Sophia’s Myopia Journey: How Outdoor Time Helped Control Her Myopia

Sophia, a bright and spirited 13-year-old girl, had always been encircled by vision challenges within her family. Her father who even though is a low myopic had suffered from Diabetes and its undesirable effect on his retina that had him undergo laser treatments to stop the progression of his diabetic retinopathy. Her 11-year-old brother had one diopter of hyperopia. Sophia, herself, was no stranger to the world of eyeglasses and vision correction. She had been referred to our practice by her ophthalmologist four years ago, at the tender age of nine, when her myopia was first discovered with a diagnosis of -1.00 diopters of myopia in her right eye with -0.25 @180 diopters of astigmatism and -1.50 diopters of myopia in her left eye.

For the past four years, Sophia and her family diligently followed up with her ophthalmologist to monitor her myopia progression and our practice to get her prescription executed. However, the most recent visit, just two days ago, brought about an unexpected surprise. Sophia’s myopia had remained stable, despite her growing taller as she is transitioning into her teenage years.

The backdrop to this remarkable story takes us to a recent event. I just returned from the American Academy of Optometry 2023 meeting where discussions about the latest findings in myopia management had taken center stage. Armed with fresh insights, I shared Sophia’s journey with the parents and highlighted the pivotal role of outdoor time in controlling myopia.

Sophia’s mother, did not attend any of the conferences, not even her father or anyone in the family have looked up about myopia management on the internet. But Sophia’s mother couldn’t contain her curiosity and promptly inquired about the underlying reason for her daughter’s myopia stability. I immediately seized this opportunity to explain how Sophia’s unique circumstances had probably led to this positive outcome.

Sophia’s myopia story began when she was a nine-year-old, full of curiosity and enthusiasm. Her initial diagnosis of myopia was a turning point in her life. I still remember the first time she was prescribed optical frames she was happy to wear eyeglasses and happy to join the clan like her dad and brother; something that no one should be happy about. She was prescribed corrective lenses to help her see distant objects clearly, but her rough journey was just beginning because for us in Lebanon we still did not have any mean to control myopia at the time. We still believed that under-correction could reduce the evolution of myopia. We were starting to think that multifocals could make a change at that time.

The next four years were marked by regular check-ups, adjustments to her eyeglass prescription did not occur since her myopia did not change, and discussions about potential interventions to manage her myopia progression were always theoretical. I closely monitored Sophia’s condition, and always had this thought in the back of my mind that her myopia will at any moment dramatically progress and we have almost nothing to offer as a solution to stop it.

Two days ago, when Sophia and her family walked into our office, they did so with the usual mix of hope and anticipation. However, what they received was a reason to celebrate. Sophia’s myopia had not progressed, remaining steady at -1.00 diopters of myopia in her right eye with -0.25 @180 diopters of astigmatism and -1.50 diopters of myopia in her left eye. This was exceptional news, and it demanded further investigation and explanation as usual.

So, I shared the story of Sophia’s unique journey and concerns around it with the parents once again, beginning with the importance of understanding myopia and its undesirable consequences. Myopia, often referred to as nearsightedness, meant that Sophia could see objects up close but struggled to see object at distant vision. Sophia’s nearsightedness can be corrected with available ophthalmic lenses and contact lenses to obtain 20/20 vision however, the progression of myopia was concerning, as it could Sophiad to serious eye conditions later in life.

I also discussed risk factors associated with myopia. Genetics played a significant role in Sophia’s case, as her father had astigmatism, and her brother had hyperopia. Additionally, environmental factors, like excessive screen time and a lack of outdoor activities, were also known and proved contributors to myopia development. Therefore, the need of a proactive rather than a reactive strategy for dealing with myopia progression is very important.

As I proactively delved into the methods for controlling and managing myopia, the discussion turned to Sophia’s remarkable progress. I explained that while various interventions did not exist four years ago, many exist now. But what I have discovered later on as I launched this conversation with the parents is that Sophia’s unique circumstances had offered a different, natural path to myopia control – outdoor time.

Sophia’s family had made a significant lifestyle change during the onset of the COVID-19 pandemic and that continued after the pandemic: Faced with the challenges of remote Sophiarning and the need for a safer environment for their children, they decided to spend all time possible – as the father also has been working remotely – in the house they had in their village, away from the hustle and bustle of city life. Here, the children spent most of their time outdoors, connecting with nature and enjoying the benefits of a healthier lifestyle. During the summer vacation their life was nothing but outdoor activities.

I emphasized the significance of this healthy change and that studies had shown a strong correlation between increased outdoor time and the reduction in myopia progression, especially in children of about the same age as Sophia. Tens of researches have been done on this subject during the past few years. In fact, the same day Sophia and her family visited my office I read about a recent study that has been published in the British Journal of Ophthalmology and that has shown that reported time outdoors protected against myopia (Li et al., 2023). Day after day we are starting to say that natural light, physical activity, and the freedom to focus on distant objects while playing outdoors had all contributed to Sophia’s remarkable journey.

Sophia’s mother listened intently, reflecting on the decision to embrace a more outdoorsy lifestyle. She realized that this lifestyle change had not only protected her children from the challenges of remote learning but had also played a vital role in stabilizing Sophia’s myopia. She immediately reminded me of the power of simple, natural solutions.

As Sophia’s story unfolded, I underscored the importance of continued eye care and regular check-ups. While Sophia’s condition had been closely monitored, I must confess once again we would not be allowed for timely interventions if her myopia had progressed due to lake of solutions at hand four years ago. However, what we can do is a least take a look at her axial length and how it is growing. It is true she has significantly grown this year passing the 150cm height however to my surprise her axial length in both eyes was 23.51mm and 23.59mm.

Sophia’s family left our office that day with a renewed sense of hope and appreciation for the role of outdoor time in myopia management. They understood that while there weren’t various methods available to control myopia, sometimes a change in lifestyle, like spending more time outdoors, could be enough to make a significant difference.

Sophia’s story became a testament to the transformative power of simple, everyday choices. It served as a reminder that, in some cases of myopia, nature’s beauty and the great outdoors could be the most effective prescription of all. However, we all know that vigilance is essential in ensuring Sophia’s visual health remains on the right track. So now, with the available methods at hand to probably control the progression of myopia and the evidence we have about myopia progression and the scarcity of compliance, moreover faced with Sophia’s case we need to be reminded of the importance of awareness as a first step in managing myopia.    

References: Li, M., Lanca, C., Tan, C. S., Foo, L. L., Sun, C. H., Yap, F., … & Saw, S. M. (2023). Association of time outdoors and patterns of light exposure with myopia in children. British Journal of Ophthalmology, 107(1), 133-139.

NB 1: “Sophia’s Myopia Journey” Case-1, is part of a series of cases brought to you by the powerful collaboration with Optic Nacouzi the Distributor of Precilens (L’innovation Visuelle sur Mesure) in Lebanon to amplify awareness about the incredible impact of Ortho-K on myopia control management! 

Together, we’re committed to educating and empowering individuals and eye care professionals about the potential of Ortho-K lenses in managing myopia. Get ready for enlightening discussions and valuable insights! 

Join us on this visionary journey!  #MyopiaControl #OrthoK #OpticalForum #OpticNacouzi #EyeCareCollaboration @everyone

NB 2: As a matter of ethical confidentiality, the name of the patient in Sophia’s case is fictitious, and ‘Sophia’ is not the real name of the patient featured in the case.