Impact of Screen Time Reduction and Outdoor Activities on Myopia Progression in School-Aged Children

Myopia is projected to affect nearly five billion people globally by 2050 and is a leading cause of distance visual impairment, posing a major socio-economic burden. Lifestyle factors, particularly increased use of electronic devices, are significant contributors to myopia development in school-going children. This mixed-method study included 390 school-going children aged 5–12 years diagnosed with myopia. The study was conducted from January 2020 to December 2022. Parents were interviewed using a structured questionnaire, and children's daily screen time was collected through 24-hour recalls. Clinical data were retrieved from diagnostic reports following comprehensive eye examinations, including distance visual acuity, intraocular pressure, and both non-cycloplegic and cycloplegic refraction tests. To observe the effect of screen time and outdoor activities, the study divided the follow-up period into three phases: before, during, and after the COVID-19 pandemic. During lockdowns, children's average screen time increased from 2.1 to 5.6 hours per day, correlating with a significant worsening of refractive errors from -2.4 D to -4.6 D. After the pandemic, as daily screen time reduced to 2.7 hours and outdoor activity increased from 19% to 71%, the progression of myopia slowed notably. Home confinement during COVID-19 markedly accelerated myopia progression in children. Post-pandemic, lifestyle adjustments involving reduced screen time and increased outdoor activities led to stabilization. These findings emphasize the need for balanced digital device use and promoting outdoor exposure to manage and potentially prevent childhood myopia.