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      Pilot study of a novel classroom designed to prevent myopia by increasing children’s exposure to outdoor light

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          Abstract

          We sought to assess light characteristics and user acceptability of a prototype Bright Classroom (BC), designed to prevent children’s myopia by exposing them to light conditions resembling the outdoors. Conditions were measured throughout the school year in the glass-constructed BC, a traditional classroom (TC) and outdoors. Teachers and children completed user questionnaires, and children rated reading comfort at different light intensities. A total of 230 children (mean age 10.2 years, 57.4% boys) and 13 teachers (36.8 years, 15.4% men) completed questionnaires. The median (Inter Quartile Range) light intensity in the BC (2,540 [1,330–4,060] lux) was greater than the TC (477 [245–738] lux, P < 0.001), though less than outdoors (19,500 [8,960–36,000] lux, P < 0.001). A prominent spectral peak at 490–560 nm was present in the BC and outdoors, but less so in the TC. Teachers and children gave higher overall ratings to the BC than TC, and light intensity in the BC in summer and on sunny days (>5,000 lux) was at the upper limit of children’s comfort for reading. In summary, light intensity in the BC exceeds TC, and is at the practical upper limit for routine use. Children and teachers prefer the BC.

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          Most cited references36

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          Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial.

          Myopia has reached epidemic levels in parts of East and Southeast Asia. However, there is no effective intervention to prevent the development of myopia.
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            Outdoor activity during class recess reduces myopia onset and progression in school children.

            The aim of this study was to investigate the effect of outdoor activity during class recess on myopia changes among elementary school students in a suburban area of Taiwan. Prospective, comparative, consecutive, interventional study. Elementary school students 7 to 11 years of age recruited from 2 nearby schools located in a suburban area of southern Taiwan. The children of one school participated in the interventions, whereas those from the other school served as the control group. The interventions consisted of performing a recess outside the classroom (ROC) program that encouraged children to go outside for outdoor activities during recess. The control school did not have any special programs during recess. Data were obtained by means of a parent questionnaire and ocular evaluations that included axial length and cycloplegic autorefraction at the beginning and after 1 year. Five hundred seventy-one students were recruited for this study, of whom 333 students participated in the interventional program, and 238 students were in the control school. At the beginning of the study, there were no significant differences between these 2 schools with regard to age, gender, baseline refraction, and myopia prevalence (47.75% vs. 49.16%). After 1 year, new onset of myopia was significantly lower in the ROC group than in the control group (8.41% vs. 17.65%; P<0.001). There was also significantly lower myopic shift in the ROC group compared with the control group (-0.25 diopter [D]/year vs. -0.38 D/year; P = 0.029). The multivariate analysis demonstrated that the variables of intervention of the ROC program and higher school year proved to be a protective factor against myopia shift in nonmyopic subjects (P = 0.020 and P = 0.017, respectively). For myopic subjects, school year was the only variable significantly associated with myopia progression (P = 0.006). Outdoor activities during class recess in school have a significant effect on myopia onset and myopic shift. Such activities have a prominent effect on the control of myopia shift, especially in nonmyopic children. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Parental history of myopia, sports and outdoor activities, and future myopia.

              To identify whether parental history of myopia and/or parent-reported children's visual activity levels can predict juvenile-onset myopia. Survey-based data from Orinda Longitudinal Study of Myopia subjects from 1989 to 2001 were used to predict future myopia. Univariate and multiple logistic regression analyses were performed, and receiver operator characteristic (ROC) curves were generated. Differences among the areas under the ROC curves were compared using the method of multiple comparison with the best. Of the 514 children eligible for this analysis, 111 (21.6%) became myopic. Differences in the third grade between eventual myopes and nonmyopes were seen for the number of myopic parents (P < 0.001) and for the number of sports and outdoor activity hours per week (11.65 +/- 6.97 hours for nonmyopes vs. 7.98 +/- 6.54 hours for future myopes, P < 0.001). Analysis of the areas under the ROC curves showed three variables with a predictive value better than chance: the number of myopic parents, the number of sports and outdoor activity hours per week, and the number of reading hours per week. After controlling for sports and outdoor hours per week and parental myopia history, reading hours per week was no longer a statistically significant factor. The area under the curve for the parental myopia history and sports and outdoor activities model was 0.73. A significant interaction in the logistic model showed a differential effect of sport and outdoor activity hours per week based on a child's number of myopic parents. Parental history of myopia was an important predictor in univariate and multivariate models, with a differential effect of sports and outdoor activity hours per week based on the number of myopic parents. Lower amounts of sports and outdoor activity increased the odds of becoming myopic in those children with two myopic parents more than in those children with either zero or one myopic parent. The chance of becoming myopic for children with no myopic parents appears lowest in the children with the highest amount of sports and outdoor activity, compared with those with two myopic parents.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: Visualization
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Visualization
                Role: ResourcesRole: SupervisionRole: Visualization
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: MethodologyRole: ResourcesRole: Visualization
                Role: ConceptualizationRole: MethodologyRole: ResourcesRole: Visualization
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: ValidationRole: Visualization
                Role: Funding acquisitionRole: Validation
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                31 July 2017
                2017
                : 12
                : 7
                : e0181772
                Affiliations
                [1 ] Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
                [2 ] State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
                [3 ] The Department of Ophthalmology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
                [4 ] School of Architecture, South China University of Technology, Guangzhou, China
                [5 ] Guangming Eye Hospital, Yangjiang, People’s Republic of China
                [6 ] Research School of Biology, Australian National University, Canberra, Australia
                [7 ] Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
                [8 ] ORBIS International, New York, NY, United States of America
                [9 ] Translational Research for Equitable Eye care, Centre for Public Health, Royal Victoria Hospital, Queen’s University Belfast, Belfast, United Kingdom
                Soochow University Medical College, CHINA
                Author notes

                Competing Interests: The authors declare no competing financial interests. None of the authors has any financial interest in the techniques or devices described in this manuscript. The funding organizations had no role in the design or conduct of this research.

                ‡ These authors are co-first authors on this work.

                Author information
                http://orcid.org/0000-0001-9866-3416
                Article
                PONE-D-17-10216
                10.1371/journal.pone.0181772
                5536284
                28759614
                20b125ea-e313-4b63-b3d4-478d9c8d9e79
                © 2017 Zhou et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 March 2017
                : 26 June 2017
                Page count
                Figures: 5, Tables: 2, Pages: 16
                Funding
                Dr Congdon is supported by a Thousand Man Plan grant from the Chinese government, and by the Ulverscroft Foundation. The funding organizations had no role in the design or conduct of this research.
                Categories
                Research Article
                Medicine and Health Sciences
                Ophthalmology
                Visual Impairments
                Myopia
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                People and Places
                Population Groupings
                Professions
                Teachers
                Physical Sciences
                Physics
                Electromagnetic Radiation
                Light
                Social Sciences
                Sociology
                Education
                Schools
                Physical Sciences
                Materials Science
                Materials by Structure
                Amorphous Solids
                Glass
                People and Places
                Geographical Locations
                Asia
                China
                Research and Analysis Methods
                Research Design
                Pilot Studies
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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