Protective behaviours of near work and time outdoors in myopia prevalence and progression in myopic children: a 2-year prospective population study

Huang, Pin Chen; Hsiao, Ya Chuan; Tsai, Ching Yao; Tsai, Der‐Chong; Chen, Chi-Wen; Hsu, Chih Chien; Huang, Su‐Cheng; Lin, Meng; Liou, Yiing Mei

doi:10.1136/bjophthalmol-2019-314101

Cited by 63 publications

(58 citation statements)

References 24 publications

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“…The present observational study suggested that AL was not associated with bad eyesight habits. Previous studies have shown that computer/Internet use was not related to incident myopia [34], and time and distance of near-work activity were not related to myopia progression [35], while protective behaviors related to close work (e.g., discontinuing close work every 30 min, longer distance in close work) could decrease myopia prevalence and reduce its progression [30]. But these studies did not measure AL.…”

Section: Discussionmentioning

confidence: 94%

“…Interestingly, our study found that AL was positively associated with time outdoors. Numerous studies have shown a protective effect of outdoor activities on myopia onset [27][28][29][30][31]. Addition of 40 min [27] or 80 min [31] of outdoor activity each day could reduce the incidence rate of myopia among primary-schoolage children in China.…”

Section: Discussionmentioning

confidence: 99%

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Time trend of axial length and associated factors in 4- and 5-year-old children in Shanghai from 2013 to 2019

Wan

Yao

et al. 2020

Int Ophthalmol

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Purpose To evaluate the time trend of axial length (AL) and associated factors in 4- and 5-year-old children in Shanghai from 2013 to 2019. Methods This was a 7-year observational study of 985 four-year-old and 1059 five-year-old children in Shanghai. AL, horizontal and vertical corneal curvature, spherical equivalent (SE), and body height and weight were measured. Furthermore, a questionnaire was collected, including time outdoors and bad eyesight habits. Results In 4-year-old children, no significant difference was found in AL (P = 0.526), but significant differences were observed in SE (P = 0.001), horizontal corneal curvature (P = 0.006), vertical corneal curvature (P = 0.004), height (P < 0.001), and weight (P = 0.022) from 2013 to 2019. In 5-year-old children, no significant differences were found in AL (P = 0.304), SE (P = 0.200), or weight (P = 0.292), but significant differences were observed in horizontal corneal curvature (P = 0.040), vertical corneal curvature (P = 0.015), and height (P < 0.001) from 2013 to 2019. Multivariate analyses revealed that AL was mainly significantly associated with boys and time outdoors in the 4- and 5-year-old children. Conclusions The AL of 4- and 5-year-old children remained relatively stable in Shanghai from 2013 to 2019. Longitudinal studies are needed to confirm the relationship between AL elongation and environmental risk factors.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Time trend of axial length and associated factors in 4- and 5-year-old children in Shanghai from 2013 to 2019

Wan

Yao

et al. 2020

Int Ophthalmol

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“…Studies both in Finland (Pärssinen 1986) and Singapore (Dirani et al 2009) along with several other studies (Rose et al 2008; He et al 2015; Guo et al 2017; Huang et al 2019; Wu et al 2020) have found that individuals who spent more time outdoors were less likely to be myopic. In the present study, the considerable differences between the Singaporean and Finnish children in time spent outdoors did not explain the differences between the two populations in myopic progression.…”

Section: Discussionmentioning

confidence: 95%

Comparison of myopic progression in Finnish and Singaporean children

Pärssinen

Soh

Tan

et al. 2020

Acta Ophthalmologica

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Purpose To compare 3‐year myopic progression between Finnish and Singaporean children. Methods Myopic progression was compared between 9‐year‐old (mean age 9.7 ± 0.4 years, n = 92) and 11‐year‐old (mean age 11.7 ± 0.4 years, n = 144) Finnish (Finnish RCT) children and Singaporean children matched by age and refraction (SCORMMatched, n = 403) and 7‐ to 8‐year‐old Singaporean children matched only by refraction (SCORM Young, n = 186). Spherical equivalent (SE) was between −0.50 and −3.00 D. Refraction with cycloplegia was controlled annually for 3 years. Information on parental myopia, mother’s education, time spent on near‐work and outdoor time was gathered by parental questionnaire. Results Three‐year myopic progression was −2.08 ± 0.96 D and −1.30 ± 0.69 D in the Finnish RCT and Singaporean SCORM Matched 9‐year‐olds, respectively, and −1.34 ± 0.78 D, and −0.52 ± 0.44 D in the 11‐year‐olds, respectively (p < 0.001 between all groups). Myopic progression was fastest (−2.69 ± 0.89 D) in the SCORM 7‐year‐olds and similar between the SCORM Matched 9‐year‐olds and Finnish RCT 11‐year‐olds (p = 0.55). The Finnish RCT and SCORM Matched children showed significant differences in both daily near‐work time (1.8 ± 1.0 versus 3.4 ± 1.9 hours per day, p < 0.001) and outdoor time (2.6 ± 0.9 versus 0.5 ± 0.4 hours per day, p < 0.001). These differences did not, however, explain the differences in myopic progression between the groups. More time spent outdoors was associated with less myopic progression in the Finnish RCT (r = 0.17, p = 0.009) group only. In the whole materials, greater myopic progression was associated with younger age at baseline (p < 0.001), younger age was associated with mother’s higher education (p < 0.001), and mothers higher education was associated with myopia in both parents (p < 0.001). Conclusion Age at baseline was the most significant factor associated with myopic progression. However, at the same age and with the same initial refraction, the Finnish and Singaporean children showed different myopic progression. This result remains unexplained. Thus, age of myopia onset should be considered when comparing myopic progression between different samples and conducting treatment trials. Parental myopia may be a weak indicator of heredity of myopia.

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“…First, some early studies 37,38 may show that behavioral modifications for six months can influence myopia development. However, these studies are limited by sample size and by the is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint…”

Section: Discussionmentioning

confidence: 99%

“…Since COVID-19 quarantine had a great influence on alterations of schoolchildren lifestyle and study behaviors, it provided a practical intervention model for comparing the differences of risk factors related to myopia between normal period and COVID-19 period. Earlier studies [37][38][39] have used the 6-month interval to measure myopia progression for exploring the intervention strategies. In addition, during August 2020, we further used a new-designed questionnaire to survey 12,013 students, which were randomly selected from all grades.…”

Section: Measurements and Outcomesmentioning

confidence: 99%

COVID-19 Quarantine Reveals Grade-specific Behavioral Modification of Myopia: One-Million Chinese Schoolchildren Study

Yuan

et al. 2020

Preprint

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SummaryBackgroundHigh prevalence of myopia of adolescent has been a global public health concern. Their risk factors and effective prevention methods for myopia across schoolchildren developmental stages are critically needed but remain uncertain due to the difficulty in implementing intervention measurements under normal life situation. We aimed to study the impact of the COVID-19 quarantine on myopia development among over one-million schoolchildren.MethodsWe designed the ongoing longitudinal project of Myopic Epidemiology and Intervention Study (MEIS) to biannually examine myopia among millions of schoolchildren for ten years in Wenzhou City, Zhejiang Province, China. In the present study, we performed three examinations of myopia in 1,305 elementary and high schools for schoolchildren in June 2019, December 2019 and June 2020. We used the normal period (June-December 2019) and COVID-19 quarantine period (January-June 2020) for comparisons. Myopia was defined as an uncorrected visual acuity of 20/25 or less and a spherical equivalent refraction (SER) of -0.5 diopters (D) or less. High myopia was defined as an SER of -6.0 D or less.FindingsIn June 2019, 1,001,749 students aged 7-18 were eligible for examinations. In the 6-month and 12-month follow-up studies, there were 813,755 eligible students (81.2%) and 768,492 eligible students (76.7%), respectively. Among all students, we found that half-year myopia progression increased approximate 1.5 times from -0.263 D (95% CI, -0.262 to -0.264) during normal period to -0.39 D (95% CI, -0.389 to -0.391) during COVID-19 quarantine (P < 0.001). Multivariate Cox regression analysis identified grade rather than age was significantly associated with myopia (Hazard ratio [HR]: 1.10, 95% CI, 1.08 to 1.13; P < 0.001) and high myopia (HR: 1.40, 95% CI, 1.35 to 1.46; P < 0.001) after adjustment for other factors. The prevalence, progression, and incidence of myopia and high myopia could be categorized into two grade groups: I (grades 1-6) and II (grades 7-12). Specifically, COVID-19 quarantine for 6 months sufficiently increased risk of developing myopia (OR: 1.36, 95% CI, 1.33 to 1.40) or high myopia (OR: 1.30, 95% CI, 1.22 to 1.39) in Grade Group I, but decreased risk of developing myopia (OR: 0.45, 95% CI, 0.43 to 0.48) or high myopia (OR: 0.57, 95% CI, 0.54 to 0.59) in Grade Group II.InterpretationThe finding that behavioral modifications for six months during COVID-19 quarantine sufficiently and grade-specifically modify myopia development offers the largest human behavioral intervention data at the one million scale to identify the grade-specific causal factors and effective prevention methods for guiding the formulation of myopia prevention and control policies.FundingKey Program of National Natural Science Foundation of China; the National Natural Science Foundation of China; Scientific Research Foundation for Talents of Wenzhou Medical University; Key Research and Development Program of Zhejiang Province.Research in contextEvidence before this studyMyopia is the most-common refractive error worldwide. Myopia with younger onset may result in developing high myopia, which is associated with sight-threatening ocular diseases such as maculopathy, retinal detachment, opticneuropathy, glaucoma, retinal atrophy, choroidal neovascularization. In light of the increasing prevalence of myopia and high myopia has been a global public health concern, the impact of COVID-19 lockdown on myopia development has gained substantial attention. We searched PubMed, Google Scholar, and MEDLINE databases for original articles reported between database inception and November 10, 2020, using the following search terms: (coronavirus OR COVID* OR SARS-COV-2 OR lockdown OR quarantine) AND (myopia OR short-sightedness OR refractive error). To date, there was no original study reported to uncover the influence of COVID-19 quarantine on myopia progression.Added value of this studyThis study provides the largest longitudinal intervention data on myopia progression in Chinese schoolchildren covering all grades of schoolchildren at one-million scale. COVID-19 quarantine model uncovers that behavioral modifications for six months may lead to significant increase of overall prevalence of myopia associated with their increased screen times and decreased outdoor activity times. Importantly, their effects on developing myopia or high myopia of students are grade-dependent, which were risk factors for elementary schools period but protective factors for high schools period partly due to reduced school education burden.Implications of all the available evidenceThis one-million schoolchildren myopia survey offers evidence that six months behavioral modifications sufficiently and grade-specifically change the progression of myopia and high myopia. In view of the increased use of electronic devices is an unavoidable trend, effective myopia prevention strategy according to grade among students is urgently needed. Since COVID-19 outbreak is still ongoing and spreading, international collaborate efforts are warranted to uncover the influence of COVID-19 on myopia progression to further substantiate these findings.

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Protective behaviours of near work and time outdoors in myopia prevalence and progression in myopic children: a 2-year prospective population study

Cited by 63 publications

References 24 publications

Time trend of axial length and associated factors in 4- and 5-year-old children in Shanghai from 2013 to 2019

Time trend of axial length and associated factors in 4- and 5-year-old children in Shanghai from 2013 to 2019

Comparison of myopic progression in Finnish and Singaporean children

COVID-19 Quarantine Reveals Grade-specific Behavioral Modification of Myopia: One-Million Chinese Schoolchildren Study

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