Just go outside, and see

September 28, 2023 4:42 AM

Here is a non-exhaustive list of things that have been blamed for nearsightedness: pregnancy, pipe smoking, brown hair, long heads, bulging eyes, too much fluid in the eyes, not enough fluid in the eyes, muscle spasms, social class. From The World Is Going Blind. Taiwan Offers a Warning, and a Cure [Wired; ungated]
posted by chavenet (46 comments total)

That is fantastic and fascinating.

Although annoyingly, it means that every time my mother just sent us all outside to play when we were kids was completely justified.
posted by plonkee at 4:48 AM on September 28, 2023 [7 favorites]

If you're a bit delicate about eye stuff maybe you want to skip the first block of text.
posted by Ashenmote at 5:33 AM on September 28, 2023 [8 favorites]

My son had -7 diopters at 3 years old, -8 at 4 and now he's 6 and -5. I come to you with the gospel of atropine drops and miyosmart lenses (which yes, are both supposed to just slow progression, not reverse it, but here we are). And yes, time outside.
posted by If only I had a penguin... at 5:37 AM on September 28, 2023 [3 favorites]

Over dinner at Kaohsiung’s opulent Grand Hotel, he flicks through files on his laptop, showing me pictures of eye surgery—the plastic rods that fix the eye in place, the xenon lights that illuminate the inside of the eyeball like a stage—and movie clips with vision-related subtitles that turn Avengers: Endgame, Top Gun: Maverick, and Zootopia into public health messages.

But Vision isn't in Endgame, though.
posted by Halloween Jack at 5:39 AM on September 28, 2023 [5 favorites]

In case you're annoyed by the structure of the article, the answers to the questions you're looking for--what causes myopia and how do we prevent it--come at about 48% in the ungated version.
posted by goatdog at 5:44 AM on September 28, 2023 [11 favorites]

In looking at the causes of myopia, the article briefly raises--and just as quickly dismisses--the heritability of the disease. Looking at the literature, I can see why: it's complicated. Separating the genetic and environmental causes of myopia is basically impossible. Still, the 200+ identified genes associated with nearsightedness are worth squinting at, if you're trying to bring the picture into focus.
posted by kozad at 5:45 AM on September 28, 2023 [6 favorites]

I just got ICL surgery after being -13 my entire adult life (and being told I was too myopic for LASIK) and it's been life-changing.
posted by saladin at 5:54 AM on September 28, 2023 [8 favorites]

Different numbers, but same story as if I only had a penguin… . My son was prescribed atropine drops when his myopia first surfaced and then rapidly accelerated, and it stalled the progress pretty much completely. It was hard to get though - we had to go through a specialty pharmacy and have it shipped, and we’re in a pretty big city.
posted by Mchelly at 6:12 AM on September 28, 2023 [2 favorites]

If you're a bit delicate about eye stuff maybe you want to skip the first block of text.

HOO BOY DO I WISH I'D SEEN THIS COMMENT BEFORE TRYING TO READ GAAAAAAAAAAAH
posted by EmpressCallipygos at 6:15 AM on September 28, 2023 [5 favorites]

As a person with terrible vision and a severe eye-stuff phobia, this post is totally for me and yet completely not for me. Thanks for the content warning, Ashenmote.
posted by Horace Rumpole at 6:33 AM on September 28, 2023 [5 favorites]

In looking at the causes of myopia, the article briefly raises--and just as quickly dismisses--the heritability of the disease.

I think this is what annoyed me about the article. I felt like the genetic component was dismissed in favour of bolstering the environmental "cure".

Don't get me wrong, if going outside more can help prevent even a handful of people getting myopia, it's a wonderful prescription to have.

However, given my own experience with myopia, even if I had the interventions available now when my eyes first started changing, while my vision might be better today I would likely still be quite near sighted!

I think that a certain amount of myopia being preventable, with a certain amount being heavily driven by genetics and less/not preventable is more likely.
posted by eekernohan at 6:34 AM on September 28, 2023 [3 favorites]

I've been severely nearsighted from early childhood and I've known for a while about the discovery that early exposure to outdoor light or lack thereof is critical. A point that might be missed is that it almost certainly matters a lot earlier than "go play outside" age. Spending time outside with infants is probably important too.
posted by Rhedyn at 6:44 AM on September 28, 2023 [6 favorites]

myopia goes down, but incidence of cataracts may go up (eventually).
posted by scruss at 6:59 AM on September 28, 2023 [2 favorites]

Spending time outside with infants is probably important too.

Whwn I was a baby, in the 1950s, iit was still the custom to leave babies outside in their prams, even in fairly cold weather, because it was generally considered "good for them". I believe tios is still done in a lot of more northern countries today, and I wonder if this might affect eyesight.

Regardless of this, and of spending a lot of my early childhood out of doors (and neither smoking a pipe or being pregnant), I needed glasses by the time I was seven.
posted by Fuchsoid at 7:01 AM on September 28, 2023 [7 favorites]

So it's "More outdoor time equaled less myopia."

The writer's hesitance to just tell us the damned answer just caused my eyes to alternately roll and glaze over. Which may be good eye exercise, for all I know.
posted by pracowity at 7:04 AM on September 28, 2023 [12 favorites]

I had the same progression as the patient described in the article, with an initial reattachment via laser followed by the radical procedure described with the scleral buckle, in turn followed by a very bad cataract which necessitated a lens replacement. This followed me moving to a place where I spent much time indoors for several years either working or staying out of the rain. I now live back where I was before, where I can get more outside time, and am hoping there is not a recurrence of this, if the article is correct. That eye following all this is nowhere near 100%, but considering the possibility of near blindness in that eye, it’s not bad. I would love to know if there is some differences in incidence between these two places, and I bet it’s never been studied. Nice to know these things.
posted by cybrcamper at 7:39 AM on September 28, 2023 [1 favorite]

Early on in my career I was tasked with transcribing and editing some copy for a local eye doctor. Having to understand and write down the information of what was happening to a person’s eye when undergoing the procedure (Radial Keratotomy) made me very uncomfortable. As I am in polite company, I will not attempt a description. Come to find out (just now, I had to look it up; I would caution against doing the same), while hailed as revolutionary at the time, RK has been all but surpassed by LASIK surgery. Cool, lasers! Still icks me out, though. As far as I am concerned, the current state of healthcare is a combination of space-age technologies and medieval torture. Lasers and leeches, baby.
posted by garisimo at 7:39 AM on September 28, 2023 [5 favorites]

I got my first pair of glasses (bifocals because I had a lazy eye and myopia). I wore them every day until I was about 13 years old. Then, one day I woke up and found that my lazy eye wasn’t lazy, and I could easily see far distances without my specs.

So I stopped wearing them.

Of course, I didn’t tell my parents right away, but they eventually found out. My mom was convinced that I was lying. It’s certainly true that, as a middle schooler, I was motivated to not wear my glasse. Middle schoolers can be brutal, and it really made life at school easier to navigate (wearing bifocals in the early 90s makes you look like a little grandpa, which is like going to school with a big red bullseye on your back). Hence my mother’s skepticism.

Nevertheless, I persisted in not wearing them.

When I turned 16 I had to take an eye test in order to get my driver’s license. My mom was certain they would tell me that I had to start wearing glasses in order to drive but, instead, I passed the test with a vision of 20/15. My vision remained that good until my mid-20s. Now, I have a very small prescription that I wear for driving at night and watching movies.

I never did anything special, but I’m pretty sure sunlight was a big factor in my improvement. Between the ages of five and 13, I lived in California and easily spent 2 to 3 hours outside every day. By the time I was 13 I no longer need my glasses.

When I was 21 I got a full-time office job and gradually spent less and less time outdoors. For years later, I needed glasses to be able to read exit signs on the freeway at night.

So anecdotally, for me, getting lots of daily sunlight absolutely has a positive effect. Just don’t forget to wear sunscreen!
posted by Doleful Creature at 8:32 AM on September 28, 2023 [4 favorites]

Well, I am quite myopic even though I spent the majority of my childhood outdoors. Could be because it was in Ireland where the sun rarely poked through the clouds.
posted by hrpomrx at 8:41 AM on September 28, 2023 [6 favorites]

Well, I am quite myopic even though I spent the majority of my childhood outdoors.

Me too, and so are my kids, who also spend a decent amount of time outdoors. I wish rather than just 'go outside', they offered a bit of quantification.
posted by The_Vegetables at 8:45 AM on September 28, 2023 [6 favorites]

This is fascinating, thanks. I always wondered what kind of a cause-effect relationship there might be between "bookishness" and nearsightedness, the indoor-nerdy-glasses-wearing stereotype. I remember coming across some woo book about curing nearsightedness by doing ridiculous looking eye exercises. (I might even have tried some to no effect.)

I had LASIK in my early 30s for mild-to-moderate nearsightedness. It was expensive (and icky), but I always said it was one of the best things I ever did. Having perfect vision is amazing.

My distant vision is still pretty good, but close vision has really started to go to hell in the last few years, right around the time I hit 50. After a squinty year or two of resisting, I finally broke down and got reading glasses. Thank god for Kindle's font size adjustment and phone accessibility options.

It seems like the line where things start to get blurry inches farther away every month; It's juuust starting to hit laptop-screen distance. Recently I had to start tightening my guitar strap so I can see the frets clearly.

In summary, getting old sucks.
posted by gottabefunky at 8:54 AM on September 28, 2023 [3 favorites]

I think this is what annoyed me about the article. I felt like the genetic component was dismissed in favour of bolstering the environmental "cure".

There’s a weird bit where this

He couldn’t understand how myopia rates could be close to 80 percent for kids leaving high school in East Asia and so much lower in his native Australia.

is framed as opposing a genetic hypothesis, which wouldn’t be my first thought? I suppose you’d want to compare rates for people of East Asian descent in Asia vs. in Australia to sort this out. Obviously genetics doesn’t easily explain the rapid increase within the past 50 years, but then that seems hard to separate from diagnosis effects.

I suppose the easy - and still probably right, because it’s how most things work - answer is that it’s an interaction of genetics and environment, though.
posted by atoxyl at 9:24 AM on September 28, 2023 [2 favorites]

It's weird to see a slight variation here of "masks don't work" logic in a lot of comments here when all the article is saying is the same thing public health people have said about masks and COVID:

More outdoor time in early childhood results in less frequent and less severe myopia. It's not a panacea, and I don't see any claims that it is.
posted by tclark at 9:24 AM on September 28, 2023 [6 favorites]

close vision has really started to go to hell in the last few years, right around the time I hit 50.

Doing better than me! I similarly had LASIK in my early 30s, and had excellent results as well. But for me, the presbyopia set in at 45. You got 5 more years than me!
posted by notoriety public at 9:25 AM on September 28, 2023 [1 favorite]

A point that might be missed is that it almost certainly matters a lot earlier than "go play outside" age.

If it's true, I would think so: I had to start wearing glasses at age 4.
posted by praemunire at 9:35 AM on September 28, 2023 [1 favorite]

It's weird to see a slight variation here of "masks don't work" logic

Not a very fair characterization - people are not broadly dismissing the intervention, just a little frustrated with the simple answer presentation of something that there is plenty of reason to think is multi-factorial. The fact that there seems to be an effective intervention, in itself, is fantastic.
posted by atoxyl at 9:50 AM on September 28, 2023 [2 favorites]

I read the article with interest since I've known for years myopia was increasing. Both of my kids born in the mid eighties have myopia but neither parent does. If asked I would have said they spent a good amount of time outside but of course not nearly as much as their baby boomer parents did, and I never forced my kids outside like we were. Also, boomers walked everywhere, my kids didn't--predators lurking! Makes me wonder if it needs to be a LOT of time, as in children working in the fields or something lol.
posted by mygraycatbongo at 9:57 AM on September 28, 2023 [3 favorites]

Only because it seems funny to me, I'd almost favor the alternate mechanism of installing truly comically bright lights in schools. Cover the ceiling with LEDs and then blast the kiddos with ~100m2 of 10000 nits. Just so that on those winter days when school starts and/or ends in the dark the school's windows would be blasting light into the neighborhood like it was a movie with Alien Shit going on there.
posted by GCU Sweet and Full of Grace at 10:11 AM on September 28, 2023 [3 favorites]

I spent lots of time outdoors as a small child - and hardly ever watched TV; the world was different in the sixties - and I was still in bottle bottom glasses by the age of six. My prescription has hovered in the -8 range for my entire life despite me spending my childhood outside just hanging out, climbing trees, sailing, riding horses, playing tennis and my adult years hiking, camping and walking around. Most of my indoors time was spent in lovely grungy bars at night. And even then I had to sit outside to smoke. In my -8 bottle bottom glasses.

I recently had to explain all this to my son in common law who is convinced he will prevent my granddaughter from having the myopia I have and my daughter has by this one simple trick of being outside a lot. I somehow doubt it.
posted by mygothlaundry at 10:21 AM on September 28, 2023 [4 favorites]

After reading the article, I am now idly wondering if there any fixes for living in regions where the sun is in short supply for most of the year...

I have high myopia (-12 diopters) + astigmatism, necessitating progressive RGP lenses instead of soft contacts, and a prescription is always a trade-off between my being able to read (sort of necessary in my profession) and being able to see distances. Distances usually lose. There's always a weird up and down adjustment between my near-sightedness & my astigmatism: this year, the near-sightedness improved but the astigmatism got worse, and other years it's vice-versa.

Bizarrely, my eyes themselves are apparently in terrific physical shape. "They're so strong!" enthuses my optometrist. "Yes, and if only I could see out of them," I respond.
posted by thomas j wise at 10:46 AM on September 28, 2023 [2 favorites]

is framed as opposing a genetic hypothesis, which wouldn’t be my first thought?

Perhaps it’s pointless to complain about a popular science article’s representation of the complexities of these things, though. Here’s one of Morgan’s papers which of course does get deeper into all that.
posted by atoxyl at 10:50 AM on September 28, 2023 [3 favorites]

I bet there is a genetic component as well, with some people being more predisposed to get myopia, but going outside and getting more sun is a pretty easy thing for everyone to do so even if the advice may benefit some people more than others it's still something I'd say we should all try to take on board.

I'm pretty sure I read some article on the original 2008 Australian research because I've been doing my best to make sure my kids spend time outside for their eyesight and I've been sharing this info with other parents too. It looks like my older kid will still need glasses but hopefully there's been some mitigation so perhaps her prescription won't be as strong.
posted by any portmanteau in a storm at 11:05 AM on September 28, 2023 [2 favorites]

"I'd almost favor the alternate mechanism of installing truly comically bright lights in schools"

Would that work, though, or does it need to be natural light to trigger dopamine? Maybe if it were huge sunlamps...

(I'm given to wonder what the rates of myopia in the Pacific Northwest are vs. the Southwest...)

"The writer's hesitance to just tell us the damned answer just caused my eyes to alternately roll and glaze over. Which may be good eye exercise, for all I know."

Yeah... this is the style for Wired, The New Yorker, etc., feature writing in general. You can't just cut to the punch, it has to be a big story and such. I get that they're not doing straight inverted pyramid style, but I find that incredibly annoying.
posted by jzb at 12:19 PM on September 28, 2023 [1 favorite]

“We knew that light stimulated the release of dopamine from the retina, and we knew that dopamine could control the rate at which the eye elongated,” Morgan says. (In 1989, an American ophthalmologist named Richard Stone found that he could induce myopia in chickens by manipulating light levels, and that there was less dopamine in the retinas of the myopic chickens.) “So once we had the actual epidemiological evidence that being outdoors was important, the mechanism was, to us, very obvious.”

This is the interesting part to me, and I wish the article spent more than one paragraph on it. As a layperson, I was unimpressed by the revelation that spending time outside helps prevent myopia, but I would have guessed entirely the wrong mechanism of action (assuming dopamine is the correct mechanism). Naïvely, it just seems like a good idea to regularly exercise the faculty of looking at faraway things, and outdoors is where you can do that.
posted by aws17576 at 12:21 PM on September 28, 2023 [2 favorites]

I just got ICL surgery after being -13 my entire adult life (and being told I was too myopic for LASIK) and it's been life-changing.

I did this in May 2019 with -10 and never in my life have I done anything that has been so worth it. My optometrist keeps telling me smugly that I will probably eventually need reading glasses, to which I always reply that even when I had no farsightedness I *still* needed to wear glasses to read because I was SO nearsighted. Wearing glasses once in a while to read when I had previously needed them every waking moment? No problem.

My vision has gotten a little worse and I'll never have the low light vision - like the amount of light at dusk, before it's truly dark - I once did but even if I do need nearsightedness correction again via glasses, I'll at least be able to choose nice frames (rather than whatever hides the cokebottle lenses) and get sunglasses, when before those things were not possible. Totally totally worth it.
posted by urbanlenny at 12:48 PM on September 28, 2023 [2 favorites]

It is grand that Wired is getting the message out now and tribs to Chavenet for flagging it. The story was covered in Nature in 2015: The Myopia Boom which shd be beyond their paywall. I was gob-smacked to see a) the myopia stats b) that feedback using dopamine was key c) that nobody in my home country was doing anything about it. I wrote an exec summary at the time. Nothing has been done w.r.t. public health interventions in the intervening 8 years. Hooshing kids outside costs nothing, after all.

I gather than indoor lights won't cut it: "A well-lit classroom might shine 500 lux on page or key-board and we're fine with that for learning the names of the Presidents of the Republic and making Lara Croft do our bidding; but children need 10,000 lux for 3 hours a day to keep them out of Specsavers until they are middle aged. "

And remember that pale freckly Irish genes are really susceptible to melanoma when they leave the drizzle and emigrate to, say, Oz. I think hats prevent sunlight kicking off the dopamine which is (I think) mediated by the pineal in the middle of your head. Another trade-off.
posted by BobTheScientist at 12:58 PM on September 28, 2023 [2 favorites]

I spent almost all day outside every day, weather permitting or not from age 3 'til 6 when I had to go to school — which I bitterly resented — and I was diagnosed with severe myopia at age 8 right after I learned to read.

I still spent as much time outside as I could, but my correction progressed to -8 in both eyes by 16, and was -10 in each eye by the time I was 30, though I never had any astigmatism.

I grew up in the days when near-sightedness was always undercorrected under the theory it retarded progression, and as a result, when I was a little league pitcher, I could only throw fastballs because I couldn’t see the catcher's fingers giving the signs. I also never saw the Milky Way until I was 21 and got my first pair of contacts, even though I lived in a small unpolluted city at 6,000+ ft.

When I got new glasses about every six months I would experience a week or so of relatively sharp vision (still no Mlky Way) which I spent much of wandering around gorging myself on all the texture and detail I couldn’t normally see.

In my early 30s, my ophthalmologist made a self described 'mistake' and ordered contacts that were a bit stronger than she intended, and I discovered there was yet another world of fine detail I had never seen before, and it was truly intoxicating.

That was also when the whole undercorrecting saga was revealed, and truth to tell, I was very unhappy about the arrogance and secrecy of the entire ophthalmological profession, which had by then consigned me to a life of really poor vision which foreclosed many options I might have chosen if I just could have seen them!
posted by jamjam at 1:19 PM on September 28, 2023 [10 favorites]

I gather than indoor lights won't cut it:

Not with that attitude they won't!

"A well-lit classroom might shine 500 lux on page or key-board and we're fine with that for learning the names of the Presidents of the Republic and making Lara Croft do our bidding; but children need 10,000 lux for 3 hours a day to keep them out of Specsavers until they are middle aged. "

If you're replying to my earlier comment I (unseriously) meant throwing gobs and gobs of LED studio lights on the ceiling. However many it takes to get something like 10000 lumens per square meter of ceiling. Eat hot luminous flux, ya little fuckers!

Their electricity bills would be hilarious.
posted by GCU Sweet and Full of Grace at 4:26 PM on September 28, 2023 [1 favorite]

I'd long assumed that the obvious increase in the number of people wearing glasses over the last few decades was because of better diagnosis/more regular eye tests, but it seems I was wrong about that also.
posted by dg at 5:09 PM on September 28, 2023 [2 favorites]

So how do you balance the directive to get more outdoor light against the fact that longterm exposure to UV light also damages your eyes? Asking for a person who has hated wearing sunglasses their whole life and now has pterygia growing on their eyes to show for it.

My shrink says to go outside and get sunlight, my dermatologist and ophthalmologist say to avoid it. You can't win. (But it's always important to remember that if you have any medical problems, it's your fault for not doing the one simple trick.)
posted by cultanthropologist at 5:52 PM on September 28, 2023 [3 favorites]

> So how do you balance the directive to get more outdoor light against the fact that longterm exposure to UV light also damages your eyes?

In favour of going outside. Because avoiding it apparently leads to functional impairment much earlier, as seen by the very high rates of myopia among children. Annual incidence of melanoma in the US seems to be around ~230 cases per million person-years across the entire age spectrum, with the bulk of that occurring after age 50.
posted by Gyan at 10:57 PM on September 28, 2023 [1 favorite]

This is very interesting. Genetically, I should be very myopic, as both my parents were, as well as their parents, though my maternal grandmother had a lot of additional eye issues that no one seems to have inherited. And all of my siblings wear glasses. I do too, but only for driving at night and watching movies in theatres, in normal light, I see better without them, and with old age, my eyesight has improved. None of my kids are myopic.
I am very much an outdoors person, it is fascinating if true that my love of forests in particular might have helped me keep my eyesight healthy.
posted by mumimor at 3:30 AM on September 29, 2023 [1 favorite]

Here is a recent summary, with links to analysis/data, of Cochrane evidence about non-dopamine interventions for childhood myopia.
"Atropine eye drops currently seem to be the most effective treatment for myopia control, but further research is needed to determine the optimal dose and duration of therapy. "
posted by BobTheScientist at 4:13 AM on September 29, 2023 [1 favorite]

I started going nearsighted in Grade 4 and my Taiwanese mother started to make me do eye exercises and stare at the greenery outside. I can't deny that my myopia did not worsen after that, but it didn't improve either.

This article feels like a time machine to my childhood for me.
posted by Pitachu at 3:00 PM on September 29, 2023 [1 favorite]

The connection to the release of dopamine was interesting to me. It seems to play a role in many of the body's systems. Was there any follow up to determine if there are other significant downstream impacts of this?
posted by clark at 8:36 PM on September 30, 2023

If more retinal dopamine does indeed tend to stave off myopia, then we might expect cat ownership to be associated with lower incidence of myopia, and lower corrections when myopia is present.

Because latent infection with T. gondii makes dopamine more available in the brain:

Chronic T. gondii infection causes specific changes in chemical messengers used by inter-neuronal connections within the brain. The T. gondii genome contains two loci with high homology for mammalian genes coding for a rate-limiting enzyme in dopamine synthesis, namely amino acid hydroxylase [56]. This homology suggests that T. gondii, once resident within the brain, can increase the availability of dopamine [57, 58], a neurotransmitter critical for the processing of motivation and pleasure. Interestingly, drugs that interfere with dopamine metabolism also rescue the effects of T. gondii on behavior [59].

About a third of human beings worldwide are infected by T. gondii, and Taiwan in particular has experienced a surge in pet ownership recently, with an emerging preference for cats.
posted by jamjam at 10:29 AM on October 4, 2023