Near Work Related Behaviors Associated with Myopic Shifts among Primary School Students in the Jiading District of Shanghai: A School-Based One-Year Cohort Study

Abstract

PurposeTo investigate the characteristics of various near work related behaviors among primary students and their associations with changes in myopia related ocular biometric parameters during one-year of follow up.MethodsA school-based sample of 4,814 primary 1st to 4th grade students aged 6–10 years old were selected by cluster randomization based on probability proportion to size in 2013. At baseline, students together with their parents filled in a self-administered questionnaire on 9 aspects of near work related behaviors and some important covariants of myopia. A comprehensive set of eye examinations including axial length (AL) and cycloplegic refraction was conducted both at baseline and one year later.ResultsWith the grade level increase, students did increasingly better at finding various ways to have an eye break, but they were increasingly likely to continuously do long-time near work without an eye break. Keeping a reasonable eye distance and correct hand posture for reading, writing, or watching TV became worse for the first time before grade 2, but then became better at grade 3. In contrast, selecting appropriate lighting environments or situations and keeping a balanced diet became better for the first time before grade 2, but then became worse at grade 3. At one-year follow up, the mean AL increased by 0.32 ± 0.35 mm, the ratio of AL divided by the mean corneal radius of curvature (AL/CR ratio) increased by 0.032 ± 0.054, the myopic spherical equivalent (SE) increased by -0.51 ± 0.51 diopters and the incidence of myopia was 16.0% (237/1,477). After controlling for the confounding effects of parental myopia, student’s age, gender, height, daily near work time, daily outdoor activity time and all of the other near work related behaviors, keeping a reasonable distance when reading, writing and watching TV was associated with elongation of the AL [standard coefficient beta = -0.062, P = 0.004], a change in SE [beta = -0.072, P = 0.020] and incident myopia [adjusted odds ratio (aOR) = 0.90, 95% confidence interval (CI): 0.84–0.96]. Selecting an environment with adequate light for visual comfort to read and write was related to elongation of the AL [beta = -0.039, P = 0.034] and increase of AL/CR ratio [beta = -0.030, P = 0.048]. Also, not continuing to do near work for more than 30–40 minutes without an eye break was related to increase of the AL/CR ratio [beta = -0.028, P = 0.044] and a change in SE [beta = -0.064, P = 0.023].ConclusionVarious near work related behaviors changed according to grade level in primary school students. Independent of hereditary factors, daily near work load and outdoor activity, near work related behaviors such as keeping an inappropriate eye distance for near work, selecting inadequate lighting environments, and continuing to do near work without an eye break were risk factors for myopic shifts.

Cohort study with 4‐year follow‐up of myopia and refractive parameters in primary schoolchildren in Baoshan District, Shanghai

“…The incidence of myopia was high, and the progression of refraction towards myopia was rapid in the primary school‐aged children in Baoshan District, Shanghai, similar to which was reported in Jiading District, Shanghai (SE of 0.50D towards myopia per year, and AL elongation of 0.32 mm per year) . Progression of SE was 0.13D in British school‐aged children of 6–7 years old, and was 0.16D in Australian primary schoolchildren, which were much slower than in the present population of young Chinese children.…”

“…Near work and outdoor activities were two most commonly recognized risk factors for myopia; however, the present study did not observe significant relationship. One possible explanation is that the variations of time of near work and outdoor activity were too small to impact on incidence of myopia or progression of SE in the present population; therefore, positive associations could not be obtained.…”

“…However, 0.5% tropicamide is one of the most common cycloplegia reagent in clinical practice in Chinese hospitals, and it was proved to be effective in refractive measurement for myopia children with dark pupil . Compared with the study we did in Jiading District, Shanghai, which using cyclopentolate for pupil dilation, the changing rate of SE and AL were similar with those in the present study . Although directive comparisons of the two agents cannot be made in the present study, the difference between the two visits might offset the over‐estimation in the both visits.…”

“…Other studies, such as the Guangzhou Twins Eye Study and the Beijing Myopia Progression Study, measuring cycloplegic refraction, suggested risk factors such as long near work time, parental myopia and short outdoor time were associated with myopia; however, the Beijing Myopia Progression Study did not observe relationship between outdoor and myopia . In another study performed by our study group in Jiading District, Shanghai, the 1‐year cohort results suggested that in addition to time outdoor and near work, near work related behaviours were also associated with incident myopia in schoolchildren . The present study followed primary schoolchildren for 4 years (from 2010 to 2014) in Baoshan District, another suburb area in Shanghai, and measured their cycloplegic refractive parameters aiming to describe incidence of myopia, change of refraction and refractive components, to explore possible risk factors for myopia incidence and to try to building models to predict myopia incidence.…”

Pengaruh Etika, Perilaku, Dan Kepribadian Terhadap Integritas Guru

“…Proses perubahan mampu mengindikasikan perubahan perilaku (Mermer, Daghan, & Bilge, 2016). Kedekatan tempat bekerja berkorelasi dengan perubahan perilaku (You, Wang, & Tan, 2016). Perilaku tidak hanya mencakup perilaku yang dilakukan untuk memenuhi kebutuhan akan peran dan tugas (Mesbahi, 2016).…”