Original article
Outdoor exposure in children from Buenos Aires Province, Argentina
Exposición al aire libre en niños de la Provincia de Buenos Aires, Argentina
L. Fernández Irigaraya, A. Balsab, A. Armestoc, I. Magnettod, A. Szepse, L.R. Iribarrenf, R. Iribarrenc,
, A. Grzybowskig,h
Corresponding author
a Fundación Dr. Nano, Provincia de Buenos Aires, Argentina
b Oftalmólogos Augen, Ciudad de Buenos Aires, Argentina
c Consulta Ocular Iribarren & Asoc., Ciudad de Buenos Aires, Argentina
d Centro de Visión Dr. Magnetto, Marcos Juárez, Provincia de Córdoba, Argentina
e Departamento de Oftalmología, Prof. Alejandro Posadas, Hospital Nacional, Provincia de Buenos Aires, Argentina
f Grupo de Enseñanza Científica, Instituto de Física de Líquidos y Sistemas Biológicos (IFLySIB), CONICET, Buenos Aires, Argentina
g Departamento de Oftalmología, Universidad de Warmia y Mazury, Olsztyn, Poland
h Instituto de Investigación de Oftalmología, Fundación de Desarrollo de Oftalmología, Poznan, Poland
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Knowledge of how many hours of outdoor exposure children spend in this second kind of environment would be very relevant.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently, there is a recommendation for preventing myopia to spend two hours outdoors per day, or 14 h per week, based on meta-analysis of more than 10 years of publications about myopia and outdoor exposure.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5,6</span></a> Since the link between the mean spherical equivalent of the population and time spent outdoors was first described 15 years ago, much has been done.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7–9</span></a> A randomized clinical trial first recognized that increasing the time children spent outdoors at school by 40 min decreased the incidence of new cases by more than 10% in 3 years.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Subsequently, other prospective randomized clinical trials observed that outdoor exposure (as measured by sensors) decreased the incidence of myopia, and decreased myopic shifts not only in myopes but also in emmetropic children.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Argentina is a country with a high rate of literacy (98%),<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> but low prevalence of myopia, indicating that a deeper analysis should be performed about risk factors.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In first place, it is a big country with a diverse geography and remarkable cultural differences. In one study, the informed prevalence was 29% in adults who had completed 6 years of university studies in the developed urban environment of Buenos Aires city.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This study in an unselected sample of highly educated adult office workers probably showed a prevalence higher than the country mean prevalence. Thus, this prevalence reached only 13.5% in adults living in a small urban environment in the province of Cordoba (Villa Maria),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and only 3% under cycloplegia in 12-year-old children from another small urban environment nearby in that province (Marcos Juarez) (Magnetto et al. <span class="elsevierStyleItalic">in preparation</span>). The last two cities are representative of the central rural region of the country (named “Pampas”), 600 Km far from the metropolitan area of Buenos Aires. Bearing in mind that data are limited, these preliminar Argentinian studies contrast with data from Hong Kong, Taiwan, Korea, Guangzhou, and Singapore, where the prevalence of myopia in 12-year-old children reaches 60%, and is near 86% in young adults, in these highly developed urban environments.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,16,17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A number of studies have determined important differences between Western and Eastern education systems, with the latter involving students in more hours of schoolwork per week.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–20</span></a> It is well known that in locations like Singapore, children of Chinese ethnicity spend only 2–3 h per week outdoors.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> So it would be useful to know how much time Argentinian children spend outdoors. The present study addresses this issue in a suburban location of Buenos Aires city, Argentina.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This cross-sectional clinic-based study was developed in the North of the metropolitan area of Buenos Aires, Argentina. The study protocol was approved by the Ethics Committee of the Argentinian Council of Ophthalmology. The tenets of the Declaration of Helsinki were followed, and thus verbal informed consent was obtained from the children and written informed consent was obtained from their parents prior to enrolment. Consecutive unselected children (outpatients) who attended the clinic during late summer and early autumn at school entrance (February and March 2020) to control their current lens prescription or perform a routine ocular exam in a private practice office were interviewed by two trained ophthalmologists (LFI & AB). The ocular exam consisted of visual acuity testing during subjective refractometry, followed by application of cycloplegia. This consisted of one initial drop of 0.2% proparacaine (Alcon) as a topical anesthesia and two drops of 1% cyclopentolate (Alcon) at 5 min intervals. Forty-five minutes after instilling the last drop, an automated refractometry was performed (averaged over three repeated measurements). The main outcome measurements were the mean spherical equivalent refractive error of the autorefractometer calculated as sphere + ½ cylinder value. Spectacles were prescribed according to preferred practice guidelines of the American Academy of Ophthalmology.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients undergoing any treatment to arrest myopia progression (e.g., atropine 0.01% drops or outdoor exposure counselling) were excluded from the study. While the subjects were waiting for the cycloplegic effect, the parents filled a questionnaire about myopia-related factors for their children. The questionnaire was developed in Spanish for this particular society, and it was based on the Sydney Myopia Study<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and the Guangzhou Myopia Trial<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> questionnaires. This questionnaire asked how much time a child spent outdoors per day after school and on weekends, how long they spent using electronic devices, and how long they spent reading and writing. It also asked about the hours of schooling (4 or 8 h a day) and if the child had tutorial classes after school. Incongruent answers (such as “24 h a day” of outdoor exposure) were recorded in only five cases, and were excluded. Parents did not raise questions about the comprehension of the questionnaire, which was straightforward and had been pre-tested for comprehension in an unpublished pilot study three months before this study. The average daily hours of outdoor exposure were calculated bearing in mind that children in Argentina are obliged to go outside during breaks exactly 30 min for every 4 h of schooling. The formula used for calculating outdoors time for each child was: Mean time outdoors = ((breaktime at school + travelling time to school * 2 + weekdays time outdoors) * 5) + (weekends time outdoors * 2) + weekly sport time at school)/7, where “breaktime at school” was equal to 0,5 h or 1 h, corresponding to 4 h or 8 h of schooling respectively. Sport time at school was equal to 2 h per week in the 4 h per day schooling schedule and 4 h per week in the 8 h per day schooling schedule, both in primary and secondary schools in Argentina.</p><p id="par0035" class="elsevierStylePara elsevierViewall">For the purpose of classifying the different refractive errors, the present study followed the protocol of the Refractive Error Studies in Children:<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> such that myopia was considered as a spherical equivalent refractive error <−0.50 diopters (D), hyperopia as >+2.00 D, and emmetropia as between −0.50 and +2.00 D. Parametric values were expressed as means and standard deviations. The data were compiled in an Excel spreadsheet and converted to an SPSS database (SPSS version 15, SPSS Inc., Chicago, IL, USA). Dependent continuous variables such as daily hours of reading or outdoor exposure were compared among refractive groups by one-way ANOVA with post-hoc Scheffe tests. Logistic regression analysis was performed with the dichotomous variable “myopia–non-myopia” with all the environmental variables, such as tutorial classes, outdoor exposure, and reading habits, controlled by age and gender. A value of <span class="elsevierStyleItalic">p</span> < 0.05 was the cut-off for statistical significance.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study involved 115 children aged 10.48 ± 3.65 years (range 5–18 years), with 56.5% being girls. Children had 8 h per day of schooling in 62.6% of cases, with the rest spending only 4 h in school each day. Only 14.8% of the sample had tutorial classes after school. The refractive error was similar for both eyes (r = 0.97%), so only the right-eye spherical equivalent was used for the present analysis. The spherical equivalent of the right eye followed a normal distribution (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and there were 38.3% myopes, 24.3% hyperopes, and 37.4% emmetropes. The mean time that these children spent outdoors per day was 3.94 ± 1.45 h (27.60 ± 10.16 per week) and the distribution of time outdoors was normal (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The total mean time spent per day on reading and writing out of school was 1.50 ± 0.98 h, and that spent using cellphones and tablets was 2.43 ± 1.66 h (<a class="elsevierStyleCrossRef" href="#fig0015">Figs. 3</a> & <a class="elsevierStyleCrossRef" href="#fig0020">4</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">There were no significant differences in outdoor exposure, hours of cellphone use, or hours of reading/writing among refractive groups (data not shown, ANOVA by groups). A logistic regression analysis for “myopia–non-myopia” as the dependent variable, controlling for age and gender, including type of schooling, tutorial classes, time outdoors, time reading, and time using cellphones, did not show any significant difference in these independent variables among groups.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Although it is difficult to perform population based study of myopia risks factors that could obtain representative data of children in a country with different social, ethnic and geographical differences like Argentina, one preliminar approach could be to study this complex phenomenon focusing on smaller scale samples chosen to represent subpopulations of this diverse demography. The main finding in this preliminary study was high outdoor exposure in children of suburban Buenos Aires, a country where the prevalence of myopia is very low.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> These unselected children who were not under counselling for increased outdoor exposure or atropine 0.01% drops to arrest myopia progression represent a sample of naive patients attending for an ocular health checkup. The prevalence of myopia in this study was higher than population values for Argentina possibly because myopic children attend frequently to control their prescription. As this sample of outpatients has more ametropic than emmetropic subjects, the distribution of refractive errors is normal and not peaked, like what has been shown in other studies with more representative samples of Argentina.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> This limitation, besides the small sample size, could have masked the expected differences in environmental factors between refractive groups which have been found in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,23</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In 2008, a study addressing the issue of myopia and outdoor exposure compared myopic children of Chinese ethnicity aged 6–7 years from Sydney and Singapore with a prevalence of myopia of 3.3% and 29.1%, respectively, and an outdoor exposure of 13.75 h a week in Sydney vs. 3.05 h a week in Singapore.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In 2013, the Sydney Myopia Study reported that children aged 6–7 years and of European Caucasian origin spent 21.66 h per week outdoors, while those of East Asian origin spent less, 13.53 h per week, and their prevalence of myopia was higher (0.7% vs. 2.4% at ages 6–7, and 8.6% vs. 52.5% at ages 12–13).<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The present study had a myopia prevalence of 38.3%, higher than the prevalence of 13.5% reported for adults in a rural town in Argentina,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> or the prevalence of 29% reported for high educated office workers in the city of Buenos Aires,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> possibly because the present study was developed using a small clinical sample of spectacle users. The importance of this study relies on the high outdoor exposure of these children living in the Northern suburban region of Buenos Aires, the thirteenth most populated city in the world, with approximately 15 million inhabitants.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> This northern suburban region has only 6.5% of its surface covered with high-rise buildings (generally, 10-floor apartments approved by local municipal laws) according to the local College of Architects, and the rest (93.5% of the land occupation) consists of American and European style one- or two-floor stand alone houses with backyard gardens with swimming pools, where children can spend time outdoors.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The education in Argentina is mainly (80%) public with 4 h of schooling a day, either in the morning or in the afternoon, with only 20% of children in private education schools (2010 National Census).<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Typical private schools have a schedule of 7–8 h a day, and this sample had more children (62.6%) in this type of schooling, probably due to the high family income of this suburban Northern region of Buenos Aires.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> This type of schooling leaves less time to spend outdoors after classes, but even in that case, our group of children spent more time outdoors than Caucasians in Australia (27.60 vs. 21.66 h a week).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The children in our study spent 10.43 h per week reading and writing after school, less than the 17.38 h per week spent in Sydney by Caucasians.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Interestingly, our children spent 17.01 h per week using cell phones. The mentioned Sydney Study in Australia was performed during 2005–2011,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> before the massive increase of cell phone use that has developed in the last 10 years. We are concerned about the high use of cell phones among our children, because near-work has been associated with myopia development, although a recent systematic review has shown no association between digital screens and myopia.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The main limitations of our study are that it is not population based but from a clinical sample, and that it probably comprises children from a private education system with 8 h per day of schooling different than 80% of the general population with public education (4 h schooling). In this case we can argue that children that go more time to school would spend less hours outdoors, so in a population sample the results could even be higher in outdoor exposure for our country. Besides, the use of questionnaires is not necessarily accurate. These have been tested for repeatability in previous studies,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,21</span></a> but should be tested against objective measurements so see if they have possible limitations.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Future studies in Argentina with questionnaires of myopia risk factors are expected to be population based and not clinical practice based (as the present study), to test logistic regression analysis of these risk factors, which in this case did not show significant differences. Family history of high myopia will also be studied, to include this probably genetic background. Interestingly, this study shows some characteristics of the study habits of Argentinian children. Educational reviews have shown that the Chinese education system introduces a high load of reading and writing of different languages from early school years onwards,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> with more than 50% of the population reaching university or tertiary education, while in our country, despite a high literacy rate of almost 98%, only 20% of the population reach superior education.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion, the present study show that children in the suburban area of Buenos Aires spend a comparatively higher average number of hours per week outdoors (27,60 h). It could be argued that the low prevalence preliminary found in our country could be related to high outdoor exposure, however, more studies are warranted.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Financial support</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have not received any funding for this article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Author contributions</span><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Leonardo Irigaray:</span> conceptualization, methodology, formal analysis, investigation, writing – original draft. <span class="elsevierStyleBold">Alejandra Balsa:</span> conceptualization, methodology, formal analysis, investigation, writing – review and editing. <span class="elsevierStyleBold">Alejandro Armesto:</span> conceptualization, formal analysis, writing – review and editing. <span class="elsevierStyleBold">Ignacio Magnetto:</span> conceptualization, methodology, investigation, writing – review and editing. <span class="elsevierStyleBold">Abel Szeps:</span> conceptualization, methodology, investigation, writing – review and editing. <span class="elsevierStyleBold">Luciano Iribarren:</span> formal analysis, investigation, writing – review and editing. <span class="elsevierStyleBold">Rafael Iribarren:</span> conceptualization, methodology, formal analysis, investigation, writing – original draft. <span class="elsevierStyleBold">Andrzej Grzybowski:</span> formal analysis, writing – review and editing.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1740881" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1535381" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1740882" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1535382" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Financial support" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Author contributions" ] 10 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-10-15" "fechaAceptado" => "2021-02-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1535381" "palabras" => array:3 [ 0 => "Myopia" 1 => "Outdoor exposure" 2 => "Reading habits" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1535382" "palabras" => array:3 [ 0 => "Miopía" 1 => "Exposición al aire libre" 2 => "Hábitos de lectura" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate myopia risk factors, mainly outdoor exposure and reading habits, in a country with low prevalence of myopia (Buenos Aires Province, Argentina).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Consecutive children interviewed in a clinical private practice setting were autorefracted under cycloplegia with cyclopentolate 1%. Their parents consented to fill a questionnaire about schooling, tutorial classes, outdoor exposure, reading habits, and cellphone use, both on weekdays and weekends. The Spanish questionnaire was based on past English questionnaires of myopia clinical trials. The spherical equivalent of the right eye was used for the refractive distribution. The average daily hours spent for each activity were calculated.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">This study involved 115 children aged 10.48 ± 3.65 years (range 5–18 years), with 56.5% being girls. Children had 8 h of schooling per day in 62.6% of cases, and only 14.8 % had tutorial classes after school. There were 38.3% myopes (<−0.50 D), 24.3% hyperopes (>+2.00 D) and the rest were emmetropes. The mean time that these children spent outdoors per day was 3.94 ± 1.45 h (27.60 ± 10.16 h per week). The total mean time spent reading and writing per day was 1.50 ± 0.98 h, and that spent using cellphones and tablets was 2.43 ± 1.66 h.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In an environment with low myopia prevalence, children spend almoast 4 h per day outdoors, much more than the usual recommendation of 2 h a day for myopia prevention.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evaluar los factores de riesgo de la miopía, principalmente la exposición al aire libre y los hábitos de lectura, en una región con baja prevalencia de miopía (Provincia de Buenos Aires, Argentina).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los niños entrevistados consecutivamente entre febrero y marzo de 2020 fueron refraccionados bajo cicloplejía con ciclopentolato al 1%. Sus padres consintieron llenar un cuestionario sobre escolaridad, clases extracurriculares, exposición al aire libre, hábitos de lectura y uso del teléfono móvil, tanto entre semana como los fines de semana. Se utilizó el equivalente esférico del ojo derecho para la distribución refractiva. Se calculó el promedio de horas diarias dedicadas a cada actividad.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">En este estudio participaron 115 niños de 10,48 ± 3,65 años y 56,5% eran niñas. Los niños tenían 8 h de escolaridad al día en el 62,6% de los casos y solo el 14,8% tenía clases de extracurriculares después de la escuela. Había 38,3% miopes (<−0,50 D), 24,3% hipermétropes (>+2,00 D) y el resto eran emétropes. El tiempo medio pasado al aire libre por día fue de 3,94 ± 1,45 h (27,60 ± 10,16 h por semana). El tiempo medio total dedicado a la lectura y a la escritura por día fue de 1,50 ± 0,98 h, y el de uso de teléfonos móviles y tabletas fue de 2,43 ± 1,66 h.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">En un entorno con baja prevalencia de miopía, los niños pasan al menos 4 horas diarias al aire libre, mucho más que la recomendación habitual de 2 horas diarias para la prevención de la miopía.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández Irigaray L, Balsa A, Armesto A, Magnetto I, Szeps A, Iribarren LR, et al. Exposición al aire libre en niños de la Provincia de Buenos Aires, Argentina. Arch Soc Esp Oftalmol. 2022;97:396–401.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0115" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0050" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1540 "Ancho" => 1671 "Tamanyo" => 120089 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Histogram with the normal refractive distribution of right-eye spherical equivalent.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1562 "Ancho" => 1673 "Tamanyo" => 129878 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histogram with the normal distribution of children’s daily hours of outdoor exposure.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1568 "Ancho" => 1673 "Tamanyo" => 116978 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histogram showing the skewed distribution of daily hours spent with cellphones.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1513 "Ancho" => 1674 "Tamanyo" => 121486 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histogram showing the skewed distribution of hours a day spent reading/writing.</p>" ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 93725 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemics of myopia: aetiology and prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I.G. 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