What Other Countries Do To Protect Kids Eyes
18 Things Other Countries Do to Protect Kids' Eyes That the U.S. Doesn't
Every year, more children around the world are becoming nearsighted — and it's happening faster than ever. Some countries have responded with bold, national-level action. The United States, for the most part, has not. Here are 18 things other countries are doing right now to protect children's vision and screen health that we should be paying attention to.
🇹🇼 TAIWAN
1. They send kids outside for two hours a day — by law.
In 2010, Taiwan launched the "Tian-Tian 120" national policy, requiring schools to send children outdoors for 120 minutes every day specifically to prevent myopia. This wasn't a suggestion from a medical society or a recommendation buried in a pamphlet — it was a government mandate applied to every school in the country. And it worked. The prevalence of reduced visual acuity in primary schoolchildren dropped from 50% in 2011 to 46% by 2015, reversing a decade-long trend that had been climbing steadily. Taiwan treated myopia like the epidemic it is and responded with a public health intervention at scale. In the U.S., recess is optional, averages 27 minutes, and is being cut in favor of more instructional time.
> Source: Wu PC, et al. "Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial." Ophthalmology, 2018.
🇨🇳 CHINA
2. They built a 30/10 rule into the school day.
China's 2018 Comprehensive Plan to Prevent Nearsightedness — issued jointly by eight government ministries — requires that children take a 10-minute vision break for every 30 minutes of near work during the school day. This isn't a classroom teacher's discretion. It's national policy, backed by a randomized trial from Guangzhou showing that just 40 minutes of added daily outdoor time reduced new myopia onset by 23%. China looked at the data, saw that sustained near work was driving an epidemic, and built mandatory breaks into the structure of the school day. In the U.S., we give kids six hours of screens and call it learning.
> Source: He X, et al. "Time Outdoors in Reducing Myopia: A School-Based Cluster Randomized Trial with Objective Monitoring of Outdoor Time and Light Intensity." Ophthalmology, 2022.
3. They limit children's video gaming to 3 hours per week.
In 2021, China's National Press and Publication Administration restricted all minors under 18 to exactly three hours of online video gaming per week — one hour on Friday, Saturday, and Sunday only. Gaming platforms are required to enforce the rule using real-name registration and facial recognition. Minors are completely blocked from gaming between 10 PM and 8 AM. The regulation was a direct response to rising rates of myopia, sleep disruption, and internet addiction among Chinese youth. The U.S. has no comparable regulation at any level of government.
> Source: Király O, et al. "Policy Responses to Problematic Video Game Use: A Systematic Review of Current Measures and Future Possibilities." Journal of Behavioral Addictions, 2018.
4. They redesigned classroom lighting to prevent myopia.
Chinese researchers discovered that the amount of light hitting a child's desk matters enormously for eye health — and then they did something about it. A study of over 3,000 students found that upgrading classroom lighting to ≥500 lux at desk level reduced new myopia onset by 60% (4% vs. 10%) and significantly slowed axial elongation. A separate Shanghai cluster-randomized trial confirmed that cumulative light exposure — measured as lux-minutes — is a key variable, with ≥5,000 lux-minutes per day providing a 15–24% reduction in myopia incidence. Chinese provinces are now redesigning school lighting as a public health intervention, treating illumination the way we treat water fluoridation — a population-level preventive measure. U.S. classroom lighting standards focus on task visibility, not eye health.
> Sources: Hua WJ, et al. "Elevated Light Levels in Schools Have a Protective Effect on Myopia." Ophthalmic and Physiological Optics, 2015. He X, et al. "Time Outdoors in Reducing Myopia." Ophthalmology, 2022.
5. They built full-spectrum indoor lighting to mimic sunlight.
If kids can't get enough outdoor time, why not bring sunlight indoors? That's exactly what Chinese schools are piloting. Full-spectrum indoor lighting systems (430–780 nm) are designed to replicate the visible light spectrum of natural sunlight. A 2026 prospective study showed that replacing standard fluorescent classroom lighting with full-spectrum LED lights significantly slowed axial elongation and myopic shift over 12 months. These children also showed increased choroidal thickness — a biomarker that indicates the eye is receiving a protective signal against myopia. The concept is elegant: outdoor light protects eyes, so engineer indoor light to behave like outdoor light. No comparable school lighting initiative exists anywhere in the U.S.
> Source: Jiang X, et al. "Violet Light Suppresses Lens-Induced Myopia via Neuropsin (OPN5) in Mice." PNAS, 2021. Full-spectrum classroom lighting studies from Chinese school-based trials, 2024–2026.
6. They track every child's eye growth on a chart — like height and weight.
Chinese researchers have developed age- and sex-specific axial length percentile charts — essentially growth curves for the eyeball — validated in over 14,000 children. The concept is simple and powerful: just as pediatricians plot height and weight at every well-child visit, clinicians in China and across East Asia now plot a child's axial length on a percentile curve. A child tracking at the 75th percentile for axial length at age 6 can be flagged for early intervention years before they develop high myopia. This shifts the entire paradigm from reactive treatment to proactive prevention. In the U.S., most children never have their axial length measured, most pediatricians have never seen an axial length growth chart, and the concept is virtually unknown outside subspecialty myopia clinics.
> Source: Tao Z, et al. "Tracking Myopia Development Through Axial Length Progression: A Retrospective Longitudinal Study." Annals of Medicine, 2025.
🇨🇳🇯🇵 CHINA & JAPAN
7. They combine myopia treatments when one isn't enough.
When a single myopia treatment isn't slowing eye growth fast enough, clinicians in China and Japan don't just accept the result — they escalate. The standard approach is to combine orthokeratology (special rigid contact lenses worn overnight to reshape the cornea) with low-dose atropine eye drops. A network meta-analysis found that this combination achieved efficacy comparable to high-dose atropine for slowing axial elongation, but with far fewer side effects like light sensitivity and near blur. A sequential escalation protocol — starting with ortho-K alone and adding increasing concentrations of atropine (0.01% → 0.025% → 0.05%) for fast progressors — reduced annual axial elongation by 28–39% beyond ortho-K alone. In the U.S., combination myopia therapy is rarely discussed, most optometrists and ophthalmologists don't offer it, and the majority of children with progressing myopia receive no myopia control treatment at all.
> Source: Network meta-analyses of combination myopia therapy, including orthokeratology plus atropine trials from East Asian centers, 2020–2025.
🇭🇰 HONG KONG
8. They invented glasses that actually slow myopia down.
Researchers at Hong Kong Polytechnic University developed the Defocus Incorporated Multiple Segments (DIMS) spectacle lens, marketed as MiYOSMART. It looks like a normal pair of glasses, but the lens surface is embedded with hundreds of tiny lenslets that create simultaneous myopic defocus — a signal that tells the eye to slow its growth. A landmark 6-year follow-up study showed sustained myopia control with no rebound effect after discontinuation, answering one of the biggest concerns in the field. A meta-analysis of 6 studies involving 1,224 children confirmed these lenses reduce axial elongation by 0.16 mm and slow prescription progression by 0.37 diopters over 12 months compared to standard single-vision lenses. These glasses are available across Asia, Europe, Canada, and Australia. They remain largely inaccessible in the U.S., where most parents don't know that glasses capable of slowing myopia even exist.
> Source: Lam CSY, et al. DIMS lens 6-year follow-up, Hong Kong Polytechnic University. Meta-analysis of myopia-control spectacle lenses, 2023–2025.
🇫🇷 FRANCE
9. They banned phones from school grounds entirely.
In 2018, France passed a national law banning mobile phones from school grounds for all students under 15. Not from classrooms — from the entire building and schoolyard. Phones must be turned off or stored from the moment a student arrives until dismissal. This wasn't a school board decision or a pilot program — it was an act of the French parliament. The law was driven by concerns about distraction, cyberbullying, and the impact of screen time on children's development and health. The U.S. has phone policies in some individual schools and districts, but no state or federal law. France decided this was too important to leave to individual teachers.
> Source: French Law No. 2018-698 (Loi relative à l'encadrement de l'utilisation du téléphone portable dans les établissements d'enseignement scolaire), enacted August 3, 2018.
10. They developed glasses that actively fight myopia.
French optics giant Essilor developed the Stellest lens using Highly Aspherical Lenslet Technology (HALT), which arranges concentric rings of aspherical lenslets across the lens surface to create a volume of myopic defocus in front of the peripheral retina. A meta-analysis comparing all available myopia-control spectacle lens designs found that HALT lenses achieved the largest reduction in both axial elongation (-0.28 mm) and prescription progression (-0.52 diopters) over 12 months. Like the Hong Kong DIMS lenses, Stellest lenses are commercially available across Europe and Asia as a first-line, non-invasive myopia control option — essentially prescription glasses that actively slow myopia progression while correcting vision normally. They are not widely marketed, prescribed, or covered by insurance in the U.S.
> Source: Meta-analysis of myopia-control spectacle lenses including HALT technology, 2023–2025.
🇫🇮 FINLAND
11. They give kids a 15-minute outdoor break every 45 minutes of class.
Finland's Basic Education Act structures the school day so that children receive a 15-minute outdoor recess break after every 45 minutes of instruction. This isn't a guideline — it's built into the legal framework of Finnish education. The result: Finnish children average well over an hour of outdoor time during school hours alone, spread across multiple breaks throughout the day. The philosophy is that children learn better when they move, play, and rest their eyes regularly. American children average 27 minutes of total recess per day — often a single break — and many schools have reduced or eliminated recess entirely to make room for standardized test preparation.
> Source: Finnish Basic Education Act (Perusopetuslaki 628/1998); Finnish National Agency for Education curriculum guidelines.
🇯🇵 JAPAN
12. They screen every child's vision — by law — and have since 1958.
Japan's School Health and Safety Act has required annual vision screening for every school-age child in the country since 1958 — making it one of the oldest and most comprehensive school-based vision programs in the world. Every child is tested every year. Results are sent home to parents with specific recommendations, including referral for further evaluation when needed. The system ensures that no child's vision problem goes undetected simply because their family didn't happen to schedule an eye exam. The U.S. has no national equivalent. Vision screening requirements vary by state, are inconsistently enforced, and millions of American children go years without any formal vision assessment.
> Source: Japan School Health and Safety Act (学校保健安全法), originally enacted 1958, revised 2008.
🇸🇬 SINGAPORE
13. They run a government-funded myopia program in every school.
Singapore's National Myopia Programme, run by the Health Promotion Board, places vision screening and myopia management infrastructure in every primary school in the country. Children are screened, their refraction is tracked over time, and those with progressing myopia are referred directly for treatment — including low-dose atropine eye drops, which are standard of care across Singapore and much of East Asia. The program finds the child; families don't have to know to ask. In the U.S., most children with progressing myopia are never told that treatments to slow it exist. Low-dose atropine requires a compounding pharmacy, is not FDA-approved for myopia, and most families have never heard of it.
> Source: Singapore Health Promotion Board, National Myopia Prevention Programme. Chia A, et al. "Atropine for the Treatment of Childhood Myopia (ATOM2)." Ophthalmology, 2012.
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🇬🇧 UNITED KINGDOM
14. They screen every child's eyes before school starts.
The United Kingdom's NHS Screening Programme checks the vision of every child between ages 4 and 5, delivered by trained orthoptists in schools and community settings. The program achieves a 96% uptake rate — meaning nearly every child in the country has their eyes examined before they start formal schooling. The primary target is amblyopia (lazy eye), which is treatable if caught early but can cause permanent vision loss if missed. The U.S. has no national vision screening program. The USPSTF recommends screening between ages 3 and 5, but there is no infrastructure, no funding, and no mandate to deliver it. If a child has amblyopia and no one catches it before age 7, the treatment window may already be closing.
> Source: Solebo AL, et al. "Whole-Population Vision Screening in Children Aged 4-5 Years to Detect Amblyopia." The Lancet, 2015.
🇳🇱 NETHERLANDS
15. They screen children's vision three times before age 6.
The Netherlands doesn't screen children's vision once — it screens them three times, at ages 3, 3¾, and 5–6, through a whole-population orthoptist-led program embedded in the national preventive child health care system. A 7-year prospective cohort study in Rotterdam showed that this serial screening approach cut the rate of persistent amblyopia by more than half compared to populations without organized screening. Children who attended fewer screening rounds had significantly worse visual acuity at age 7. The repeated testing catches problems that a single screen might miss — intermittent strabismus, slowly developing refractive errors, and amblyopia that hasn't yet declared itself. The U.S. has no national screening program, and the USPSTF recommendation for a single screen at ages 3–5 has no delivery infrastructure behind it.
> Sources: de Koning HJ, et al. "Effectiveness of Screening for Amblyopia and Other Eye Disorders in a Prospective Birth Cohort Study." Journal of Medical Screening, 2013. Van der Ploeg CPB, et al. "Costs and Effects of Conventional Vision Screening and Photoscreening in the Dutch Preventive Child Health Care System." European Journal of Public Health, 2021.
🇩🇰 DENMARK
16. They built outdoor school into the national curriculum.
Denmark has formalized outdoor education — known as "udeskole" — into its national school curriculum. One in five Danish schools now dedicates at least one full day per week entirely to outdoor learning, where children study math, science, language, and art outside the classroom in forests, parks, and schoolyards. Research from Aarhus University has shown that udeskole increases physical activity, improves social well-being, and provides sustained exposure to natural light — all factors associated with reduced myopia risk. The concept treats the outdoors not as recess but as a legitimate learning environment. There is no American equivalent at any scale.
> Source: Danish Ministry of Education; Bentsen P, et al. "The Effect of Danish 'Udeskole' on Physical Activity and Health." Danish School of Education, Aarhus University.
🇩🇪 GERMANY
17. They made screen limits a medical guideline, not a suggestion.
In 2023, Germany published a formal national clinical guideline — an AWMF S2k guideline — on the "Prevention of Dysregulated Screen Media Use in Children and Adolescents." It sets strict, age-specific limits: no screens at all before age 3, no more than 30 minutes per day for ages 3–6, and 45–60 minutes per day for ages 9–12. It explicitly recommends against personal gaming devices for young children. The American Academy of Pediatrics offers broadly similar advice, but the difference is in how each country treats it. Germany codified these limits as a formal medical standard — the same level of authority as a guideline for managing diabetes or hypertension. In the U.S., we treat screen time limits like a parenting opinion.
> Source: AWMF S2k Guideline: "Prevention of Dysregulated Screen Media Use in Children and Adolescents," German Federal Ministry of Health, 2023.
🇦🇺 AUSTRALIA
18. They banned social media for kids under 16.
In 2024, Australia became the first country in the world to pass a law banning children under 16 from social media. The Online Safety Amendment (Social Media Minimum Age) Act covers TikTok, Instagram, YouTube, Snapchat, Facebook, and other major platforms. The burden of enforcement falls on the platforms, not on parents or children. The law was driven by mounting evidence linking social media use to anxiety, depression, sleep disruption, and excessive screen time in young people. A JAMA Network Open dose-response meta-analysis of 45 studies found that each additional hour of daily screen time increases a child's odds of developing myopia by 21%. Early follow-up data at 3 months showed that behavioral change has been slow — over 85% of under-16s were still accessing social media — but the policy signal is unmistakable: Australia decided that protecting children from social media is a government responsibility, not a parenting challenge.
> Sources: Australia Online Safety Amendment (Social Media Minimum Age) Act, 2024. Ha A, et al. "Digital Screen Time and Myopia: A Systematic Review and Dose-Response Meta-Analysis." JAMA Network Open, 2025. Barnes C, et al. "Assessing Early Effects of Australia's Social Media Minimum Age Act on Adolescents' Social Media Use." BMJ, 2026.
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🇰🇷 SOUTH KOREA
20. They built a national infrastructure to fight screen addiction.
South Korea didn't just pass a law — it built an entire system. In 2011, the government implemented the "Cinderella Law," a mandatory midnight-to-6 AM online gaming shutdown for all children aged 15 and under. But that was just the beginning. South Korea went on to establish government-funded Internet addiction prevention centers, school-based screening programs that identify at-risk youth, and residential treatment boot camps for children with severe internet and gaming addiction. The country also created a national index to measure problematic internet use across the population. It is the most coordinated, most resourced national response to digital overuse anywhere in the world. The U.S. has no equivalent infrastructure at any level — federal, state, or local.
> Sources: Choi J, et al. "Effect of the Online Game Shutdown Policy on Internet Use, Internet Addiction, and Sleeping Hours in Korean Adolescents." Journal of Adolescent Health, 2018. King DL, et al. "Policy and Prevention Approaches for Disordered and Hazardous Gaming and Internet Use: An International Perspective." Prevention Science, 2018.
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🇮🇹 ITALY
21. They built a national consensus on how to manage childhood myopia.
In 2025, Italy completed a formal three-round modified Delphi process — bringing together ophthalmologists, optometrists, and public health experts — to establish 53 evidence-based consensus statements for the management of childhood myopia. The recommendations include universal vision screening starting at age 3, the creation of dedicated pediatric myopia clinics, national public awareness campaigns to educate families, financial support programs to make myopia treatments accessible, and standardized monitoring protocols using cycloplegic refraction and axial length measurement every 6 months. Italy treated myopia management as a question important enough to deserve a formal national answer. The U.S. has no equivalent consensus document, no national myopia strategy, and no coordinated approach to a condition that now affects nearly half of young adults.
> Source: Schiavetti I, et al. "Italian Consensus on Pediatric Myopia: Findings From a Three-Round Modified Delphi Study." Graefe's Archive for Clinical and Experimental Ophthalmology, 2026.
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🌍 114 COUNTRIES
22. Over half the world bans phones in school — bell to bell.
Over half of countries worldwide — 114 education systems — now enforce "bell-to-bell" phone bans during school hours, meaning phones are confiscated or locked away from the moment students arrive until dismissal. These aren't classroom-level policies left to individual teachers. They are system-wide mandates. A Dutch study found that approximately 40% of countries have implemented formal smartphone ban policies, and the number is growing rapidly. The U.S. has phone policies in some individual schools and districts, but no state-level mandate and no federal policy. More than half the world decided this was too important to leave to chance. We're still debating it.
> Sources: Schweitzer K. "Major Meta-Analysis
