Effect of Text Messaging Parents of School-Aged Children on Outdoor Time to Control Myopia: A Randomized Clinical Trial

Global prevalence of myopia in children using digital devices: a systematic review and meta-analysis

BACKGROUND

The global prevalence of myopia among children has considerably increased over the past few decades, affecting the children's eye health and quality of life. According to the inconsistent reports of myopia among children, the purpose of this systematic review and meta-analysis study was to determine the global prevalence of myopia in children using digital devices.

METHODS

Various databases (PubMed, ScienceDirect, Embase, Web of Science, Scopus, and Google Scholar) were searched systematically (No time limit until September 2023, last updated in May 2024) using keywords of "Myopia Prevalence", "Children", "TV", "Computer", "Video games", and "Smartphone". PRISMA guideline was also used for paper collection based on the Inclusion/Exclusion criteria. The quality of articles was determined based on the STROBE checklist. Data analysis, heterogeneity assessment, publication bias, and all factors influencing heterogeneity were executed using the CMA software (v.2).

RESULTS

Initially, 828 articles were identified through database assessment. 563 and 133 papers were evaluated using primary and secondary assessments, respectively. Ultimately, 17 eligible articles were selected for meta-analysis following paper exclusion. In this era, the global prevalence of myopia among children using computer and video games was reported 28.8% (95%CI:21.1-38), using TV (TV watching) was 35.4% (95%CI:20.6-53.7), and smartphone usage was 31.4% (95%CI:13.5-57.3).

CONCLUSION

Myopia is now recognized as a critical global issue with a daily increasing rate. Technology, along with various digital devices, causes several issues in this era. It is suggested that the application of all digital screens and smart devices can potentially increase the risk of myopia among children. Thus, the reduction of these smart device applications in children can alleviate the potential risk of myopia. The results of this study can be a guide for health policymakers and a useful advertisement for society and families in paying attention to this problem in children, as well as increasing health interventions such as early screening and timely diagnosis for treatment. In this regard, it can be effective in both prevention and increasing the quality of life of children.

Myopia control efficacy of peripheral defocus modifying spectacle lenses in children and adolescents: a Meta-analysis

AIM

To evaluate the effects of microlens design of peripheral defocus modifying spectacle lenses (PDMSLs) and non-microlens design of PDMSLs on controlling myopia progression in children and adolescents.

METHODS

A systematic search was carried out in the PubMed, Cochrane Library, Embase, CNKI, and Web of Science databases. The search targeted randomized controlled trials (RCTs) and cohort studies (CTs) that explored the effects of PDMSLs on myopia control among children and adolescents. The Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale were employed to evaluate the risk of bias in the included studies. The published biases of the included studies were evaluated using Egger's test.

RESULTS

Nine studies (7 RCTs, 2 CTs) were included, involving 4332 participants in the PDMSLs group and 7317 participants in the single vision lenses (SVLs) group. Meta-analysis showed that PDMSLs with microlens design had lower change in spherical equivalent refraction (SER) than SVLs at 6, 12, 18, and 24mo after wearing glasses, with reductions of 0.19 D (95%CI: 0.14 to 0.24, P<0.00001), 0.36 D (95%CI: 0.25 to 0.46, P<0.00001), 0.43 D (95%CI: 0.32 to 0.55, P<0.00001), and 0.51 D (95%CI: 0.33 to 0.69, P<0.00001), respectively. The changes in axial length (AL) were also lower in PDMSLs compared to SVLs, with reductions of -0.09 mm (95%CI: -0.13 to -0.04, P=0.0002), -0.15 mm (95%CI: -0.21 to -0.08, P<0.00001), -0.27 mm (95%CI: -0.34 to -0.20, P<0.00001), and -0.29 mm (95%CI: -0.38 to -0.20, P<0.00001), respectively. There was no significant difference between the non-microlens group and SVLs in controlling the changes of SER and AL in myopia (both P>0.05).

CONCLUSION

The synthesized evidence indicates superior myopia management outcomes with microlens design of PDMSLs compared to both SVLs and non-microlens design of PDMSLs in children and adolescents.

Four-Year Longitudinal Investigation of the Relationship Between Myopia and Retinal Shape in Chinese Children: The Anyang Childhood Eye Study

PURPOSE

To investigate the longitudinal relationship between myopia and retinal shape in Chinese children.

METHODS

A total of 2471 seven-year-old Chinese children were measured for axial length, anterior corneal radius of curvature, anterior chamber depth, lens thickness, central spherical equivalent, and peripheral refractions along the horizontal meridian (±15°, ±30°) under cycloplegia. Retinal shape was fitted using vertex radius of curvature, asphericity, and an offset. The areas under the horizontal retinal curve, the nasal side of areas under the horizontal retinal curve and the temporal side of areas under the horizontal retinal curve, were calculated. Children were tested annually for 5 years from year 0 to 4, with 1123 newly developed myopes divided into eight subgroups based on relative time to myopia onset.

RESULTS

In follow-up subgroups, vertex radius of curvature showed positive correlations with central spherical equivalent from years 1 to 4. Smaller temporal side of areas under the horizontal retinal curve was associated with negative central spherical equivalent each year. Myopic shift (Δcentral spherical equivalent) was negatively correlated with baseline central spherical equivalent and with greater change in areas under the horizontal retinal curve from year 0 to 4. The absolute change in temporal side of areas under the horizontal retinal curve (0.39 ± 1.15 mm2) was significantly larger than the absolute change in nasal side of areas under the horizontal retinal curve (0.05 ± 1.11 mm2) over the 4 years. In myopia onset subgroups, temporal side of areas under the horizontal retinal curve was significantly smaller than nasal side of areas under the horizontal retinal curve. The ratio of temporal side of areas under the horizontal retinal curve/nasal side of areas under the horizontal retinal curve was closest to 1 in the year before myopia onset and decreased as myopia developed. Vertex radius of curvature, areas under the horizontal retinal curve, and temporal side of areas under the horizontal retinal curve decreased linearly as myopia progressed.

CONCLUSION

A progressive steepening of the horizontal posterior retina was associated with myopia progression. Myopia shift was negatively correlated with baseline central spherical equivalent and with greater change in posterior retinal shape. As myopia progressed, the horizontal retina shape displayed increased asymmetry.

Efficacy of Myopia Prevention in At-Risk Children: A Systematic Review and Network Meta-Analysis

Objectives: To evaluate the efficacy of myopia prevention methods in children without pre-existing myopia. Methods: A network meta-analysis was conducted following the PRISMA-NMA guidelines. Comprehensive searches were performed in PubMed, Embase, and Cochrane CENTRAL databases. The analysis focused on randomized controlled trials evaluating myopia prevention strategies in children without prior myopia. Primary outcomes included annual changes in refraction and axial length, while secondary outcomes encompassed myopia incidence and adverse events. Effect sizes were reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs). Data synthesis utilized a random-effects model under a frequentist framework, with intervention efficacy ranked by P-scores. Study quality was assessed using the Cochrane risk-of-bias tool, and robustness was ensured via sensitivity and consistency analyses. Results: Low-level red light therapy and low-dose atropine were the most effective interventions for reducing refractive progression (MD: 0.48 D, 95% CI: 0.38-0.59 D; MD: 0.33 D, 95% CI: 0.23-0.43 D) and axial elongation (MD: -0.23 mm, 95% CI: -0.27 to -0.19 mm; MD: -0.12 mm, 95% CI: -0.16 to -0.08 mm). In addition, both significantly lowered myopia incidence (RR: 0.59, 95% CI: 0.45-0.79; RR: 0.55, 95% CI: 0.41-0.75). Outdoor activities and myopia awareness programs demonstrated moderate efficacy. Adverse events, including photophobia and dry eyes, were minor and self-limiting, with no serious complications reported. Conclusions: Low-level red light therapy and low-dose atropine are the most effective, generally safe strategies for preventing myopia in at-risk children without myopia, while a non-invasive approach, outdoor activities, provides moderate benefits.

Comparison of myopia-related behaviors among Chinese school-aged children and associations with parental awareness of myopia control: a population-based, cross-sectional study

Background

In China, approximately 30 and 70% of primary and middle school students, respectively, have myopia, making myopia prevention and control necessary. Eye-use behaviors are closely related to myopia, highlighting the importance of determining the behavioral compliance rates of children. Parental awareness also affects children's behaviors. Therefore, we assessed the myopia-related behaviors and parental awareness of school-aged children in different city tiers of China with different refractive statuses.

Methods

A population-based, cross-sectional study was conducted on Chinese children from 110 cities aged 7-15 years. Samples were equally allocated to each subgroup of city tiers, children's age groups, and children's refractive statuses. Questionnaires were designed to investigate children's behaviors, including responses to sitting position, time of eye use (single continuous near work time and breaks in between, total near work time after school each day), eye rest (break time and style during near work and outdoor time per week), light conditions in the learning environment at home, and parents' knowledge about myopia prevention and control. Associations between parental awareness and children's behaviors were analyzed using logistic regression.

Results

In total, 896 questionnaires were collected. The prevalence of children's poor behaviors related to myopia ranged from 23.44 to 84.82%, with the highest and lowest being sitting position and the use of eye-protecting lamps, respectively. Children in third-tier cities were more likely to have poor sitting position (p < 0.01), a non-open view in front of a desk at home (p = 0.02), and more near activities during break times (p = 0.04). After adjustment for parental myopia condition and the child's sex, poor parental awareness was mainly associated with not using an eye-protecting lamp (odds ratio [OR]: 1.95, 95% confidence interval [CI]: 1.40-2.72), poor break styles (OR: 1.60, 95% CI: 1.21-2.12), and excessive total near work time (OR: 1.45, 95% CI: 1.02-2.05).

Conclusion

Myopia-related behaviors were poorly performed in children, particularly among older children and those living in third-tier cities. Eye-protecting lamps, time spent doing near work, and break style were all associated with parental awareness, suggesting that better parental awareness helps children in the long run. More targeted measures could be adopted to help improve children's behaviors.

Investigating the Trajectories of Poor Vision in Children and Adolescents in Wuhan, China From 2016 to 2019: Prospective Cohort Study

Background

Poor vision is a challenging public health problem among children and adolescents globally and in China. It is well-recognized that early onset of poor vision and progressing to moderate and severe poor vision will increase the risk of irreversible blinding complications. To achieve the national goal of poor vision control and prevention, it is essential to investigate and understand the development of poor vision among children and adolescents in China.

Objective

This study aims to investigate the progression of poor vision among children and adolescents in Wuhan, China, based on a prospective cohort and to provide scientific evidence for the development and implementation of effective poor vision prevention and control programs.

Methods

Data were derived from a 4-year prospective cohort (2016-2019) of primary and middle school students (N=108,585) in Wuhan, China. Vision condition was measured using the standard logarithmic visual acuity charts. A group-based trajectory model was used to identify trajectories of poor vision overall and by gender and region.

Results

The mean age of the study subjects was 11.13 (SD 3.33) years, 200,110 (53.91%) were male and the majority (354404, 95.48%) were from urban areas. The prevalence of poor vision was 58.51% in 2016, 58.95% in 2017, 53.83% in 2018, and 54.79% in 2019. Group-based trajectory model identified 3 groups, including normal vision group (NVG) (27.4%), vision decline group (VDG) (17.8%), and moderate poor vision group (MPVG) (54.8%). A higher proportion of girls (57.8%) were in the MPV group compared to boys (50.5%), and the VDG showed greater changes in girls compared to boys. Furthermore, urban students (55.3%) had a higher proportion of MPV compared to rural students (47.5%), while urban students (17.2%) had a smaller proportion in the VDG compared to rural students (24%). Further analyses showed that as age increased, the likelihood of being categorized in the NVG decreased (β=-.417, P<.001), while the likelihood of being in the VDG (β=.058, P<.001) increased. Compared with boys, girls were more likely to be categorized in the VDG (β=.597, P<.001) and MPV group (β=.362, P<.001). Rural students were less likely than urban students to be categorized in the VDG (β=-.311, P<.001).

Conclusions

The prevalence of poor vision among children and adolescents in Wuhan has remained high over the years, with a slight decrease in recent years. The study identified three groups: normal vision, vision decline, and moderate poor vision. Girls and students from urban areas were more likely to have moderate poor vision, while boys and rural students had a higher proportion of vision decline. These findings provide valuable information for implementing poor vision prevention and control policies in the region.

Impact of 'Double Reduction' policy on the trend of myopia in school-aged children in Eastern China

Background

The high prevalence of myopia among school-aged children has become a significant global challenge. Implementing effective measures, including public policies, is essential to reducing its progression. In this study, we aimed to estimate the impact of the 'Double Reduction' policy, introduced in July 2021, on myopia progression among school-aged children in Eastern China.

Methods

We conducted a longitudinal observational study from September 2019 to August 2022 in two cities in Eastern China. The study participants were schoolchildren receiving compulsory education from grades one to nine. We performed a regression discontinuity analysis to calculate the differences in spherical equivalent (SE) and axial length (AL) pre- and post-policy using both community-based and hospital-based cohort data.

Results

Of the included 136 616 participants, 65 903 (48.24%) were girls. The mean age was 10.24 years (standard deviation (SD) = 2.94). Baseline SE averaged -1.47 D (standard error of the mean (SEM) = 0.01), and AL averaged 24.27 mm (SEM = 0.01). After one year of policy implementation, myopic progression was estimated to slow by 0.058 D (95% confidence interval (CI) = 0.043, 0.059) and -0.009 mm (95% CI = -0.05, 0.033) in the right eye within the hospital-based cohort. The community-based cohort showed a similar trend, with a change in SE of 0.115 D (95% CI = 0.017, 0.208) and AL of -0.163mm (95% CI = -0.375, 0.052). The policy had a greater effect on the participants with mild to moderate myopia compared to those with high myopia.

Conclusions

The 'Double Reduction' policy slowed the myopia shift at the population level after one year of implementation. A public policy on education reduction might play a role in controlling myopia among schoolchildren, particularly in countries with high myopia prevalence.

Adherence to the Canadian 24-hour movement guidelines and vision impairment in children and adolescents: a cross-sectional study

Objectives

To investigate the associations between adherence to the Canadian 24-hour movement guidelines-covering physical activity (PA), screen time (ST), and sleep duration (SD)-and vision impairment, specifically myopia and myopic anisometropia, among children and adolescents in Shenzhen, China.

Methods

A cross-sectional study was conducted in 2022 with 4,649 participants. Adherence to the guidelines was assessed using self-reported PA, ST, and SD measures, while vision impairment was clinically evaluated. Logistic regression models were used to analyze the associations, adjusting for sociodemographic factors.

Results

Among the participants, 48.63% were diagnosed with myopia and 11.01% had myopic anisometropia. Meeting the ST guideline was associated with a reduced risk of myopia (aOR = 0.86, 95% CI = 0.76-0.98) and myopic anisometropia (aOR = 0.78, 95% CI = 0.64-0.95). Meeting both PA and ST guidelines further reduced the odds of myopia (aOR = 0.73, 95% CI = 0.56-0.97) and myopic anisometropia (aOR = 0.60, 95% CI = 0.41-0.89). Meeting all three guidelines (PA, ST, and SD) significantly reduced the odds of myopia (aOR = 0.71, 95% CI: 0.53-0.93) and showed a trend toward reduced risk of anisometropia (aOR = 0.69, 95% CI: 0.47-1.02), compared to those who met none. Meeting two guidelines also significantly reduced the risk of myopia (aOR = 0.76, 95% CI: 0.59-0.97) and anisometropia (aOR = 0.71, 95% CI: 0.51-1.00).

Conclusion

Adherence to the 24-hour movement guidelines, particularly meeting the ST and PA recommendations, was associated with a lower risk of myopia and myopic anisometropia. These findings highlight the importance of promoting balanced lifestyle behaviors, such as limiting screen time and encouraging physical activity, to mitigate vision impairment among children and adolescents.

Lower indoor spatial frequency increases the risk of myopia in children

BACKGROUND/AIMS

Animal models have shown that the absence of high-frequency visual information can precipitate the onset of myopia, but this relationship remains unclear in humans. This study aims to explore the association between the spatial frequency content of the visual environment and myopia in children.

METHODS

Images from the rooms of children and their frequently visited outdoor areas were taken by their parents and collected by the researcher through questionnaires. The spatial frequency was quantified using Matlab. Cycloplegic refraction was used to measure the spherical equivalent (SE), and IOL Master was used to measure axial length (AL) and corneal radius (CR). AL/CR ratio was calculated.

RESULTS

The study included 566 children with an average age of (8.04±1.47) years, of which 270 were girls (47.7%), and the average SE was (0.70±1.21) D. Image analysis revealed that indoor spatial frequency slope was lower than that of the outdoor environment (-1.43±0.18 vs -1.11±0.23, p<0.001). There were 79 myopic individuals (14.0%). Images from indoor content of myopic children had a lower spatial frequency slope than non-myopic children (-1.47±0.16 vs 1.43±0.18, p=0.03) while there was no significant difference in outdoor spatial frequency slope. Regression analysis indicated that the indoor spatial frequency slope was positively associated with SE value (β=0.60, p=0.02) and inversely related to myopia (OR=0.24, p<0.05).

CONCLUSION

The spatial frequency of the outdoor environment is significantly higher than that of the indoor environment. Indoor spatial frequency is related to children's refractive status, with lower indoor spatial frequency being associated with a higher degree of myopia.

The whole life cycle myopia management

Myopia stands as a prevalent ocular condition with global implications, impacting individuals at various life stages. In school-age children and adolescents, uncorrected myopia impedes reading and academic performance. Among middle-aged and elderly populations, myopia poses severe risks such as macular degeneration, macular holes and retinal detachment, leading to irreversible visual impairment. The term "myopia management" is widely embraced by ophthalmic practitioners and optometry associations worldwide, encompassing strategies to correct refractive errors and ongoing assessment of disease progression, aiming to reduce the progression of myopia and axial elongation. To date, current management strategies for myopia include public health policies, optical solutions, medical interventions and surgical options, but these interventions are general and lack age specificity. Despite existing interventions, we propose the concept of "Whole Life Cycle Myopia Management" in this review. This approach outlined major risk factors of myopia through the whole life cycle, discussed current interventions for myopia and provided age-specific management strategies for myopia of eight different life stages-infancies, toddlers, preschoolers, school-age children, adolescents, young adults, middle-age and old-age, including the prevention of myopia onset, slowing of myopia progression and monitoring of myopia complications. Achieving the "Whole Life Cycle Myopia Management" requires collaborations efforts from government, schools, hospitals and families, to restore vision and enhance the quality of life for those individuals affected by myopia.

Corrected Myopia and Its Association with Mental Health Problems Among Rural Primary School Students in Northwest China

PURPOSE

The aim of this study was to evaluate the myopia correction and its association with mental health problems among rural primary school students in China.

METHODS

Using survey data from 17,950 students in 251 rural primary schools, this study examines the association between corrected myopia and mental health problems, as well as academic performance among rural students in China. Vision exams were offered to sample students, and student mental health status was measured using the Mental Health Test (MHT).

RESULTS

The results show that 21.98% of sample students failed the vision screening for myopia. Over 65% of sample students showed some form of anxiety, with 56.86% experiencing learning anxiety and 18.71% experiencing body anxiety. The MHT score of myopic students was higher than that of students with normal vision, indicating that myopic students had worse mental health overall. Correcting myopia with eyeglasses was associated with better mental health, indicated by a lower MHT score (by 0.62 points) when controlling for covariates. Myopic students with high baseline academic performance who wore eyeglasses benefited especially from myopia correction, as they had a lower total MHT score (by 1.77 points) and lower body anxiety score (by 0.49 points, p < 0.05) than their high-performing peers with uncorrected myopia.

CONCLUSIONS

These findings suggest that future mental health prevention programs in rural China should focus on reducing the prevalence of myopia and providing eyeglasses to myopic students as potential interventions.

Measuring the visual environment of children and young people at risk of myopia: a scoping review

PURPOSE

Myopia (short-sightedness) is an emerging WHO priority eye disease. Rise in prevalence and severity are driven by changes in lifestyle and environment of children and young people (CYP), including less time spent in bright daylight and more time spent on near-vision activities. We aimed to systematically map the literature describing direct, objective measurements of the visual environment of CYP.

METHODS

We conducted searches in Ovid Medline 1946, Ovid Embase and The Cochrane Central Register of Controlled Trials in November 2024. We included primary research written in English on environmental/behavioural factors and myopia onset/progression in CYP 3-18 years. Two reviewers independently screened titles/abstracts/full texts.

RESULTS

We included 34 articles: 21 explored the association of indoor and/or outdoor light exposure and myopia and included light measurements, two near-vision activities, four both light and near-work, four time outdoors without illuminance measurements, and three light exposure based on meteorological data. Most measurements were carried out at the level of individual children, rather than the surrounding environment alone.

CONCLUSION

Despite limitations in measurement techniques, there is evidence that reduced illuminance, less time spent in bright light and increased daily duration/sustained episodes of near-vision activities and reduced working distance are associated with increased myopia prevalence/progression.

Behavioral Intervention with Eye-Use Monitoring to Delay Myopia Onset and Progression in Children: A Cluster Randomized Trial

PURPOSE

To assess the efficacy of a behavioral intervention using Eye-Use Monitoring technology to delay the onset and progression of myopia in children.

DESIGN

A prospective, cluster-randomized, parallel-groups, examiner-masked, clinical trial (Chinese Clinical Trial Registry, ChiCTR2100052101).

PARTICIPANTS

A total of 413 children from grades 2 to 4 in Shandong, China, from October 2021 to December 2023 were randomized by class into 3 groups: reminder and feedback (6 classes, 156 children), reminder-only (5 classes, 147 children), and control (3 classes, 110 children). Children with prior myopia control interventions, significant eye conditions, or a history of eye diseases were excluded.

METHODS

The reminder-only group received simultaneous vibration alerts for prolonged near work, close proximity, head tilt, or inadequate lighting. The reminder and feedback group received these alerts plus behavioral feedback, including praise, rewards, and weekly reports. The control group received no intervention. The intervention lasted 49 weeks, followed by a 49-week observation period without intervention.

MAIN OUTCOME MEASURES

The primary outcome was the mean change in cycloplegic spherical equivalent (SE) at 49 weeks. Secondary outcomes included changes in axial length (AL), myopia incidence, rates of rapid myopic shift, participant compliance, and eye-use behaviors.

RESULTS

At 49 weeks, changes in SE and AL were least in the reminder and feedback group (SE: 0.52 ± 0.35 diopters [D] vs. 0.59 ± 0.43 D vs. 0.73 ± 0.48 D, AL: 0.30 ± 0.14 mm vs. 0.33 ± 0.16 mm vs. 0.40 ± 0.20 mm, in reminder and feedback group, reminder only group, and control group, respectively, both P < 0.001). Myopia incidence was lowest in the reminder and feedback group (13.3% vs. 21.6% vs. 27.8%, in reminder and feedback group, reminder only group, and control group, respectively, P < 0.05). However, differences diminished by the 98-week follow-up.

CONCLUSIONS

This study demonstrated that the combination of Eye-Use Monitoring reminders and feedback on eye-use behaviors can effectively delay the onset and progression of myopia in children. However, sustained intervention may be necessary to maintain long-term benefits.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Evaluation of Auricular Acupressure on Myopia Prevention among Children Aged 6-12 Years with Pre-Myopia in China: Study Protocol of a Prospective Multi-Center Randomized Controlled Trial

BACKGROUND

The increasing prevalence of myopia among Chinese children and adolescents, especially at younger ages, has emerged as a significant concern in recent years. Pre-myopia is a key period for myopia prevention and control in children and adolescents. Previous studies suggested auricular acupressure (AA) therapy might offer a viable approach to prevent and slow down myopia progression. Nonetheless, these studies lack robust, high-quality, large-scale, multi-center evidence to conclusively support such assertions. The purpose of this research is to evaluate the efficacy, safety, and economic benefits of AA therapy in preventing myopia in Chinese children aged 6-12 years with pre-myopia.

METHODS

The single-blind, multi-center, parallel-group, randomized controlled trial will involve 318 pre-myopic children from 20 different centers across China. After recruitment, these participants will be randomly assigned to two groups (the AA group and the control group) at a 1:1 ratio. The AA group will receive auricular point sticking therapy along with health education for a period of 24 weeks, while the control group will be provided the sham AA treatment and routine health education. The assessments of outcomes will be conducted at the start of this study, and then after 4, 8, 12, and 24 weeks. The primary outcome is the change in spherical equivalent refraction at various follow-up times. The secondary outcomes include the number of myopia cases, uncorrected visual acuity, axial length, corneal curvature radius, accommodation amplitude, retinal and choroidal thickness, and eye behavior management. In addition, the cost-effectiveness analysis will be used as the evaluation index for economic assessment.

DISCUSSION

The results of this research will provide evidence on the efficacy, safety, and economic benefits of AA therapy in preventing myopia among children aged 6-12 years with pre-myopia in China.

Parental awareness on myopia prevention and control among 350 children

AIM

To understand the current situation of parental perspectives, knowledge, and practices concerning myopia prevention and control for both pre- and school-aged children.

METHODS

This study was a cross-sectional survey that involved children aged 0 to 15y and their parents. Participants were required to respond to an online questionnaire by scanning a quick response (QR) code. The questionnaire consisted of 25 tick-box questions and was open to response from December 22, 2022, to January 5, 2023. The dioptric traits of the children, the visual status and educational background of the parents, the parental perspectives towards myopia and its risks, and the parents' knowledge and practices related to myopia prevention and control were recorded and measured. The Chi-square test and binomial logistic regression were used for statistics.

RESULTS

Totally 350 parents responded to the questionnaire. The prevalence and severity of myopia among the surveyed children exhibited a positive correlation with advancing age (P<0.001 and P=0.004, respectively). Nearly half of parents with myopic children considered myopia did not pose any health threat and could be effectively corrected (P<0.001). Parents who held master's or doctoral degree demonstrated a better understanding of children's vision standards for each age group (P=0.001), and 31.63% of them could undergo initial vision screening for their children during the age of 0 to 3y while parents with bachelor's degree (34.04%) and below (32.43%) mainly initiated the vision examination for their children at the age of 4 to 6y (P=0.05). Parents with master's or doctoral degree also exhibited more rational practices concerning outdoor time (P=0.048) and sleep time (P=0.044). No other significant discrepancy among the different educational groups in additional conceptions of myopia, such as hyperopia reserve, axis length, and corneal curvature alterations. Most parents preferred to employ conventional interventions, such as enhancing indoor lighting condition (80.00%) and ensuring appropriate reading posture and distance (71.71%).

CONCLUSION

The current status of parental knowledge and practices about myopia prevention and control remains outdated and deficient. The administrative department should implement efficacious and adaptable measures to enhance parental awareness and foster their commitment towards myopia prevention and control.

Efficacy of outdoor interventions for myopia in children and adolescents: a systematic review and meta-analysis of randomized controlled trials

Objectives

The objective of this systematic review and meta-analysis was to evaluate the overall efficacy of outdoor interventions for myopia in children and adolescents, and to provide evidence for the prevention and control of myopia.

Methods

Randomized controlled trials of outdoor interventions for myopia in children and adolescents were identified using electronic databases and manual searches. The Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias in randomized controlled trials. A mean difference (MD) and a risk ratio (RR) with a 95% confidence interval (CI) were used to combine effect sizes. A sensitivity analysis was performed for each outcome using a stepwise elimination method to assess whether the pooled results were significantly affected by individual studies.

Results

The analysis included seven randomized controlled trials involving a total of 9,437 subjects. The meta-analysis showed marked and statistically significant improvements in spherical equivalent refraction (MD = 0.19; 95% CI 0.14 to 0.25; p < 0.01), axial length (MD = -0.09; 95% CI -0.13 to -0.05; p < 0.01), and myopia incidence (RR = 0.84; 95% CI 0.78 to 0.91; p < 0.01) following outdoor interventions.

Conclusion

Outdoor interventions effectively contributed to the prevention and control of myopia in children and adolescents, positively impacting spherical equivalent refraction, axial length, and myopia incidence. Outdoor interventions were characterized by low risk and high therapeutic benefits and could serve as alternative or adjuvant approaches to medication for the treatment of myopia. Considering the advantages in terms of safety and efficacy, outdoor interventions may be considered as a preferred intervention for the treatment of myopia in children and adolescents, while susceptibility to diseases associated with sunlight, particularly UV exposure, must be taken into account.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, Identifier CRD42024538695.

Establishing and Validating Refractive Error Reference Values for Myopia Prediction Among Children Aged 6-12 Years - Jiangsu Province, China, 2018-2023

What is already known about this topic?

Previously, it has been proved that a simplified model that uses refraction error value provides a robust and efficient means of predicting myopia for non-myopic students. Intervention targeting non-myopic children with alert refraction errors (or insufficient hyperopia reserve) holds significant importance in reducing the incidence rate of myopia.

What is added by this report?

This study, comprising two phases (surveillance and cohort studies), was aiming to pinpoint the precise refractive error value for the onset of myopia prediction among non-myopic children in Jiangsu Province.

What are the implications for public health practice?

First, when conducting myopia screenings using pupil dilation for non-myopic populations: the cycloplegic 50th percentile refractive error emerges as a more precise predictive indicator. Second, when conducting myopia screenings without pupil dilation: this study advocates for the incorporation of axial length (AL) and corneal curvature (CC) values as supplementary indicators in screenings.

Temporal effects of an original myopia song on school children's myopia and awareness: a 3-year prospective study

CLINICAL RELEVANCE

Raising children's myopia prevention awareness and behaviour tends to exhibits a protective effect against myopia among schoolchildren.

BACKGROUND

To investigate the effect of an original myopia song in raising school children's awareness of healthier eye use behaviour and on myopia prevention.

METHODS

In this prospective randomised control study, two groups of students from one primary schools in Jiangxi, China, were enrolled and monitored from grade 3 to grade 6 (2016-2019). The primary outcome was the change in axial length (AL) after the intervention. Secondary outcomes included changes in spherical equivalent refraction (SER), near work and outdoor time, corrected near and distant visual acuity, visual discomfort score (VDS) and accommodative lag.

RESULTS

Four hundred students (193 females, 48.25%) aged 9.3 (range 8-10) years with emmetropia to moderate myopia were enrolled. Children in the myopia song group had a significantly shorter AL and less myopic refractive change than those in the control group (p = 0.04 and 0.02, respectively). Compared with the control group, children in the myopia song group spent less time on near work and more time outdoors (p = 0.04 and 0.04, respectively). At the final follow-up, the proportion of children with myopia was significantly lower in the myopia song group (30.5%) than in the control group (41%) (p = 0.03). No significant differences were found for the secondary outcomes, including corrected near and distant visual acuity, VDS and accommodative lag.

CONCLUSIONS

An original myopia song performed twice daily in primary schools appeared to have a modest effect on myopia control among school-aged children by changing their lifestyles in the long term.

PAX6 gene promoter methylation is correlated with myopia in Chinese adolescents: a pilot sutdy

PURPOSE

A large number of epidemiological studies have shown that myopia is a complex disease involving genetic, environmental, and behavioral factors. The purpose of this study was to explore the role of PAX6 gene methylation in myopia in Chinese adolescents.

METHODS

Eighty junior high school students were divided into four groups based on their vision test results: mild myopia, moderate myopia, severe myopia, and non-myopia control. The methylation level of PAX6 gene promoter was detected by bisulfate pyrosequencing.

RESULTS

The methylation level of PAX6 gene in myopia group (8.06% ± 1.43%) was slightly but significantly higher than that in non-myopia controls (7.26% ± 1.17%). In addition, PAX6 gene methylation levels presented a decreasing pattern along with the aggravation of myopia. Post-hoc analysis indicated significant inter-group differences for the mild myopia group and other groups (All p < .05). In the subgroup analysis by gender, the methylation level of PAX6 gene promoter in girls was higher than that in boys (p = .023). The ROC curves showed a high accuracy of PAX6 gene methylation to predict mild myopia (AUC (95% CI) = 0.828 (0.709-0.947), p < .001).

CONCLUSIONS

The methylation of PAX6 gene might play a role in the onset and progression of myopia in Chinese adolescents. And this could potentially explore the potential molecular mechanisms of juvenile myopia in the future.

Is Spending More Time Outdoors Able to Prevent and Control Myopia in Children and Adolescents? A Meta-Analysis

INTRODUCTION

Spending more time outdoors was treated as a safe and cost-effective method to prevent and control myopia. While prior research has established an inverse association between outdoor time and the risk of myopia onset, the effect of increasing outdoor time in delaying the progression of myopia remains a subject of debate. The present meta-analysis aimed to assess the relationship between outdoor time and the myopia onset, and further examine whether there is a dose-response relationship between outdoor time and the risk of myopia onset. Meanwhile, perform whether the outdoor time is related to delaying the progression of myopia.

METHODS

Studies were retrieved from PubMed, Web of Science, Embase, Medline, and the Cochrane Database, spanning from their inception to February 2023. Three cohort studies and 5 prospective intervention studies were included, with a total of 12,922 participants aged 6-16 years.

RESULTS

Comparing the highest with the lowest exposure levels of time spent outdoors, the highest outdoor time was strongly associated with a reduced risk of myopia onset (odds ratio [OR]: 0.53; 95% confidence interval [CI]: 0.34, 0.82). A nonlinear dose-response relationship was found between outdoor time and myopia onset risk. Compared to 3.5 h of outdoor time per week, an increase to 7, 16.3, and 27 h per week corresponded with a respective reduction in the risk of myopia onset by 20%, 53%, and 69%. Among children and adolescents who were not myopic, spending more time outdoors significantly slowed down the speed of change in spherical equivalent refractive (weighted mean difference [WMD] = 0.10D, 95% CI: 0.07, 0.14) and axial length (WMD = -0.05 mm, 95% CI: -0.06, -0.03). Among children and adolescents who were already myopic, spending more time outdoors did not slow myopia progression.

CONCLUSIONS

Overall, spending more time outdoors can prevent the onset of myopia, but it does not seem to slow its progression. Further studies are needed to better understand these trends.

The impact of light properties on ocular growth and myopia development

The objective of this article is to comprehensively review the effect of environmental lighting on ocular growth and refractive status in both animal and clinical studies, with an emphasis on the underlying mechanisms. This review was performed by searching research articles and reviews utilizing the terms "myopia," "light therapy," "axial length," "refractive error," and "emmetropization" in PubMed datasets. The review was finalized in December 2023. In the animal studies, high lighting brightness, illumination periods aligning with circadian rhythm, and color contrast signals including multiple wavelengths all help regulate ocular growth against myopia. Long wavelengths have been found to induce myopia in chicks, mice, fish, and guinea pigs, whereas shorter wavelengths lead to hyperopia. In contrast, red light has been observed to have a protective effect against myopia in tree shrews and rhesus monkeys. Apart from wavelength, flicker status also showed inconsistent effects on ocular growth, which could be attributed to differences in ocular refractive status, evolutionary disparities in retinal cone cells across species, and the selection of myopia induction models in experiments. In the clinical studies, current evidence suggests a control effect with red light therapy. Although the lighting conditions diverge from those in animal experiments, further reports are needed to assess the long-term effects. In conclusion, this review encompasses research related to the impact of light exposure on myopia and further explores the retinoscleral signaling pathway in refractive development. The aim is to establish a theoretical foundation for optimizing environmental factors in lighting design to address the epidemic of childhood myopia.

Effects of online family health education on myopia prevention in children by parental myopia: a randomized clinical trial

CLINICAL RELEVANCE

Online family health education may be effective for myopia prevention in children, and the effects may be different between children with myopic and non-myopic parents.

BACKGROUND

Myopia is a common cause of vision loss. The aims of this study were to evaluate the effects of online family health education on preventing the development of myopia in children, and to estimate whether the effects vary according to parental myopia.

METHODS

A cluster randomised trial including grade 1 and grade 2 children from 12 primary schools was conducted in Guangzhou, China. Weekly online family health education messages were sent to parents in the intervention group. Data collection included eye examinations of children and questionnaires completed by parents.

RESULTS

Among the 3123 children included at baseline (1703 boys [54.5%]; mean [SD] age, 6.83 [0.73] years), 2376 completed the follow-up after 3 years. The differences in the incidence of myopia and myopic shift between the study groups were not significant in total. However, the 3-year cumulative incidence rate of myopia in the intervention group (125 of 445 [28.1%]) was significantly lower than that in the control group (225 of 603 [37.3%]; difference, 9.2% [95% CI, -14.9% to -3.5%]; P = 0.001) among children with non-myopic parents. In parallel, among children with non-myopic parents, the mean myopic change in SER was less for the intervention group than for the control group (-1.10 D vs. -1.24 D; difference, 0.13 D [95% CI, 0.03 to 0.23 D]; P = 0.01).

CONCLUSIONS

Compared with children with myopic parents, online family health education was more effective in children with non-myopic parents. The incidence of myopia and myopic shift in refraction have been reduced in children with non-myopic parents. Further studies are needed to assess these differences by parental myopia.

Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis

Background: Early-onset myopia increases the risk of irreversible high myopia. Methods: This study systematically evaluated the efficacy and safety of low-dose atropine for myopia control in children with premyopia through meta-analysis using random-effects models. Effect sizes were calculated using risk ratios (RRs) with 95% confidence intervals (CIs). Comprehensive searches of PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov were conducted until 20 December 2023, without language restrictions. Results: Four studies involving 644 children with premyopia aged 4-12 years were identified, with atropine concentrations ranging from 0.01% to 0.05%. The analysis focused on myopia incidence and atropine-related adverse events. Lower myopia incidence (RR, 0.62; 95% CI, 0.40-0.97 D/y; p = 0.03) and reduction in rapid myopia shift (≥0.5 D/1y) (RR, 0.50; 95% CI, 0.26-0.96 D/y; p < 0.01) were observed in the 12-24-month period. Spherical equivalent and axial length exhibited attenuated progression in the atropine group. No major adverse events were detected in either group, whereas the incidence of photophobia and allergic conjunctivitis did not vary in the 12-24-month period. Conclusions: Our meta-analysis supports atropine's efficacy and safety for delaying myopia incidence and controlling progression in children with premyopia. However, further investigation is warranted due to limited studies.

Eye exercises for myopia prevention and control: a comprehensive systematic review and meta-analysis of controlled trials

OBJECTIVES

To evaluate the efficacy of eye exercises in preventing and controlling myopia.

METHODS

We searched studies on eye exercises from nine Chinese and English databases from their inception to December 15, 2022. Using random-effect models and sensitivity/subgroup analyses, we estimated the effects of eye exercises compared to control on changes in three measures: visual acuity, refractive error (both quantified using standardized mean differences, SMDs), and protective/mitigating effects (assessed through risk ratios, RRs).

RESULTS

Eleven studies were included in the meta-analysis, with 921 participants. Nine studies had some concerns of bias in at least two domains, and two studies had a high risk of bias in two domains. Seven studies used visual acuity to measure myopia; visual acuity declined after eye-exercise interventions (SMD = -0.67, 95% CI -1.28 to -0.07, Z = 2.17, P = 0.03) and the effect was not better than control (SMD = -0.50, 95% CI -1.16 to 0.16, Z = 1.49, P = 0.14). Two studies used refractive error to measure myopia; the effect of eye-exercise interventions did not differ from control (SMD = -1.74, 95% CI -6.27 to 2.79, Z = 0.75, P = 0.45). Seven studies reported on protective/mitigating effects; eye exercises exhibited a greater protective/mitigating effect than control (RR = 0.40, 95% CI 0.23-0.71, Z = 3.13, P < 0.01).

CONCLUSIONS

Overall, the results suggest that eye exercises have limited to no efficacy in preventing or controlling myopia progression. Until robust evidence supports their efficacy, available evidence suggests retiring the eye-exercise policy.

The association between iris color and refractive errors in children

This study aimed to evaluate the association between iris color and refractive errors in children aged 6-12 years. This cross-sectional study was based on data obtained from the first phase of the Shahroud Schoolchildren Eye Cohort Study. The target population was 6 to12 year-old students living in urban and rural areas. Iris colors were classified by comparing eye colors with close-up images of iris colors. Myopia was defined as a spherical equivalent (SE) ≤ - 0.5 diopter and hyperopia was defined as SE ≥ 2 diopter in cycloplegic refraction. The association of iris color with hyperopia and myopia was investigated by fitting two separate multiple logistic regression models adjusted for place of residence, age, sex, and times for outdoor activity and near work. Among the 5394 participates with the mean age of 9.7 year, the prevalence of myopia and hyperopia was 4.8% and 4.7% respectively. The number and proportion (in parentheses) of amber, light blue, light brown, dark brown, gray, green and hazel iris colors were 19(0.4%), 26(0.5%), 645(12.0%), 4517(83.7%), 4(0.1%), 59(1.1%), and 124(2.3%) respectively. Compared to dark brown, the odds ratios and 95% confidence intervals (in parentheses) of myopia were 4.8(1.2-18.7), 0.8(0.1-5.8), 1.0(0.7-1.5), 0.4(0.1-2.7) and 0.6(0.2-1.8) for amber, light blue, light brown, green and hazel iris colors in multiple logistic regression model. No significant association was observed between iris colors and hyperopia. This study shows that amber iris is significantly associated with higher odds of myopia. These children should be further monitored and examined. More studies with higher sample size in all iris colors are recommended.

Treatment of Rapid Progression of Myopia: Topical Atropine 0.05% and MF60 Contact Lenses

This retrospective study evaluates the effectiveness of combining 0.05% atropine with MF60 contact lenses in managing rapid myopia progression in children over one year. The study involved three groups: the treatment group (TG) with 15 children (53% male, average age 12.9 ± 1.04), the MF group (MF) with 12 children (50% male, average age 12.8 ± 0.8) using only MF60 lenses, and the control group (CG) with 14 children (43% male, average age 12.1 ± 0.76). Baseline myopia and axial length (AL) were similar across groups, with the TG, MF, and CG showing -4.02 ± 0.70 D, -4.18 ± 0.89 D, -3.86 ± 0.99 D, and 24.72 ± 0.73 mm, 24.98 ± 0.70 mm, 24.59 ± 1.02 mm, respectively. Prior to the study, all groups exhibited significant myopia and AL progression, with no previous myopia control management. The treatment involved daily 0.05% atropine instillation, the use of MF60 lenses and increased outdoor activity. Biannual cycloplegic refraction and slit lamp evaluations confirmed no adverse reactions. After one year, the TG showed a significant reduction in myopia and AL progression (-0.43 ± 0.46 D, p < 0.01; 0.22 ± 0.23 mm, p < 0.01), whereas the CG showed minimal change (-1.30 ± 0.43 D, p = 0.36; 0.65 ± 0.35 mm, p = 0.533). The MF group also exhibited a notable decrease (-0.74 ± 0.45 D, p < 0.01; 0.36 ± 0.23 mm). Increased outdoor activity during the treatment year did not significantly impact myopia control, suggesting its limited additional effect in this cohort. The study concludes that the combination of 0.05% atropine and peripheral defocus soft contact lenses effectively controls myopia progression in children.

Outdoor time influences VIPR2 polymorphism rs2071623 to regulate axial length in Han Chinese children

Clinical relevance

Identification of individuals with a higher risk of developing refractive error under specific gene and environmental backgrounds, especially myopia, could enable more personalized myopic control advice for patients.

Background

Refractive error is a common disease that affects visual quality and ocular health worldwide. Its mechanisms have not been elaborated, although both genes and the environment are known to contribute to the process. Interactions between genes and the environment have been shown to exert effects on the onset of refractive error, especially myopia. Axial length elongation is the main characteristic of myopia development and could indicate the severity of myopia. Thus, the purpose of the study was to investigate the interaction between environmental factors and genetic markers of VIPR2 and their impact on spherical equivalence and axial length in a population of Han Chinese children.

Methods

A total of 1825 children aged 13~15 years in the Anyang Childhood Eye Study (ACES) were measured for cycloplegic autorefraction, axial length, and height. Saliva DNA was extracted for genotyping three single-nucleotide polymorphisms (SNPs) in the candidate gene (VIPR2). The median outdoor time (2 h/day) was used to categorize children into high and low exposure groups, respectively. Genetic quality control and linear and logistic regressions were performed. Generalized multifactor dimensional reduction (GMDR) was used to investigate gene-environment interactions.

Results

There were 1391 children who passed genetic quality control. Rs2071623 of VIPR2 was associated with axial length (T allele, β=-0.11 se=0.04 p=0.006), while SNP nominally interacted with outdoor time (T allele, β=-0.17 se=0.08 p=0.029). Rs2071623 in children with high outdoor exposure had a significant interaction effect on axial length (p=0.0007, β=-0.19 se=0.056) compared to children with low outdoor exposure. GMDR further suggested the existence of an interaction effect between outdoor time and rs2071623.

Conclusions

Rs2071623 within VIPR2 could interact with outdoor time in Han Chinese children. More outdoor exposure could enhance the protective effect of the T allele on axial elongation.

Gene-environment interaction in myopia

Myopia is a health issue that has attracted global attention due to its high prevalence and vision-threatening complications. It is well known that the onset and progression of myopia are related to both genetic and environmental factors: more than 450 common genetic loci have been found to be associated with myopia, while near work and outdoor time are the main environmental risk factors. As for many complex traits, gene-environment interactions are implicated in myopia development. To date, several genetic loci have been found to interact with near work or educational level. Gene-environment interaction research on myopia could yield models that provide more accurate risk predictions, thus improving targeted treatments and preventive strategies. Additionally, such investigations might have the potential to reveal novel genetic information. In this review, we summarised the findings in this field and proposed some topics for future investigations.

The association between sleep duration and risk of myopia in Chinese school-aged children: a cross-sectional study

BACKGROUND

Myopia is one of the most commonly diagnosed refractive disorders worldwide. Identifying risk factors for myopia at an early age may help to characterize children who would benefit most from individualized lifestyle advice and early interventions. The influence of sleep duration on myopia risk remains controversial and thus needs to be evaluated.

METHODS

A population-based cross-sectional study of Chinese school-aged children was conducted. Information on sleep duration was derived. The association between sleep duration and myopia risk was investigated by logistic regression analysis.

RESULTS

Myopia prevalence among 9530 Chinese school-aged children was 75.4% and decreased from 84.9%, 76.5%, 65.8%, to 61.3% along with the extension of sleep duration. Univariate logistic regression found longer sleep duration of 8-9 h (OR = 0.58, 95% CI: 0.51-0.66), 9-10 h (OR = 0.34, 95% CI: 0.30-0.39), and ≥ 10 h (OR = 0.28, 95% CI: 0.24-0.33) were protective factors for myopia in all participants (P for trend < 0.001). In the multivariate analyses, sleep duration was inversely associated with the risk of myopia, and a dose-effect relationship was observed when the analysis was split by age category.

CONCLUSIONS

Long sleep duration was associated with decreased risk of myopia in Chinese school-aged children.

Chinese Parents' Perspective on Myopia: A Cross-Sectional Survey Study

INTRODUCTION

The prevalence of myopia in young generations has dramatically increased over the years, especially in China. This study aims to understand Chinese parents' perspectives on myopia for further improvement of treatment compliance and informing future health planning and policy.

METHODS

This was a prospective cross-sectional survey study. A self-administrated, internet-based questionnaire was distributed to 2545 parents in China. Detailed information about the demographics, the awareness of myopia, related complications, and practices of myopia prevention and control of the respondents were collected. The distribution of answers was compared among different groups of children's age, children's refractions, and parents' residential locations. Relationships between parental cognition and behavior were also analyzed.

RESULTS

Eligible responses were returned by 2500 parents. A total of 55.1% of the respondents considered myopia as a disease and more than 70% of respondents did not realize pathological changes related to myopia. Most parents thought myopia could be prevented (82.0%) and controlled (75.2%), and these parents were more likely to take measures than the parents who did not think so (P < 0.001). The most common myopia control modality was spectacles (87.0%), among which single-vision spectacles are the most used (63.7%).

CONCLUSIONS

Knowledge about health risks related to myopia was lacking in Chinese parents and their practices of myopia control mainly involved single-vision glasses. Nationwide education for parents about myopia is needed to further advance outcomes of myopia prevention and control.

Using Light Meters to Investigate the Light-Myopia Association - A Literature Review of Devices and Research Methods

With the increasing prevalence of myopia, evaluating its relationship with objective light exposure as a potential adjustable environmental factor in myopia development has been an emerging research field in recent years. From a thorough literature search, we identify ten wearable light meters from human studies on light exposure and myopia and present an overview of their parameters, thereby demonstrating the wide between-device variability and discussing its implications. We further identify 20 publications, including two reanalyses, reporting investigations of light-myopia associations with data from human subjects wearing light meters. We thoroughly review the publications with respect to general characteristics, aspects of data collection, participant population, as well as data analysis and interpretation, and also assess potential patterns regarding the absence or presence of light-myopia associations in their results. In doing so, we highlight areas in which more research is needed as well as several aspects that warrant consideration in the study of light exposure and myopia.

Implementing a digital comprehensive myopia prevention and control strategy for children and adolescents in China: a cost-effectiveness analysis

Background

Children and adolescents' myopia is a major public problem. Although the clinical effect of various interventions has been extensively studied, there is a lack of national-level and integral assessments to simultaneously quantify the economics and effectiveness of comprehensive myopia prevention and control programs. We aimed to compare the cost-effectiveness between traditional myopia prevention and control strategy, digital comprehensive myopia prevention and control strategy and school-based myopia screening program in China.

Methods

A Markov model was used to compare the cost-utility and cost-effectiveness among school-based myopia screening, traditional myopia prevention and control strategy, and digital comprehensive myopia prevention and control strategy among 6 to 18-year-old rural and urban schoolchildren. Parameters were collected from published sources. The primary outcomes were quality-adjusted life-year, disability-adjusted life-year, incremental cost-utility ratio, and incremental cost-effectiveness ratio. Extensive sensitivity analyses were performed to test the robustness and sensitivity of base-case analysis.

Findings

Compared with school-based myopia screening strategy, after implementing digital comprehensive myopia prevention and control strategy, the prevalence of myopia among 18-year-old students in rural and urban areas was reduced by 3.79% and 3.48%, respectively. The incremental cost-utility ratio per quality-adjusted life-year gained with the digital myopia management plan ($11,301 for rural setting, and $10,707 for urban setting) was less than 3 times the per capita gross domestic product in rural settings ($30,501) and less than 1 time the per capita gross domestic product in urban settings ($13,856). In cost-effectiveness analysis, the incremental cost-effectiveness ratio produced by digital comprehensive myopia management strategy ($37,446 and $41,814 per disability-adjusted life-year averted in rural and urban settings) slightly exceeded the cost-effectiveness threshold. When assuming perfect compliance, full coverage of outdoor activities and spectacles satisfied the cost-effectiveness threshold, and full coverage of outdoor activities produced the lowest cost ($321 for rural settings and $808 for urban settings).

Interpretations

Health economic evidence confirmed the cost-effectiveness of promoting digital comprehensive myopia prevention and control strategies for schoolchildren at the national level. Sufficient evidence provides an economic and public health reference for further action by governments, policy-makers and other myopia-endemic countries.

Funding

National Natural Science Foundation of China, NSFC (82171051), Beijing Natural Science Foundation (JQ20029), Capital Health Research and Development of Special (2020-2-1081), National Natural Science Foundation of China, NSFC (82071000), National Natural Science Foundation of China, NSFC (8197030562).

Advances in myopia prevention strategies for school-aged children: a comprehensive review

Myopia has significantly risen in East and Southeast Asia, and the pathological outcomes of this condition, such as myopic maculopathy and optic neuropathy linked to high myopia, have emerged as leading causes of irreversible vision loss. Addressing this issue requires strategies to reduce myopia prevalence and prevent progression to high myopia. Encouraging outdoor activities for schoolchildren and reducing near-work and screen time can effectively prevent myopia development, offering a safe intervention that promotes healthier habits. Several clinical approaches can be employed to decelerate myopia progression, such as administering low-dose atropine eye drops (0.05%), utilizing orthokeratology lenses, implementing soft contact lenses equipped with myopia control features, and incorporating spectacle lenses with aspherical lenslets. When choosing an appropriate strategy, factors such as age, ethnicity, and the rate of myopia progression should be considered. However, some treatments may encounter obstacles such as adverse side effects, high costs, complex procedures, or limited effectiveness. Presently, low-dose atropine (0.05%), soft contact lenses with myopia control features, and orthokeratology lenses appear as promising options for managing myopia. The measures mentioned above are not necessarily mutually exclusive, and researchers are increasingly exploring their combined effects. By advocating for a personalized approach based on individual risk factors and the unique needs of each child, this review aims to contribute to the development of targeted and effective myopia prevention strategies, thereby minimizing the impact of myopia and its related complications among school-aged children in affected regions.

Biomechanical homeostasis in ocular diseases: A mini-review

Diabetes mellitus-induced hyperglycemia is responsible for multiple pathological ocular alternations from vasculopathy to biomechanical dyshomeostasis. Biomechanical homeostasis is crucial to maintain the normal physiological condition of the eyes. Biomechanical features vary in eye tissues regarding different anatomical positions, tissue components, and cellular functions. The disturbance in biomechanical homeostasis may result in different ocular diseases. In this review, we provide a preliminary sketch of the latest evidence on the mechano-environment of the eyeball and its possible influencing factors, thereby underscoring the relationship between the dyshomeostasis of ocular biomechanics and common eye diseases (e.g., diabetic retinopathy, keratoconus, glaucoma, spaceflight-associated neuro-ocular syndrome, retinal vein occlusion and myopia, etc.). Together with the reported evidence, we further discuss and postulate the potential role of biomechanical homeostasis in ophthalmic pathology. Some latest strategies to investigate the biomechanical properties in ocular diseases help unveil the pathological changes at multiple scales, offering references for making new diagnostic and treatment strategies targeting mechanobiology.

The Efficacy of Defocus Incorporated Multiple Segments Lenses in Slowing Myopia Progression: Results from Diverse Clinical Circumstances

PURPOSE

Defocus incorporated multiple segments (DIMS) spectacle lenses were reported to slow myopia progression significantly in a randomized controlled trial (RCT). The study evaluated their effectiveness in clinical settings.

DESIGN

Retrospective study.

PARTICIPANTS

Patient records involving use of DIMS and single-vision (SV) spectacle lenses were collected from subsidiary hospitals of Aier Eye Hospital Group.

METHODS

The spherical equivalent (SE), determined by subjective refraction, was adopted to assess the myopia progression. The strategy of propensity score matching (PSM) was applied to match the confounding baseline characteristics between the 2 groups. The effectiveness was calculated based on the difference of myopia progression of these 2 approaches.

MAIN OUTCOME MEASURES

Change in SE.

RESULTS

Three thousand six hundred thirty-nine patients with DIMS and 6838 patients with SV spectacles were included. The age of the patients was 6 to 16 years (mean ± standard deviation: 11.02 ± 2.53 years). The baseline SE was between 0.00 and -10.00 diopters (D) (mean ± standard deviation: -2.78 ± 1.74 D). After the PSM, data on 2240 pairs with 1-year follow-up and on 735 pairs with 2-year follow-up were obtained. Significantly slower progression was seen in the DIMS group at both the 1-year (DIMS, -0.50 ± 0.43 D; SV, -0.77 ± 0.58 D; P < 0.001) and 2-year (DIMS, -0.88 ± 0.62 D; SV, -1.23 ± 0.76 D; P < 0.001) subdataset. In the 1-year subdataset, 40% and 19% showed myopia progression of no more than 0.25 D for the DIMS and SV groups, respectively (chi-square, 223.43; P < 0.001), whereas 9% and 22% showed myopia progression of more than 1.00 D for the DIMS and SV groups, respectively (chi-square, 163.38; P < 0.001). In the 2-year subdataset, 33% and 20% showed myopia progression of no more than 0.50 D for the DIMS and SV groups, respectively (chi-square, 31.15; P < 0.001), whereas 12% and 29% showed myopia progression of more than 1.50 D for the DIMS and SV groups (chi-square, 65.60; P < 0.001).

CONCLUSIONS

Although the magnitude was lower than that reported in the previous RCT, this large-scale study with diversity of the data sources confirmed the effectiveness of DIMS spectacles to slow myopia progression in clinical practice.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.