Epidemiological Characteristics and Influencing Factors of Myopia Among Primary School Students in Southern China: A Longitudinal Study

Development of a nomogram for predicting myopia risk among school-age children: a case-control study

OBJECTIVES

To analyze the factors influencing myopia and construct a nomogram to forecast the risk of myopia among school-age children, providing a reference for identifying high-risk groups to aid prevention and control.

METHODS

This case-control study enrolled 3512 students from three primary schools in Shenzhen using random cluster sampling for a questionnaire survey, myopia screening and ocular biometric parameter measurement. Logistic regression was used to analyze the influencing factors of myopia, and a nomogram was constructed to forecast myopia risk. Bootstrap resampling was used to verify the practicability of the nomogram.

RESULTS

Older age (odds ratio[OR] = 1.164; 95% confidence interval [CI]: 1.111-1.219), female sex (OR = 2.405; 95% CI: 2.003-2.887), maternal myopia (OR = 1.331; 95% CI: 1.114-1.589), incorrect posture during reading and writing (OR = 1.283; 95% CI: 1.078-1.528) and axial length (OR = 7.708; 95% CI: 6.044-8.288) are risk factors for myopia, whereas an increase in corneal radius (OR = 0.036; 95% CI: 0.025-0.052) is a protective factor against myopia. The area under the receiver operating characteristic (ROC) curve of the nomogram was 0.857, and the net benefit was high when the risk threshold of the decision curve analyses (DCA) ranged from 0.20 to 1.00. The measured values were consistent with the prediction.

CONCLUSION

The nomogram was accurate in predicting the risk of myopia among schoolchildren. This study provides a reference for screening high-risk students and for individualized myopia prevention and control.

Comparison of the long-term effects of atropine in combination with Orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents

PURPOSE

The aim of this study was to evaluate the efficacy of Orthokeratology (Ortho-K), defocus incorporated multiple segment (DIMS) lens, combined Ortho-K/atropine, and combined DIMS/atropine for myopia control in children.

METHODS

A retrospective study included 167 myopic children aged 6-14 years with a spherical equivalent refraction (SER) of -0.75 to -4.00 diopter treated with Ortho-K (OK, n = 41), combined Ortho-K/atropine (OKA, n = 43), DIMS (n = 41), or combined DIMS/atropine (DIMSA, n = 42). Axial length (AL) was measured at baseline and at 3, 6, 9 and 12 months. Axial elongation over time and between groups were analysed.

RESULTS

After 12 months, the AL change was 0.20 ± 0.12 mm, 0.12 ± 0.14 mm, 0.22 ± 0.14 mm, and 0.15 ± 0.15 mm in the OK, OKA, DIMS, and DIMSA, respectively. There was no significant difference in AL change between OK and DIMS. OKA and DIMSA significantly slowed axial elongation compared to OK and DIMS monotherapy. After stratification by age, in the subgroup aged 6-10 years, there was significant difference in AL change between OKA and DIMS (p = 0.013), and no difference between other groups, while in the subgroup aged 10-14 years, the difference between OKA and DIMS became insignificant (p = 0.237), and the difference between OK and OKA, OK and DIMSA, DIMS and DIMSA became significant.

CONCLUSIONS

Ortho-K and DIMS lenses show similar reductions in myopia progression among children with low initial myopia. Atropine can significantly improve the efficacy of myopia control of both Ortho-K and DIMS lenses, and this add-on effect is better in older children.

Link between parental myopia and early-onset high myopia: Insights from a clinical retrospective analysis

INTRODUCTION

Genetic aetiology is suspected in the development of early-onset high myopia (spherical equivalent refractive error [SER] ≤-6.00 D at ≤6 years of age), considering that the role of environmental factors in inducing high myopia is improbable at an early age. Therefore, we aimed to understand if early-onset high myopia is associated with parental myopia in a clinical setting.

METHODS

A retrospective study was conducted in which information about demographics, age of apparent onset of myopia, refractive error, axial length, number of myopic parents, time spent outdoors and time spent on near-work was obtained from electronic medical records (EMR). It included 195 myopic individuals categorised into (1) Early-onset high myopes (EOHM): SER ≤ -6.00 D with age of presentation ≤6 years, (2) Early-onset low myopes (EOLM): SER > -6.00 D with age of apparent onset ≤6 years, (3) Late-onset high myopes (LOHM): SER ≤ -6.00 D with age of presentation and age of apparent onset >6 years and (4) Late-onset low myopes (LOLM): SER > -6.00 D with age of apparent onset >6 years.

RESULTS

Overall, 63% of individuals were found to have parental myopia. The proportion of individuals with EOHM, EOLM, LOHM and LOLM with parental myopia was 57%, 74%, 53% and 64%, respectively. After adjustment for age, gender and environmental factors, the odds of development of EOHM (Odds ratio: 0.78, 95% confidence interval: 0.25-2.48), EOLM (1.54, 0.65-3.67) or LOHM (0.70, 0.30-1.65) were similar in the presence of myopic parents, when compared with LOLM. The SER and axial length did not differ based on the number of myopic parents in any of these categories.

CONCLUSION

This retrospective analysis reveals that the presence of parental myopia, which was self-reported, did not induce additional risk for early-onset high myopia.

Association of sleep traits with myopia in children and adolescents: A meta-analysis and Mendelian randomization study

PURPOSE

The association between sleep and myopia in children and adolescents has been reported, yet it remains controversial and inconclusive. This study aimed to investigate the influence of different sleep traits on the risk of myopia using meta-analytical and Mendelian randomization (MR) techniques.

METHODS

The literature search was performed in August 31, 2023 based on PubMed, Embase, Web of Science, and Cochrane library. The meta-analysis of observational studies reporting the relationship between sleep and myopia was conducted. MR analyses were carried out to assess the causal impact of genetic pre-disposition for sleep traits on myopia.

RESULTS

The results of the meta-analysis indicated a significant association between the risk of myopia and both short sleep duration [odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.08-1.42, P = 0.003] and long sleep duration (OR = 0.75, 95% CI = 0.66-0.86, P < 0.001). MR analyses revealed no significant causal associations of genetically determined sleep traits with myopia, including chronotype, sleep duration, short sleep duration and long sleep duration (all P > 0.05).

CONCLUSIONS

No evidence was found to support a causal relationship between sleep traits and myopia. While sleep may not independently predict the risk of myopia, the potential impact of sleep on the occurrence and development of myopia cannot be disregarded.

Spatial epidemiological characteristics and driving factors of myopia among school-age children based on geographical detector: a national study

The present study aimed to examine the spatial characteristics of myopia and identify the socioeconomic and environmental factors influencing its prevalence. Myopia prevalence among children of school age of Han ethnicity in China was 56.6% in 2019, with the highest and lowest prevalence's in Shandong (66.8%) and Guizhou (47.3%), respectively. There was a spatial aggregation of myopia prevalence in China. Environmental factors (atmospheric PM2.5 concentration and forest coverage) and socioeconomic factors (gross domestic product per capita, per capita disposable income, hospital beds per thousand people, and Engel coefficient) have significant influences on myopia prevalence. The interaction of each factor on myopia showed nonlinear enhancement. Myopia prevalence among children of school age was spatially clustered, and environmental and socioeconomic conditions are associated with myopia prevalence. Our findings provide novel perspectives for the comprehensive prevention and control of myopia.

Association between sleep duration, sleep quality, bedtime and myopia: A systematic review and meta-analysis

BACKGROUND

We performed a systematic review and meta-analysis to investigate the links between different sleep characteristics and risk of myopia.

METHODS

PubMed, EMBASE, Web of Science, the Cochrane Library, PsycINFO, Wanfang, and CNKI were searched from inception to August 26, 2022, without any language restriction. Cross-sectional, case-control, or cohort studies that explored the association between sleep duration, sleep quality, bedtime, and myopia were included. NIH quality assessment tools were used to assess the methodological quality of included studies. Random-effect or fixed-effect models were used to pool the associations according to whether there is heterogeneity.

RESULTS

A total of 31 studies with 205 907 participants were included in the final analysis (25 studies reporting sleep duration; four studies examining sleep quality and six studies evaluating bedtime). Compared to reference sleep duration, sufficient sleep duration (OR = 0.63, 95% CI = 0.51-0.78) was associated with a lower risk of myopia, and short sleep duration (OR = 1.66, 95% CI = 1.14-2.42) was associated with a higher risk of myopia. In addition, poor sleep quality (OR = 1.24, 95% CI = 1.05-1.47) was associated with a higher risk of myopia while late bedtime (OR = 1.30, 95% CI = 0.96-1.75) was not significantly associated with an increased risk of myopia.

CONCLUSIONS

Alteration in sleep duration and sleep quality may influence the risk of myopia. Well-designed cohort studies are needed in future investigations to identify a causal relationship between different sleep characteristics and myopia.

Analysis of Refractive Errors in a Large Italian Cohort of Pediatric Subjects Post the COVID-19 Pandemic

BACKGROUND

The prevalence of refractive errors has sharply risen over recent decades. Despite the established role of genetics in the onset and progression of such conditions, the environment was also shown to play a pivotal role. Indeed, the COVID-19 pandemic has majorly impacted people's lifestyles and healthy habits, especially among the youth, which might have led to a significant increase in this trend. Therefore, the aim of this study was to investigate the actual prevalence of refractive errors in a large cohort of pediatric patients.

METHODS

A large cohort of 496 participants was screened through anamnesis, a non-cycloplegic autorefractometry, a corrected and uncorrected visual acuity assessment, and a questionnaire and was retrospectively evaluated.

RESULTS

Overall, refractive errors were present in 25.1% of eyes, of which 14.6% were diagnosed with myopia/myopic astigmatism and 10.5% with hyperopia/hyperopic astigmatism. Among the patients enrolled, 298 (60%) had their eyes checked one year earlier or before and 122 (25%) had never had ophthalmological consultations; a total of 105 (21%) needed glasses and 34 (7%) required a change in their previous prescription. A substantial increase in daily electronic device screen exposure was declared by 426 patients (87.6%).

CONCLUSIONS

Pediatric patients appear to have a higher prevalence of refractive errors than before.