Darkness and near work: Myopia and its progression in third-year law students

Abstract

Purpose To evaluate myopia prevalence, myopia progression, and various potential myopia risk factors in third-year law students. Design Cross-sectional study and survey. Participants One hundred seventy-nine third-year law students at the University of Pennsylvania. Methods We administered a questionnaire to assess the prevalence of myopia, myopia progression, and risk factors, including near work, family history, and daily light/dark exposure. We conducted a screening eye examination to ascertain myopia status. Myopia was defined as the mean spherical equivalent of the two eyes of ≤−0.5 diopters; myopia progression was defined by the self-reported need for a stronger eyeglass prescription during law school. Main outcome measures (1) prevalence of myopia, (2) progression of myopia. Results Seventy-nine percent of the class participated (n = 179, two were excluded for amblyopia leaving 177 students). Fifty-eight percent were male, 75% were Caucasian, and the mean age was 27 years. Seventy-nine percent reported parental myopia. The mean amount of near work was 7.4 hours/day; mean sleep was 7.9 hours/day; mean darkness was 5.3 hours/day. Sixty-six percent of the students were myopic. Of 96 participants myopic before law school, myopia increased in 83 (86%) during law school. Among 75 students not myopic at the beginning of law school, 14 (19%) became myopic. The onset of myopia could not be determined for 6 patients. There were trends for higher myopia prevalence among those with a parental myopia history ( P = 0.14) and for increased myopia progression among those reporting more daily near work ( P = 0.18). Students with ≤5.6 hours of daily darkness were more likely to report myopia progression than those with >5.6 hours of darkness per day (95% vs. 80%, P = 0.07). To account for possible confounding effects of risk factors with myopia progression, logistic regression with categorization of the continuous exposure variables (hours of near work, sleep, and darkness) above or below median values weakened the near work association (odds ratio 1.8, 95% confidence interval 0.5–6.7, P = 0.35) but continued to identify darkness association with daily hours of darkness (odds ratio 4.8, 95% confidence interval 1.0 ≥ 23.3, P < 0.05). Among the 77 students with myopia onset before college, those with ≤5.6 hours of daily darkness were more likely to progress than those with more hours of daily darkness (97% vs. 76%, P = 0.01). Conclusions This study confirms high rates of myopia prevalence and myopia progression among law students. The strongest association, especially in those with myopia onset before college, was a relation of myopia progression during law school with less daily exposure to darkness, a potential risk factor previously identified in childhood myopia. The role of exposure to darkness in refractive development warrants additional study.