Missouri State Medical Association

House of Delegates

Resolution #13

(A-17)

Introduced by:Shannon Tai, Saint Louis University medical student; Ingrid Hsiung, University of Missouri-Kansas City medical student; the St. Louis Metropolitan Medical Society and the Kansas City Medical Society

Subject:Decreasing Screen Time and Increasing Outdoor Activity to Offset Myopia Onset and Progression in School Children

Referred to:Reference Committee A

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WHEREAS, myopia (1) is increasing among children worldwide, (2) remains the leading cause of visual impairment globally, (3) will likely affect 50% of the world’s population by 2050,1 (4) may lead to a lower quality of life, financial burden, retinal detachment, and macular degeneration2 and (5) increasing time spent outdoors and decreasing screen time3,4,5 may reduce myopia incidence or slow progression; and

WHEREAS, generation Z spends nearly 8 hours/day staring at electronic screens,6 and the shift towards doing near activity in low light raises the likelihood of developing myopia,4,7 and screen time takes away from outdoor activity, physical activity, and face-to-face social interaction in the real world;8 and

WHEREAS, the American Academy of Pediatrics defines ‘screen time’ as time spent using digital media for entertainment purposes8 and recommends parentally determined restrictions for their own children’s screen time8 combined with a minimum of 1 hour of physical activity per day for overall well-being in children9 in order to make time for outdoor activity and exercise distance vision; and

WHEREAS, the American Academy of Ophthalmology Journal confirms the association of myopia progression with darkness and near work,4,7 recommending that schools increase outdoor activity time during class recess to help reduce the development and progression of myopia in children and adolescents10,11; therefore be it

RESOLVED, that the Missouri State Medical Association will support the efforts of the American Academy of Pediatrics and American Academy of Ophthalmology to educate, promote public awareness, and promote guidelines to reduce the incidence and burdens of myopia to physicians, public health agencies and schools, and encourage the American Medical Association to do likewise.

Fiscal Note:Less than $500

Current Policy:None

References:

  1. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. American Academy of Ophthalmology. 2016; 123 (5): 1036-1042. doi: 10.1016.j.ophtha.2016.01.006. Available at
  2. Repka M. Prevention of Myopia in Children. Journal of the American Medical Association. 2015. doi: 10.1001/jama.2015.10723. Available at
  3. He M, Xiang F, Zeng Y. Effect of Time Spent outdoors at School on the Development of Myopia Among Children in China. Journal of the American Medical Association. 2015; 314 (11):1142-1148. doi: 10.1001/jama.2015.10803. Available at
  4. Loman et al. Darkness and Near Work. American Academy of Ophthalmology Journal. 2002; 109(5): 1032-1038. Available at
  5. Pei-chang, W. Outdoor activity during class recess reduces myopia onset and progression in school children. American Academy of Ophthalmology Journal. 2013; 120 (5): 1080-1085. Available at
  6. The Henry J. Kaiser Family Foundation (2005). “Generation M: Media in the Lives of 8-18 Yr-olds.” Available at
  7. French et. Al. Risk factors for Incident Myopia in Australian Schoolchildren. American Academy of Ophthalmology Journal. 2013; 120 (10): 2100-2108. Available at
  8. American Academy of Pediatrics (2016). “American Academy of Pediatrics Announces New Recommendations for Children’s Media Use”. Available at
  9. American Academy of Pediatrics (2016). “Energy Out: Daily Physical Activity Recommendations”. Available at
  10. Sherwin JC, Reacher MH, Keogh RH, Khawaja AP, Mackey DA, & Foster PJ. The Association between Time Spent Outdoors and Myopia in Children and Adolescents. American Academy of Ophthamology. 2012; 119 (10): 2141-2151. doi: 10.1016/j.ophtha.2012.04.020. Available at
  11. American Academy of Ophthalmology (2014.) “More Time Outdoors May Reduce Kids’ Risk of Nearsightedness”. Available at