[HN Gopher] Eye exercises for myopia prevention and control: com...
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       Eye exercises for myopia prevention and control: comprehensive
       systematic review
        
       Author : gnabgib
       Score  : 138 points
       Date   : 2024-05-31 16:34 UTC (6 hours ago)
        
 (HTM) web link (www.nature.com)
 (TXT) w3m dump (www.nature.com)
        
       | billconan wrote:
       | As someone who grew up in China, we were forced to do this
       | exercises everyday at school. And yet, China has the highest
       | myopia rate.
        
         | onemoresoop wrote:
         | Maybe these exercises help some people but myopia is largely
         | hereditary. It's worth trying though, it's free.
        
           | xpe wrote:
           | > It's worth trying though, it's free.
           | 
           | The above claim strays far from the way of logic. Follow that
           | pattern of thinking, and you'll never run out of things to
           | try.
        
           | daveguy wrote:
           | It's only free if you don't value your own time.
        
           | powersnail wrote:
           | > Maybe these exercises help some people
           | 
           | Similar studies have been conducted in China for multiple
           | times, no clinically significant results were ever found. It
           | probably doesn't help anybody, other than encouraging a short
           | while of not using your eyes.
           | 
           | The guy who first invented the exercise basically just made
           | it up from thin air, trying to fix his own myopia, which was
           | a reasonable effort that didn't work out. But for some
           | reason, it caught on in schools nevertheless.
        
           | hosh wrote:
           | Turns out, myopia isn't hereditary. It has to do with
           | dopamine interactions and the retina receiving outdoor
           | lighting. When there is insufficient outdoor lighting, the
           | retina starts growing in a different shape, leading to
           | myopia. Just let the kids play outside.
           | 
           | I don't know if going outside more often will reverse it.
           | 
           | Astigmatism, on the other hand, may be hereditary.
        
             | lucb1e wrote:
             | > Just let
             | 
             | I don't know about you, but in my case that would have been
             | "just push". RCT1+2 was a lot more fun and even if I would
             | play with the (often mean) village kids, they too were more
             | into video games than ball games, albeit more something
             | like Postal (rated for mature audiences, like ten years
             | older than we were). There was some voluntary playing
             | outside as well as inverse curfews imposed to make sure we
             | don't only game and watch Pokemon inside at some age, but
             | this notion of "just let them do what they enjoy" is so
             | contradictory to my personal experience
        
               | hosh wrote:
               | In China and Taiwan, where many kids are pushed to study
               | more, outside play would be a treat. Although I don't
               | know about video games.
               | 
               | In the US, the complicating factor is that parents get in
               | trouble for letting kids play unsupervised outside. Both
               | custom and legislation discourages this kind of
               | parenting. There is an advocacy group in the US trying to
               | lobby for legislative protections for parents, so "just
               | let them play outside" means something a bit different.
        
           | yorwba wrote:
           | Anything that is even slightly hereditary looks "largely
           | hereditary" in the absence of environmental factors. That
           | doesn't mean that large changes in environmental conditions
           | cannot have a large effect on hereditary traits.
           | 
           | Body height is largely hereditary if you can avoid
           | malnutrition. But improved nutrition has led to an increase
           | in average height over time.
           | 
           | It's not improbable that spending ten hours a day indoors to
           | study could have an effect on myopia in children, even if the
           | variation among children who all study for approximately the
           | same duration appears to be explainable by hereditary
           | factors.
        
         | colinb wrote:
         | from the conclusion:
         | 
         | "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."
        
         | rahimnathwani wrote:
         | ISTR reading that lack of time outdoors is one of the culprits.
         | 
         | This study wasn't conclusive:
         | https://iovs.arvojournals.org/article.aspx?articleid=2360831
        
         | hosh wrote:
         | Taiwan had something similar, found it it has to do with
         | outdoor lighting (because many kids in both China and Taiwan
         | stay indoors to study), and started a program to let kids play
         | outside. Along with an early childhood intervention, myopia
         | rates have been dropping.
        
       | xpe wrote:
       | Given that the Nature research (above) shows that eye exercises
       | don't seem to work, we should focus [1] on what does. Research
       | shows more outdoor time can help with myopia. See
       | https://onlinelibrary.wiley.com/doi/full/10.1111/aos.13403
       | 
       | [1] See [1] what I did there?
        
         | tremon wrote:
         | Why is spending time outdoors not considered an eye exercise?
        
           | powersnail wrote:
           | The study is about a specific type of eye exercise. The
           | translated English title makes it sounds more general than it
           | is.
        
           | jspash wrote:
           | It's probably similar to the difference between doing
           | "proper" squats in a squat rack vs. using a cheater frame.
           | The muscle movement is more varied and not as linear as doing
           | a single left/right up/down exercise. But that's just a
           | guess.
        
             | 0cf8612b2e1e wrote:
             | Is there any hard data on how much a machine impacts muscle
             | growth/flexibility/whatever vs free weights?
             | 
             | I agree that free weights are probably better overall, but
             | would love if that were quantified somehow.
        
           | adrianmonk wrote:
           | I don't think they know for sure what it is about being
           | outdoors that helps prevent myopia. But it's thought that it
           | might be the bright light. To me, passively taking in bright
           | light wouldn't qualify as an exercise.
        
         | calebm wrote:
         | I recently was required to renew my glasses prescription
         | because the other one was 2 years old (so considered expired).
         | When I got my new prescription, my optometrist said "your
         | vision improved". I have been spending more time outside. I
         | have found that time on the water seems to make my vision
         | improve. I also suspect that walking through forests and
         | experiencing the parallax effect might function as something
         | like a depth perception calibration. It's also worth noting
         | that I do wear glasses, but not all the time - intentionally so
         | I can exercise my eyes.
        
           | hosh wrote:
           | It's the dopamine interaction of the retina receiving outdoor
           | lighting which changes things.
           | 
           | I don't think this works on astigmatism though.
        
           | LorenPechtel wrote:
           | While I can see this altering your prescription why should it
           | improve your vision?
        
         | napoleoncomplex wrote:
         | How does wearing sunglasses affect time outside effectiveness?
         | Any research on that?
         | 
         | (Just something I've wondered since sunglasses are super
         | prevalent)
        
           | happyopossum wrote:
           | My understanding is that the benefit of being outdoors is the
           | ability and opportunity to regularly focus on things at a
           | distance that helps, so sunglasses wouldn't factor in.
        
             | hinkley wrote:
             | Isn't that eye exercises?
        
             | JumpCrisscross wrote:
             | It's also exposure to natural light. Myopia jumps when kids
             | are exposed to artificial lighting [1]. It seems some
             | constant is hard coded into our genes to calibrate our eyes
             | to the Sun's light. (Artificial natural light, despite
             | sounding like an oxymoron, can help.)
             | 
             | [1] https://pubmed.ncbi.nlm.nih.gov/38766340/
        
           | kyriakos wrote:
           | Sunglasses are not just a fashion item they also protect your
           | eye lens from gradual damage from UV. It may be a good
           | compromise in the end.
        
           | drjasonharrison wrote:
           | The issue isn't brightness, it's distance to what you are
           | looking at and focus on the retina. When your eyes can still
           | bring far objects into focus, they produce a signal that
           | causes your eyes to grow longer.
           | https://newsroom.uw.edu/news-releases/glasses-stop-myopia-
           | ar...
        
             | hinkley wrote:
             | I wonder if this is something VR headsets can eventually
             | fix by putting things at a longer focal length?
             | 
             | Maybe instead of a 50" screen 24" away, a 500' screen 240'
             | away.
        
         | incognito124 wrote:
         | Rarely do the jokes on HN get a chuckle out of me, but you did
         | it!
        
         | medstrom wrote:
         | This is why we hackers need to install Emacs/Vim on an e-reader
         | and use that as our dev environment... outdoors with Bluetooth
         | keyboard every day.
        
           | sieste wrote:
           | This, or you could switch to an outdoors-themed wallpaper.
        
             | xpe wrote:
             | You belong in a basement-level late-night comedy club. No
             | sunlight for you.
        
             | steve_adams_86 wrote:
             | This is why myopia wasn't as much of a problem back in the
             | Windows XP days.
             | 
             | https://d7hftxdivxxvm.cloudfront.net/?quality=80&resize_to=
             | w...
        
           | initplus wrote:
           | I assumed outdoor time helps because your eyes spend time
           | focusing at a greater distance. Going outside, but only to
           | use a phone/ereader/book is likely not effective.
        
             | abeppu wrote:
             | I think this assumption, though perhaps reasonable, is
             | incorrect, for at least two reasons:
             | 
             | - There are animal model studies which vary environment
             | brightness and show a causal relationship between darker
             | environments and myopia. The animals in the darker
             | experimental groups aren't reading etc, and the animals in
             | the brighter experimental groups aren't in larger cages.
             | 
             | - There are studies on myopia that varied indoor lighting
             | brightness and showed brighter lighting later/decreased
             | myopia onset. Classroom sizes (or distances from desk to
             | blackboard, etc) did not change. These studies also found a
             | bunch of other variables were important including longer
             | sleep time, and less screen time.
             | 
             | https://onlinelibrary.wiley.com/doi/abs/10.1111/opo.12207
        
         | matthewdgreen wrote:
         | 23 of 25 studies were in children, and also it didn't seem to
         | have any effect in people who already have the problem :(
        
         | amelius wrote:
         | If VR goggles have the image focal point at infinity, does that
         | count too?
         | 
         | Also, what if you wear glasses that move points close by (e.g.
         | your screen) to infinity?
        
         | jeremiahbuckley wrote:
         | I've heard this is important for young kids when eyes are
         | developing. Once the weakness is built in, there's not much t
         | that can be done.
         | 
         | But I definitely recommend this to people I know with new
         | babies. We do a bad job consciously recognizing the difference
         | between indoor and outdoor light, but they're orders of
         | magnitude different in actual brightness.
        
           | dsego wrote:
           | I only started understanding the difference after getting
           | into photography.
        
       | jurassicfoxy wrote:
       | Does anyone here suffer from double vision? Do exercises help
       | with that?
        
         | 4gotunameagain wrote:
         | The 20-20-20 rule[1] can help with diplopia from computer
         | vision syndrome.
         | 
         | Although I would advise to reduce screen time rather than treat
         | just the symptoms that arise because of it.                 [1]
         | https://wiki.endmyopia.org/wiki/20-20-20_rule       [2]
         | https://en.wikipedia.org/wiki/Computer_vision_syndrome
        
         | Eugr wrote:
         | What helps me is:
         | 
         | 1. Taking breaks more often. 2. Using bigger monitor with
         | bigger fonts, so I could sit further away. 3. Using Apple
         | Vision Pro as a monitor replacement as it gives you 4-5 feet
         | focal distance.
         | 
         | The last one lets me work at my computer all day without
         | getting double vision, but it's not very comfortable and you
         | start to feel the weight after 2 hours or less. Plus the
         | friction on putting it on, connecting, etc.
        
         | hi-v-rocknroll wrote:
         | I have monofixation syndrome without amblyopia, discovered only
         | after age 40 when an ophthalmologist who actually knew what
         | they were doing did their job. My understanding is there no
         | durable or neuroplastic adaptation to double vision, amblyopia,
         | or monofixation syndrome after youth because it is permanently
         | wired that way in the ocular-vestibular systems. Corrective
         | eyewear, eye surgery, and/or weaker eye training at early ages
         | may help, but show no evidence of correction in later years.
         | Monofixation syndrome is a neurological adaptation of the brain
         | to minimize the experience of double vision.
        
         | humanfromearth9 wrote:
         | Double vision ? Is this when one sees with both eyes
         | simultaneously ? =)
        
         | dbcurtis wrote:
         | I have double vision from strabismus. There are quite a number
         | of eye therapy exercises that you can do to improve the
         | condition. The older you get, the more of it that it takes. I
         | have made improvements, but before I made this discovery and
         | started the therapy I was too far gone and too old to fully
         | cure. But... I can get decent life improvements if I put in the
         | effort.
         | 
         | If you look hard enough you may find an optometrist that
         | specializes in eye therapy for strabismus and similar vision
         | issues. Expect to be the only adult in the waiting room that is
         | not a parent, most patients will be early-grade-school-age
         | kids.
        
         | lucb1e wrote:
         | I only ever heard about seeing double after some sort of
         | accident. Do you know what causes yours? The sibling comments
         | seem to assume it is from looking at screens for too long, is
         | that it or does that make it worse?
        
       | arijo wrote:
       | As a teenager, my myopia led me to a book promising clear vision
       | through eye exercises alone. My doctor quickly dismissed it as
       | nonsense, insisting only "science" could help.
       | 
       | Fast forward 30 years, and this post reminds me how valuable it
       | is to approach even expert opinions with a healthy dose of
       | skepticism.
       | 
       | It's a funny twist, highlighting that while expertise is
       | valuable, it's crucial to maintain a discerning mind and not
       | blindly accept any claim as absolute truth.
        
         | tarentel wrote:
         | Did you even read it? It clearly says they're ineffective. Your
         | doctor was correct to dismiss it as nonsense.
        
           | s1artibartfast wrote:
           | If the parent poster successfully treated their myopia, they
           | have a n=1 to the contrary and it is the only n that matters
           | for them.
        
             | pessimizer wrote:
             | They didn't say they did, they said that they once saw a
             | book that their doctor dismissed as quackery. Reading the
             | title of this study that also dismisses it as quackery has
             | convinced them that it wasn't quackery.
        
           | IncreasePosts wrote:
           | Ironically, OP saw a random thing that seemed like a claim
           | and blindly believed it.
        
         | aatd86 wrote:
         | I don't know wvy you're being downvoted. From various
         | experiences, I have had that realization as well.
        
       | francisofascii wrote:
       | Had a conversation yesterday with an optometrist about this. My
       | daughter's myopia jumped from -.75 to -2.0 in a year. Asked about
       | the atropine drops, special contacts, etc. He said the number one
       | thing was to make sure my daughter was outdoors in sunlight. You
       | can read or be on screens, just outdoors. His opinion was mixed
       | on the drops and special contacts. The tricky part is you don't
       | know how bad the myopia would be without interventions. So my
       | child's myopia might be progressing, but maybe would have been
       | even worse if we didn't do the drops or whatever. He also said
       | growth spurts correlate with myopia progression.
        
         | avery17 wrote:
         | Theres a brand of glasses for kids that stops the progression
         | of myopia. Posted on HN the other day, cant remember the name.
         | Look it up!
        
           | drjasonharrison wrote:
           | https://newsroom.uw.edu/news-releases/glasses-stop-myopia-
           | ar...
        
         | Nicholas_C wrote:
         | Look into ortho-k contact lenses. My siblings all have terrible
         | eyesight but mine is ok around -1.5 and I was the only one who
         | used ortho-k contacts.
        
       | abdullahkhalids wrote:
       | So, what is important is what sort of exercises are being used.
       | From the paper, the types are
       | 
       | 1. 3D visual training combined with ciliary muscle exercise
       | training
       | 
       | 2. Massage (point, eye muscle, head and neck, facial massage
       | roller, automated eye massager)
       | 
       | 3. Dazhui vibration (looks like acupuncture)
       | 
       | 4. Auricular plaster therapy (some sort of acupuncture using
       | magnetic seeds applied to ear)
       | 
       | 5. Badminton training
       | 
       | 6. Yoga eye therapy
       | 
       | 7. Eyesight gymnastics with physical exercise for health
       | maintenance
       | 
       | First of all, it would be reasonable to concentrate on the
       | interventions where there is a plausible causal model. Should 1
       | and 7, and maybe 6 (depending on what exercises are being done)
       | be looked at more carefully?
       | 
       | Be being a mere physicist cannot read the forest plots in Fig 2,
       | to determine which of the studies had some positive effect. Can
       | someone else do that?
        
       | inanutshellus wrote:
       | Since the Nature.com link just basically says "myopia exercises
       | don't work"...
       | 
       | NPR just had a piece talking about a 2-yr study in Sydney that
       | found that spending time outdoors reduces myopia in children and
       | a 15-year-old program in Taiwan to ensure primary school children
       | are sent outdoors more, which has reduced their % of myopia.
       | 
       | Theory is that we change our focus distance regularly when we're
       | outside. ("hey look, a bird!" "i think i'll stare blankly at that
       | tree while I ponder that document" etc)
       | 
       | https://www.npr.org/sections/health-shots/2024/05/13/1250555...
       | 
       | Notably -- I guess -- the study was about children. Maybe adults
       | are screwed. It certainly is easier to get kids outside more if
       | the govt is backing the changes.
        
         | molave wrote:
         | Anecdotally, this worked on for me. It's not a great
         | improvement, but it was noticeable.
        
         | gdevenyi wrote:
         | The theory is not focus distance changes, but high angle high
         | brightness overhead lighting (sun) and sufficient blue light.
        
           | lucb1e wrote:
           | I've also heard the high brightness during the daytime helps
           | with getting into a good sleep cycle by setting the
           | biological clock to "ok now it is definitely day". Even when
           | sitting close to a window, the light level is typically still
           | something like 1/10th (or less) of what it is outside.
           | 
           | Not that I do any of this; I enjoy reading long articles and
           | writing code until 5am
        
       | outdoorsun wrote:
       | what is the best time for outdoor activities w.r.t myopia?
       | morning? noon? evening? night? dusk?
        
         | brigandish wrote:
         | According to Dr Goldberg, who I heard on Huberman's podcast[1],
         | morning sunlight so you can get red light. Dusk/twilight also
         | has red light, but I've heard that it's helpful to combat the
         | effect of bright light before sleep, like that from screens,
         | for some reason I forget. Now I make sure to get a bit of both.
         | 
         | [1] https://www.hubermanlab.com/episode/dr-jeffrey-goldberg-
         | how-...
        
       | outdoorsun wrote:
       | if your doctor put new prescription, do not throw away your old
       | glasses
       | 
       | try these instead. it's free and reproducible.
       | 
       | test on variations: on bright day with sun light (outdoor) focus
       | on a fixed distance, say 4 meter. wear old glasses of -.5, -1, -2
       | ... and your new prescription keep note which if those glasses
       | give clear vision
       | 
       | then vary the distance to 15cm, 30cm, 1m, 2m ... very far
       | 
       | then vary the brightness level, next go to building with low
       | light intensity, like underground parking
       | 
       | then do the variation on distances and glasses' power
       | 
       | keep notes of all your experiments
       | 
       | the idea borrows from design of experiment of 2^3 factorial
       | design: high and low brightness short and long distances old and
       | new glasses
       | 
       | the conclusion would be use the least power for different
       | situations and best if you dont use any glasses (well, there's
       | plus lens therapy which is the next step)
       | 
       | say if you can see clearly thing on your phone (15 cm, light
       | emiting screen -- i always use max brightness) without glasses,
       | the don't use glasses
       | 
       | if your -1 glasses are sufficient for desktop work, don't use
       | higher power although no glasses wont hurt (i increase the font
       | size till legible)
       | 
       | anyway, if you're determined to do the experiments, please let us
       | know
       | 
       | thank you in advance
        
       | komodus wrote:
       | I remember my eyesight was 20/20 all my life until I started
       | playing more and more with phones and tablets, now I can barely
       | see any font in a regular browser tab at 100% zoom so I set it to
       | 150% by default.
       | 
       | One thing that changed for good is using a 50" TV as monitor
       | connected to my mac mini at 4' distance from my chair. Now my
       | eyes don't cross anymore and my sight has improved a lot.
       | 
       | So yes, I concur that looking at clouds and the horizon everyday
       | may be a good way to recalibrate our eyes. Spend more time
       | outdoors.
       | 
       | [edit] Oh, and whenever I can, I cast my phone to my tv in the
       | bedroom so I don't spend countless hours on tiktok forcing my
       | eyes. I wish tiktok and instagram were available in landscape
       | mode.
        
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