Will online gaming restrictions reduce childhood myopia?

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China has recently outlined a new national policy limiting the hours children under 18 can play online games. Gaming for children is now restricted to between 8pm and 9pm, on Friday, Saturday or Sunday and on public holidays. Comparing online gaming to “spiritual opium,” the enforcement applies to hand held gaming, online gaming and phone gaming.1这将由单个登录帐户（具有现实名称验证系统）来完成，现在是中国对游戏机和电话游戏的要求。

The state-run China Internet Network Information Centre reported that more than 30% of children in China were suffering from a gaming disorder, recognised by the World Health Organisation as an emerging condition.2The decision has wiped millions in share prices off one of the most lucrative gaming markets in the world1and has raised many questions - how will this be successfully implemented? Is this an overstep of government into family choices? This article will primarily address the ocular relationship. Will government regulations in gaming lead to a slowing in the rate of myopia seen in Chinese children?

该视频野孩g in children be limited?

对游戏的限制不是一个新概念。弹球机器曾经在1940年代纽约被谴责，被认为是浪费时间和“阴险的镍偷”World Economic Forum邮政。中国过去曾尝试过类似的政策。这是2019年先前规则的升级，在该学期期间，与儿童的游戏访问仅限为每天1.5小时。

美国儿科学会3and the Australian Government Department of Health4在学校时间以外的屏幕上，建议每天不超过2个小时。全球玩视频游戏的平均小时数为每周8.45小时,5and this is not taking in to account social media, movie and video content and social app usage.

中国和游戏

图1，每个国家 /地区的游戏时间，莱茨·J。来自世界经济论坛2021的数据（（link)。6

The negative impacts of online gaming

There are popular suggestions that gaming, due to its graphic imagery, can increase violent tendencies in young children however there is limited evidence that this is true. A study published in Nature looking at the long term impacts of gaming compared violent to non-violent games and assessed children via survey after two months of play. They found no difference in a large battery of tests assessing behavioural measures of aggression and empathy measures between the two groups.7

然而，哈佛大学警告说，根据《美国精神病学杂志》（American of Psychiatry）的说法，肥胖和互联网游戏障碍（IGD）对美国人的美国人有0.3％至1.0％的影响。8Gaming addiction may include issues such as social withdrawal, loss of relationships, poorer educational outcomes or career opportunities or negative mood states.9

It’s not just gaming itself that holds the market share. YouTube last year reported that over 10 billion hours of game play was watched on the channel; children are not just playing games but also spending time watching others play games. Whilst the link between screen time and myopia is not yet clear, likely due to a lack of objective data10we do know the following.

每天使用屏幕超过三个小时的孩子近视的可能性几乎是四倍。11

Younger age groups are at higher risk:6至7岁的儿童在使用大屏幕上近视的可能性是近视的五倍。延长的屏幕时间也与儿童和成人的眼睛疲劳，头痛和干眼综合症有关。12

那学校表现呢？在中国的中学中，对成千上万的儿童进行了调查，研究了媒体与青少年的技术消费与学校表现之间的关系。他们发现，有62％的儿童使用互动技术进行娱乐，例如在线游戏，而40％的儿童在上学期间使用了这些系统。在学校花费的时间和学校表现之间存在不利的，显着的关联。在一个上学之夜使用技术超过一个小时的技术和周末超过四个小时的儿童在几乎所有科目中的学校成绩都明显下降，并且上课的出勤率和专心较差。13

Will gaming restrictions lead to more outdoor time?

China already had childhood gaming restrictions in place, albeit less severe at 1.5 hours on any day and three hours on holidays, which were instituted in 2019.1Despite this, there's been a steady increase in childhood myopia since, although this is complicated by COVID-19 related home confinement in 2020 which seems to have had greatest impact on 6- to 8-year-old rates of myopia.14

的唯一方法就是回答这个问题look at studies which investigate interactions between near work and outdoor time. The Sydney Myopia Study showed a stronger positive impact of outdoor time than negative impact of near work time on development of myopia, when the time spent outdoors was high (more than 3 hours per day).15This would seem to indicate thata high amount of outdoor time is more important than the time spent near work, which is a good news message for parents struggling with their children's screen time.

In another study involving European children, though, when children had low amounts of near work time (less than 1 hour per day), increasing amounts of near work had a larger impact on myopia onset.这是上述消息的另一面：室外时间较低，近工作时间增加的近视风险更大。16后一项研究还发现，近室外暴露的积极作用减少了近工作时间的负面影响。

The sum total? More time spent on reading and screens can be balanced by outdoor time, but only if the outdoor time is high, averaging at least 2-3 hours per day.15,16

在线游戏有积极的方面吗？

The last two years have brought a unique set of challenges with widespread lockdowns, social distancing and online schooling. Online gaming and social media have provided togetherness and communication, even when physically apart. The World Economic Forum reported asurveythat suggested that 64% of parents said their children’s screen media usage lead to stronger friendship and connections with peers. Gaming has also seen recent applications in improving cognition in Attention Deficit Hyperactivity Disorder (ADHD) and decreasing symptoms in both ADHD and Autism Spectrum Disorder.17,18

“青少年是未来，”一位关于中国游戏限制的政府消息人士说，1and they are certainly right. Whilst technology has certainly enriched our lives, especially in the socially distant recent past, with new tech comes new challenges and supporting children's physical and mental health must be a priority. Will video and online gaming restrictions provide a positive framework? Time will tell.

Further reading on visual environment

Cassandra Haines BIO image 2019_white background

About Cassandra

Cassandra Hainesis a clinical optometrist, researcher and writer with a background in policy and advocacy from Adelaide, Australia. She has a keen interest in children's vision and myopia control.

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