J. Association between Chinese eye exercises and onset of myopia: a meta-analysis. Int J Clin and Exp Med. 2019;12:4580-88. Google Scholar 39. Li SM, Kang MT, Peng XX, Li SY, Wang Y, Li L, et al. Efficacy of Chinese eye exercises on reducing accommodative lag in school-aged children: a randomized controlled trial. PLoS One. 2015;10:e0117552. Article PubMed PubMed Central Google Scholar 40. Kang MT, Li SM, Peng X, Li L, Ran A, Meng B, et al. Chinese eye exercises and myopia development in school age children: a nested case-control study. Sci Rep. 2016;6:28531. Article ADS CAS PubMed PubMed Central Google Scholar 41. He M, Xiang F, Zeng Y, Mai J, Chen Q, Zhang J, et al. Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial. JAMA. 2015; 314:1142-48. Article CAS PubMed Google Scholar 42. Li SM, Ran AR, Kang MT, Yang X, Ren MY, Wei SF, et al. Effect of text messaging parents of school-aged children on outdoor time to control myopia: a randomized clinical trial. JAMA Pediatr. 2022; 176:1077-83. Article PubMed PubMed Central Google Scholar 43. Li Q, Guo L, Zhang J, Zhao F, Hu Y, Guo Y, et al. Effect of school-based family health education via social media on children's myopia and parents' awareness: a randomized clinical trial. JAMA Ophthalmol. 2021;139:1165-72. Article PubMed PubMed Central Google Scholar 44. Lingham G, Mackey DA, Lucas R, Yazar S. How does spending time outdoors protect against myopia? A review. Br J Ophthalmol. 2020; 104:593-99. Article PubMed Google Scholar 45. Wildsoet CF, Chia A, Cho P, Guggenheim JA, Polling JR, Read S, et al. IMI - Interventions Myopia Institute: interventions for controlling myopia onset and progression report. Invest Ophthalmol Vis Sci. 2019;60:M106-31. Article PubMed Google Scholar Download references Acknowledgements Yichen Wu and Xinran Ge contributed to the literature search, screening, and coding; and Xiani Jia contributed to the editing of a preliminary draft of methods and results. Funding The study was supported by the National Key R&D Program of China (STI2030-Major Projects+2021ZD0204200), National Natural Science Foundation of China (32071045), Guangdong Basic and Applied Basic Research Foundation (2019A1515110574), and Shenzhen Fundamental Research Program (JCYJ20210324134603010). The funding bodies had no role in the study design, data collection, analysis, and interpretation, report writing, or the decision to submit for publication. Author information Author notes 1. These authors contributed equally: Feng Xiao, Weiye Cheng. Authors and Affiliations 1. The Chinese University of Hong Kong, Shenzhen, Shenzhen, China Zhicheng Lin, Feng Xiao & Weiye Cheng Authors 1. Zhicheng Lin View author publications You can also search for this author in PubMed Google Scholar 2. Feng Xiao View author publications You can also search for this author in PubMed Google Scholar 3. Weiye Cheng View author publications You can also search for this author in PubMed Google Scholar Contributions ZL conceived and designed the study. WC and FX searched the literature and screened articles. FX and WC analyzed the data, constructed the table, and drew the figures under the supervision of ZL. ZL wrote the manuscript. FX and WC had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. FX and WC contributed equally to this work. Corresponding author Correspondence to Zhicheng Lin. Ethics declarations Competing interests All authors approved the final version of the manuscript and were responsible for the decision to submit the manuscript. The authors declare no competing interests. Additional information Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information Supplementary material PRISMA checklist Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. Reprints and permissions About this article Check for updates. Verify currency and authenticity via CrossMark Cite this article Lin, Z., Xiao, F. & Cheng, W. Eye exercises for myopia prevention and control: a comprehensive systematic review and meta-analysis of controlled trials. Eye 38, 473-480 (2024). https://doi.org/10.1038/ s41433-023-02739-x Download citation * Received: 13 April 2023 * Revised: 11 August 2023 * Accepted: 08 September 2023 * Published: 22 September 2023 * Issue Date: February 2024 * DOI: https://doi.org/10.1038/s41433-023-02739-x Share this article Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. 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