Risk factors for myopia progression in second-grade primary school children in Taipei: a population-based cohort study

Hsu, Chih Chien; Huang, Nicole; Lin, Pei Yu; Fang, Shao You; Tsai, Der‐Chong; Chen, Shing Yi; Tsai, Ching Yao; Woung, Lin‐Chung; Chiou, Shih Hwa; Liu, Catherine Jui Ling

doi:10.1136/bjophthalmol-2016-309299

Cited by 78 publications

(100 citation statements)

References 24 publications

(9 reference statements)

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“…In the analyses for possible risk factors for myopia, only parental myopia was associated with incident myopia and progression of SE, but not near work, outdoor activities or attending tutoring classes. The relationship between parental myopia and school myopia has been proposed in previous literatures . The present study found that as grade level increased, the strong association between parental myopia and progression of refraction (or incident myopia) decreased.…”

Section: Discussioncontrasting

confidence: 99%

“…The average annual change of SE was 0.63D for myopic children and 0.29D for non‐myopic children at baseline in Hong Kong schoolchildren more than 10 years ago . The Myopia Investigation Study in Taipei reported annual progression of SE of 0.12D, 0.98D and 0.42D for children who remained non‐myopia, children who became myopia and children who were already myopia in baseline, respectively . Compared with the RESC study carried out during 1998–2000 in Beijing Shunyi, a suburban area in mainland China, the present population showed higher incidence and larger progress of SE, probably because of the increasing severity of myopia prevalence during the recent decade, and the more urbanized setting of the present population.…”

Section: Discussionsupporting

confidence: 69%

“…The relationship between parental myopia and school myopia has been proposed in previous literatures. [11][12][13]17,27 The present study found that as grade level increased, the strong association between parental myopia and progression of refraction (or incident myopia) decreased. Similar results were also observed in the Sydney Adolescent Vascular and Eye Study (SAVES), in which parental myopia was not associated with incident myopia in the older cohort.…”

Section: Discussionsupporting

confidence: 51%

“…26 The Myopia Investigation Study in Taipei reported annual progression of SE of 0.12D, 0.98D and 0.42D for children who remained nonmyopia, children who became myopia and children who were already myopia in baseline, respectively. 12,27 Compared with the RESC study carried out during 1998-2000 in Beijing Shunyi, 28 a suburban area in mainland China, the present population showed higher incidence and larger progress of SE, probably because of the increasing severity of myopia prevalence during the recent decade, and the more urbanized setting of the present population. A recent study performed in Chong Qing also presented a relatively lower annual incidence (10.6%) of myopia and progress (0.43D), 29 which is in accordance with the regional discrepancy of myopia prevalence in mainland China.…”

Section: Discussionmentioning

confidence: 59%

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

Zou

Lin

et al. 2018

Clinical Exper Ophthalmology

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ImportanceCohort studies could not only reveal associations between change of refractive components and onset/progression of myopia, but also risk factors, which is important for understanding mechanism and providing strategies.BackgroundPrevalence of myopia is high in Shanghai, being reported to be 52.2% in children aged 10 years old.DesignCohort study.ParticipantsA total of 1856 students from six randomly selected primary schools in Baoshan District, Shanghai.MethodsChildren underwent comprehensive ocular measurement, including axial length (AL), corneal curvature radius and cycloplegic auto‐refraction. Questionnaires about eye usage time were collected. Grade 1 students were followed for 4 years, and grade 2 and 3 students for 2 years.Main Outcome Measures(i) Change of spherical equivalent (SE) and AL and (ii) risk factors for progression and incidence of myopia.ResultsThe average 2‐year progress of SE was 0.91D, 0.91D and 1.11D for grade 1, 2 and 3, respectively, and the average elongation of AL was 0.70 mm, 0.64 mm and 0.71 mm, respectively. Only parental myopia, but not near work time, near work diopter time, outdoor activity time or attending tutoring classes, was associated with myopia incidence and progression in the present population. Using baseline SE could be a simple and effective indicator for myopia prediction.Conclusions and RelevanceIncidence and progression of myopia is relatively high in schoolchildren in Shanghai compared with children of Western countries, East Asia and other parts of China. Effective strategies to control myopia prevalence are in urgent need.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 59%

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

Zou

Lin

et al. 2018

Clinical Exper Ophthalmology

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“…Time spent using tablets and time spent watching television were not associated with the prevalence of myopia, SER or AL, consistent with findings in previous studies . In past studies, tablet use was usually included as a component of near work; therefore, few studies have separately analysed the effects of tablet use on myopic refraction.…”

Section: Discussionsupporting

confidence: 87%

Electronic devices and myopic refraction among children aged 6‐14 years in urban areas of Tianjin, China

Liu

Wei

et al. 2019

Ophthalmic Physiologic Optic

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Purpose To assess associations between different types of electronic devices, myopic refraction and ocular biometric parameters in children aged 6–14 years in urban areas of Tianjin, China. Methods A school‐based, cross‐sectional study was performed on 566 children (302 boys and 264 girls). The children underwent a comprehensive eye examination, including cycloplegic autorefraction and ocular biometry. The children's parents completed a detailed questionnaire that included each child's demographics, the use of electronic devices and other related risk factors. Results Myopia was not associated with time spent using various electronic devices. However, the mean spherical equivalent refraction (SER) decreased by 0.28 D (p = 0.042) and 0.33 D (p = 0.018) for each 1‐h increase in the time spent using smart phones and computers, respectively. In the multiple linear regression analyses of factors associated with the SER, the standardised coefficient B for time spent reading and writing was approximately four to five times larger than the standardised coefficient for time spent using smart phones or computers. Time spent using tablets and watching television was not significantly associated with the SER. A longer axial length (AL) was associated with more time spent using smart phones (B = 0.23, p = 0.006) and computers (B = 0.26, p = 0.002) but not using tablets (p = 0.45) and watching television (p = 0.45). No significant association was found between other ocular biometric parameters and time spent using various electronic devices. Conclusions On average, a more myopic SER and longer AL were both associated with more time spent using smart phones and computers, but not with time spent using tablets and watching television. The magnitude of the association between SER and time spent reading and writing was a substantially larger than that for smart phone or computer use. Different types of electronic devices had differing levels of association with myopic refraction.

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Analysis of Secondhand Smoke Exposure and Myopia Among Children Aged 6 to 8 Years in Hong Kong

Zhang

et al. 2023

JAMA Netw Open

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ImportanceSecondhand smoke (SHS) exposure potentially threatens ocular health; however, its association with myopia is unknown.ObjectiveTo examine the association between SHS exposure and childhood myopia.Design, Setting, and ParticipantsCross-sectional data from the population-based Hong Kong Children Eye Study were used. Data were collected from March 5, 2015, to September 12, 2021, at The Chinese University of Hong Kong Eye Center. Participants included children aged 6 to 8 years. Secondhand smoke exposure was evaluated using a validated questionnaire. All participants underwent comprehensive ophthalmic and physical examinations.ExposureSecondhand smoke exposure.Main Outcomes and MeasuresGeneralized estimating equations were constructed to examine the association of SHS exposure with spherical equivalent and axial length; logistic regression models, with myopia rate; and linear regression models, with myopia onset.ResultsA total of 12 630 children (mean [SD] age, 7.37 [0.88] years; 53.2% boys) were included in the analysis. Among the participants, 4092 (32.4%) had SHS exposure. After adjusting for age, sex, parental myopia, body mass index, near-work time, outdoor time, and family income, SHS exposure was associated with greater myopic refraction (β = −0.09 [95% CI, −0.14 to −0.03]) and longer axial length (β = 0.05 [95% CI, 0.02-0.08]). Children with SHS exposure were more likely to develop moderate (odds ratio [OR], 1.30 [95% CI, 1.06-1.59]) and high myopia (OR, 2.64 [95% CI, 1.48-4.69]). The association of SHS exposure with spherical equivalence and axial length was magnified in younger children. For each younger year of a child’s exposure to SHS, SHS exposure was associated with a 0.07-D decrease in spherical equivalence (β = 0.07 [95% CI, 0.01-0.13]) and a 0.05-mm increase in axial length (β = −0.05 [95% CI, −0.08 to −0.01]). Exposure to SHS was associated with an earlier mean (SD) age at onset of myopia (72.8 [0.9] vs 74.6 [0.6] months; P = .01). Every increase in SHS exposure in units of 10 cigarettes per day was associated with greater myopic refraction (β = −0.07 [95% CI, −0.11 to −0.02]), axial length (β = 0.04 [95% CI, 0.01-0.06]), and likelihood of developing moderate (OR, 1.23 [95% CI, 1.05-1.44]) and high myopia (OR, 1.75 [95% CI, 1.20-2.56]), and earlier myopia onset (β = −1.30 [95% CI, −2.32 to −0.27]).Conclusions and RelevanceThe findings of this cross-sectional study suggest that SHS exposure was associated with greater myopic refraction, longer axial length, greater likelihood of developing moderate and high myopia, and earlier myopia onset. The larger the quantity of SHS exposure and the younger the child, the more advanced myopia development and progression with which SHS exposure is associated.

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Risk factors for myopia progression in second-grade primary school children in Taipei: a population-based cohort study

Abstract: Children with fast annual myopia progression were more myopic at baseline and had a shorter reading distance. Our study results highlight the importance of having children keep a proper reading distance.

Cited by 78 publications

References 24 publications

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

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

Electronic devices and myopic refraction among children aged 6‐14 years in urban areas of Tianjin, China

Analysis of Secondhand Smoke Exposure and Myopia Among Children Aged 6 to 8 Years in Hong Kong

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