Reducing childhood myopia, boosting resilient aging through novel light exposure app

TUMCREATE, a multidisciplinary research platform of the Technical University of Munich (TUM) in Singapore, and the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), kick off a new research project that examines the efficacy of optimizing light exposure to reduce myopia prevalence among school-going children and promote resilient aging through a novel smartphone-delivered behavior-changing program.

This multi-disciplinary research project will lead to the rollout of an individually tailored, low-intensity behavior-modification program delivered through the smartphone application "LightUP". The app empowers parents to ensure that their children get the right light at the right time to prevent myopia, and senior citizens to improve sleep quality, cognition, alertness, and mood.

This non-invasive program leverages individual behavior as the key strategy to empower individuals to take a proactive role in enhancing their eye health, sleep, alertness, cognitive functioning, and mental well-being. Additionally, LightSPAN will look into testing and establishing evidence-based lighting designs and policy recommendations for myopia-safe classroom lighting.

Studies have revealed that light has a profound influence on human health, cognition, and well-being. Exposure to bright light has also proven to provide strong benefits in reducing cognitive decline in dementia. The use of high-intensity light, sunlight or blue-enriched white light has also shown to stimulate the melanopsin system—the neurobiological pathway that supports normal circadian rhythms, which helps improve sleep quality, alertness, cognition and mood—functions that change with increasing age.

In Singapore, the aging population comprised 17.6 percent of the total population (in 2021) and is projected to increase to 23.8 percent by 2030. In response to the increasing aging population and rising health care costs, Singapore has rolled out the national health care reform—Healthier SG—to shift the national health care strategy from treatment to prevention.

Amid the challenges of coping with an aging population, Singapore is also simultaneously grappling with a high prevalence of myopia (near-sightedness), with more than 80% of young adults in Singapore affected by the condition. In addition to its very high socio-economic burden, high myopia, which affects nearly 3% of the world population, can lead to irreversible vision loss.

Without adequate interventions, myopia is projected to affect 50% of the world's population by 2050, with over 1 billion individuals with high myopia, making myopia the leading cause of irreversible blindness worldwide. While regular outdoor exposure and exposure to bright light (e.g., sunlight) remains a robust behavioral preventive measure to reduce the incidence of myopia, the implementation remains a challenge for working parents to gauge outdoor time and optimize time spent outdoors in bright light for their children.

LightUP: a smartphone application to optimize light exposure for resilient aging and myopia prevention. The LightSPAN project will leverage behavior as its key intervention strategy and examine its efficacy by targeting two key life stages—childhood and adolescence and late adulthood to optimize light exposure through the innovation of the smartphone application "LightUP".

Using data collected by a novel, wearable light sensor measuring visible and ultra-violet (UV) light exposure, the LightUP mobile app will provide personalized feedback for the user by presenting visualizations of light exposure throughout the day, showing long-term trends in light exposure and sending daily notifications to encourage the user to modify and adapt their behavior to improve circadian rhythms, alertness, mood, and cognition.

Professor Manuel Spitschan, from TUMCREATE and co-Principal Investigator of the LightSPAN project, said, "As of now, there are no established guidelines or recommendations for healthy light exposure for senior citizens in Singapore or globally. With preventive care and mental well-being taking center stage in how people manage their health, the research project aims to empower users to take a proactive approach to take care of their well-being by leveraging light exposure, which is an element that is available in abundance to ease age-related alterations in sleep, cognition, alertness and mood."

"With the widespread usage of smartphones among Singaporeans, adopting the LightUP application certainly presents a scalable potential for nationwide adoption of the app to deliver low-threshold behavioral intervention to get the right light at the right time."

The app will also provide quick and easy access, transfer, and tracking of light exposure details and nudges whenever additional light exposure is needed so that parents can effectively monitor and optimize their children's light exposure.

Assistant Professor Raymond Najjar, from the Department of Ophthalmology at NUS Medicine and co-Principal Investigator of LightSPAN project, said, "Children today are experiencing insufficient outdoor and natural sunlight exposure, a concerning trend that is contributing to the alarming increase in childhood myopia. The younger the age of myopia onset, the higher the risk of myopia and associated sight-threatening conditions during adulthood."

"We need to stop or at least delay the onset of myopia in children. Recognizing the pivotal role that outdoor exposure and natural sunlight play in reducing myopia risk, the LightSPAN project aims to introduce innovative, evidence-based strategies for myopia prevention. Through wearable light sensors, coupled with the LightUP mobile app, our initiative will empower parents to monitor their children's light exposure and support them in cultivating healthier daily light exposure habits to safeguard against myopia."

With a growing focus on patient interaction with health management as part of the global shift from providing reactive, illness-oriented care to preventive care, a growing body of mobile apps are developed to deliver behavioral health intervention and adopt healthier lifestyle habits in pursuit of better health outcomes.

Digitally-enabled health applications are increasingly adopted by patients, providing a window of opportunity to improve public health outcomes. Basic intervention strategies such as sending of text reminders have been reported to increase the odds of medication adherence and reduce the frequency of missed appointments.

The research complements the nation's efforts to create an integrated and technology-driven health care ecosystem that extends beyond providing clinical support to social and mental support by drawing the use of mobile phones to deliver a non-invasive, low-threshold behavior-changing program that empowers elderly individuals to take a proactive approach in adopting a healthy light exposure lifestyle to promote a healthier eye development and improve cognitive functioning and mental well-being across the lifespan.

To ensure the successful translation of research outcomes, the research team will work with local health and education agencies such as the Ministry of Education, the Ministry of Health Office of Health care Transformation, the Ministry of Health Aging Planning Office, and the Health Promotion Board to generate key data to establish evidence-based design recommendations and guidelines for optimal light exposure in and outside of classrooms for myopia prevention, but also guidelines to promote physical, mental and emotional health and well-being in Singapore.

Provided by National University of Singapore