In recent years, there has been an exponential increase in the prevalence of myopia in children worldwide,1 which in turn increases the risk of eye complications such as glaucoma or retinal detachment.

Interventions to slow the progression of myopia in children can be behavioral, optical, or medical.2,3 Behavioral interventions consist in lifestyle recommendations that have been found effective in preventing the development of myopia or slowing its progression. These recommendations include spending more time outdoors, avoiding near work under dim light conditions, or reducing the time spent using digital devices with short viewing distances. At present, no tool is available in Spain for the objective assessment of the adherence to these recommendations.

To this end, we developed a questionnaire (GARCOM questionnaire, Fig. 1) comprised of 4 epidemiological items and 4 other items concerning these recommendations and based on the current guidelines from scientific societies2,3 and the 2024 screentime recommendations of the Asociación Española de Pediatría (AEP, Spanish Association of Pediatrics).4 The study was approved by the Research Ethics Committee of the Hospital Universitario Virgen Macarena.

Figure 1.

GARCOM questionnaire.

The questionnaire was completed, with the help of parents or legal guardians, by patients aged 5 to 14 who attended their first ophthalmology appointment during a 4-month period, who were included in the study by consecutive sampling. If there were any questions about the questionnaire, the ophthalmologist clarified them during the appointment. We calculated the degree of adherence to the recommendations based on the responses to questions 1, 4, 5, and 6.

The sample included 152 participants with a mean age of 7.88 years (SD, 1.74 years) (32 participants aged 0–6 years, 119 aged 7–12 years, and one aged 13–16 years). The sex distribution was 48.68% female and 51.31% male. In the overall sample, 62.5% of patients had at least one parent with myopia. Myopia was present in 18.92% of patients with a significant refractive error.

Only 46.71% of participants reported spending more than two hours a day outdoors, and 76.98% exceeded the screentime limits recommended for their age group.

In addition, 16.45% of respondents performed near tasks at a distance of less than 20 cm, and 37.49% reported reading or studying in dim light conditions on a regular or frequent basis.

Also, 71.71% of participants were unaware of the behavioral recommendations concerning myopia. In the subset who knew about them, the most frequent source of information was the ophthalmologist (51.31%), followed by the pediatrician (13.81%), even though the responsible use of technology and the promotion of healthy lifestyle habits are included in the current recommendations for routine child health checkups.

The mean adherence score was 3.94 out of 8, indicative of moderate adherence. Adherence was low (0−2 points) in 5.92% of participants, and moderate (3−5 points) in 65.79%. Table 1 summarizes the responses to the GARCOM questionnaire.

The results of our study show that, in the analyzed sample, the adherence to these recommendations was moderate or low, even though more than half of the participants had a parent with myopia, a group for whom adherence to these recommendations is particularly important.

The recommendations with the lowest adherence were reducing the time spent using digital devices at close range, followed by the recommendation to spend more time outdoors. Most of the surveyed patients were unaware of these recommendations. This highlights the importance of collaboration between ophthalmology and pediatric primary care providers in promoting lifestyle changes that can have an impact on the development of myopia.

A recent study in Spain demonstrated the association between engagement in outdoor activities and a lower prevalence of myopia, and how excessive screen use may indirectly contribute to the risk of myopia despite the absence of an independent association.5 These findings underscore the need to implement preventive measures to address the impact of digital media on children’s health,6 especially when it displaces healthy lifestyle habits.

Further studies are needed to validate this questionnaire in larger samples and different populations, and to assess compliance with these recommendations prospectively.

Efforts must be made to increase adherence to these recommendations in the pediatric population through collaboration and the dissemination of preventive measures among ophthalmology and primary care pediatric providers.