Epidemiological characteristics of myopia among school-age children before, during, and after the COVID-19 pandemic: a cohort study in Shenzhen, China.

Objectives: To evaluate the epidemiological characteristics of myopia among school-aged children before, during, and after the coronavirus disease (COVID-19) pandemic. Methods: A total of 848,697 students aged 6-15 years from 786 primary and secondary schools in Shenzhen, China, were randomly selected as research subjects. We conducted annual myopia screenings from 2019 to 2022. 2019 was considered before the COVID-19 pandemic, 2020 as during the pandemic, and 2021 and 2022 as after the pandemic. Demographic characteristics, visual acuity, and spherical equivalent refraction (SE) were collected. Results: During the 4-year follow-up period, the uncorrected visual acuity (UCVA) of the study subjects progressed following a trend of -0.18 ± 0.30D (-0.17 ± 0.29D for boys, -0.21 ± 0.32Dfor girls) (p < 0.001). Those students who were in grade 4 aged 9-10 years at the baseline examination showed the greatest decline in visual acuity (0.23). The SE of the study subjects progressed following a trend of -1.00 ± 1.27D (-0.96 ± 1.25D for boys, -1.05 ± 1.31D for girls) (p < 0.001). The students who were in grade 5 aged 10-11 years at the baseline examination showed the greatest decline in SE (1.15D ± 1.22, p < 0.001). The prevalence of myopia (UCVA<5.0 and SE < -0.50D of any eye) increased by 28.2% (27.0% for boys and 29.8% for girls). Those students who were in grade 2 aged 7-8 years at the baseline examination showed the greatest increase in myopia prevalence (37.6%, p < 0.001). During the COVID-19 pandemic, the subjects' visual acuity and SE measurements decreased by -0.05 ± 0.19 (p < 0.001) and - 0.36 ± 0.89D (p < 0.001) respectively, and the prevalence of myopia increased by 11.3% (10.6% for boys and 12.2% for girls) (p < 0.001). The 3-year cumulative incidence of myopia for non-myopic grade 1 aged 6-7 years students with baseline SE of ≥1.00D, ≥ 0.50D and < 1.00D, ≥0D and < 0.50D, and ≥ -0.50D and < 0D were 6.8, 24.8, 39.0, and 48.1%, respectively. Conclusion: During the COVID-19 pandemic, the SE of school-aged children showed myopic drift and decreased visual acuity. Myopia progressed faster among girls than among boys in the same grades. The risk of myopia among school-aged children persisted even after the home quarantine of the COVID-19 pandemic was lifted.

Relative peripheral refraction in school children with different refractive errors using a novel multispectral refraction topographer.

AIM: To compare relative peripheral refraction (RPR) in Chinese school children with different refractive errors using multispectral refraction topography (MRT). METHODS: A total of 713 eyes of primary school children [172 emmetropia (E), 429 low myopia (LM), 80 moderate myopia (MM), and 32 low hypermetropia (LH)] aged 10 to 13y were analyzed. RPRs were measured using MRT without mydriasis. MRT results showed RPR at 0-15° (RPR 0-15), 15°-30° (RPR 15-30), and 30°-45° (RPR 30-45) annular in the inferior (RPR-I), superior (RPR-S), nasal (RPR-N), and temporal (RPR-T) quadrants. Spherical equivalent (SE) was detected and calculated using an autorefractor. RESULTS: There were significant differences of RPR 15-30 between groups MM [0.02 (-0.12; 0.18)] and LH [-0.13 (-0.36; 0.12)] (P<0.05), MM and E [-0.06 (-0.20; 0.10)] (P<0.05), and LM [-0.02 (-0.15; 0.15)] and E (P<0.05). There were also significant differences of RPR 30-45 between groups MM [0.45 (0.18; 0.74)] and E [0.29 (-0.09; 0.67)] (P<0.05), and LM [0.44 (0.14; 0.76)] and E (P<0.001). RPR values increased from the hyperopic to medium myopic group in each annular. There were significant differences of RPR-S between groups MM [-0.02 (-0.60; 0.30)] and E [-0.44 (-0.89; -0.04)] (P<0.001), and LM [-0.28 (-0.71; 0.12)] and E (P<0.05). There were also significant differences of RPR-T between groups MM [0.37 (0.21; 0.78)] and LH [0.14 (-0.52; 0.50)] (P<0.05), LM [0.41 (0.06; 0.84)] and LH (P<0.05), and LM and E [0.29 (-0.10; 0.68), P<0.05]. A Spearman's correlation analysis showed a negative correlation between RPR and SE in the 15°-30° (P=0.005), 30°-45° (P<0.05) annular (P=0.002), superior (P<0.001), and temporal (P=0.001) quadrants. CONCLUSION: Without pupil dilation, values for RPR 15-30, 30-45, RPR-S, and T shows significant differences between myopic eyes and emmetropia, and the differences are negatively correlated with SE.

Effects of ambient PM2.5 on non-accidental death: a time-series study in Shenzhen, China during 2014-2019.

This study aims to investigate the impact of PM2.5 on non-accidental death of residents. The single-pollutant model revealed that the influence of PM2.5 on non-accidental death was significant at lag0 and lag4-6, and was greatest at lag5. A 10 µg/m3 increase in PM2.5 was related with a 1.31% increase in non-accidental deaths. The connection between PM2.5 and non-accidental death was stronger in femalesthan males, in people aged ≥ 65 years than people aged < 65 years, and in people below high school education than people with high school education or above. Two-pollutant model revealed that the influence of PM2.5 on non-accidental death was essentially unchanged when CO, SO2, and O3 were included and reduced when NO2 was included. The multiple-pollutant model showed that the effect of ambient PM2.5 on non-accidental death was reduced. An increase in PM2.5 concentrations may cause an increase in non-accidental death.

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.

Older age, female sex, maternal myopia, incorrect posture during reading and writing, and prolonged axial length are risk factors for myopia among primary school students.The nomogram constructed based on age, sex, maternal myopia, incorrect posture during reading and writing, axial length and corneal radius showed good predictive accuracy and practicability.The nomogram constructed in this study can be used for individualized myopia risk assessment.

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.

Research trends and hotspots in the relationship between outdoor activities and myopia: A bibliometric analysis based on the web of science database from 2006 to 2021.

Objectives: This study aimed to explore the current status, hotspots, and emerging research trends regarding the relationship between outdoor activities and myopia. Methods: Publications on the relationship between outdoor activities and myopia from 2006 to 2021 were collected from the Web of Science Core Collection database. CiteSpace (version 6.1.R2) was used to performed a bibliometric analysis, and R software (version 4.1.0) was used to visualize the trends and hot map of publications. Results: A total of 640 publications were collected and analyzed in the present study. China was the major contributor (n = 204), followed by the United States of America (n = 181) and Australia (n = 137). The United States of America had the most extensive foreign cooperation (centrality = 0.25), followed by Australia (centrality = 0.20). The National University of Singapore contributed the largest number of publications (n = 48), followed by Sun Yat-Sen University (n = 41) and the Australian National University (n = 41). Among institutions, Cardiff University in the United Kingdom had the most extensive foreign cooperation (centrality = 0.12), followed by the National University of Singapore (centrality = 0.11). Saw S from Singapore had the largest number of publications (n = 39), followed by Morgan I from Australia (n = 27) and Jonas J from Germany (n = 23). Investigative ophthalmology & visual science is the most important journal to study the relationship between outdoor activities and myopia. "Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050" published by Holden BA was the most cited paper in this field with 177 citations. Co-occurrence and burst analyses of keywords showed that research trends and hotspots in this field focused mainly on "risk," "prevention" and "school". Conclusions: The influence of outdoor activities on myopia remains a concern. In the future, deeper cooperation between countries or institutions is required to explore the effects of outdoor activities on myopia. Outdoor activities for the prevention of myopia and reduction of the risk of myopia among school students may be the focus of future research.

The accuracy of the axial length and axial length/corneal radius ratio for myopia assessment among Chinese children.

Objectives: The aim of this study was to assess the association between axial length/corneal radius ratio (AL/CR ratio), AL, and refractive status and evaluate the accuracy of AL and AL/CR ratio for myopia assessment among Chinese children. Methods: A diagnostic trial was conducted in Shenzhen Eye Hospital from June 2020 to December 2020. Cycloplegic refraction and demographic characteristic survey were carried out, and AL and CR were measured. The Pearson correlation analysis between AL, AL/CR ratio, and spherical equivalent (SE) was carried out. The sensitivity, specificity, Youden index, positive predictive value, and negative predictive value of the AL/CR ratio and AL for myopia assessment were analyzed using cycloplegic refraction as the gold standard by drawing receiver operating characteristic (ROC) curves. Results: A total of 300 children aged 8-18 years participated in this study. The Pearson correlation coefficient between AL and SE was -0.667 (P < 0.05) and -0.754 (P < 0.05) between AL/CR ratio and SE. There were significant differences in SE, AL, and AL/CR ratio among different age groups (p < 0.05). SE decreased by 1.185 diopter (D) for every 1 mm increase in AL and decreased by 0.667 D for every 0.1 increase in the AL/CR ratio. Taking cycloplegic refraction SE ≤ -0.50 D as the gold standard for the diagnosis of myopia, the area under the ROC curve of AL for myopia assessment was 0.836 (95% confidence interval [CI]: 0.767-0.906), with specificity, sensitivity, and Youden index of 0.833, 0.767, and 0.600, respectively. The area under the ROC curve of AL/CR ratio for myopia assessment was 0.937 (95% CI: 0.878-0.996), with specificity, sensitivity, Youden index, positive predictive value, and negative predictive value of 0.703, 0.913, 0.622, 0.956, and 0.771, respectively. The area under the ROC curve of the combination of AL/CR ratio and parental myopia for myopia assessment was 0.976 (95% CI: 0.957-0.996). Conclusion: The correlation between SE and AL/CR ratio was stronger than that between SE and AL in children. The AL/CR ratio may be an alternative indicator for myopia assessment in children, and the combination of demographic factors and AL/CR ratio can improve the accuracy of myopia assessment.

Trends in Myopia Development Among Primary and Secondary School Students During the COVID-19 Pandemic: A Large-Scale Cross-Sectional Study.

Objectives: To evaluate myopia development among primary and secondary school students during the coronavirus 2019 (COVID-19) pandemic. Methods: A cross-sectional study was conducted to evaluate the development of myopia among students in Shenzhen, China during the COVID-19 outbreak. Results: The study included 1,472,957 and 1,573,824 students in 2019 and 2020, respectively. The prevalence of myopia was 46.9 and 50.5% in 2019 and 2020, respectively. The prevalence of myopia among students in the former Shenzhen Special Economic Zone (SEZ) was higher than that in areas outside the former Shenzhen SEZ (2019: 47.0 vs. 43.7%; 2020: 50.5 vs. 47.3%). The prevalence of myopia among girls was higher than that among boys (2019: 50.4 vs. 44.0%; 2020: 54.0 vs. 47.6%). The 50th percentile (P50) of spherical equivalent refraction (SER) in the right eye among girls was lower than that in boys. The prevalence of myopia continued to increase as the grade increased, with the greatest annual increase observed in Grades 2-5 (3.4-3.9%). The P50 of SER in the right eye of students decreased as the grade increased. Conclusions: The prevalence of myopia among students increased during the COVID-19 pandemic, especially in primary school Grades 2-5.

Online Decision Aids for Knee Osteoarthritis and Low Back Pain: An Environmental Scan and Evaluation.

Background. Musculoskeletal conditions are leading causes of disability. Management options are plentiful, but the current evidence base suggests many are ineffective or unproven. Online decision aids can help support patients make informed health care choices. However, there are little data on the quality of online decision aids for common musculoskeletal conditions such as knee or low back pain. Purpose. To identify all publicly available online decision aids for knee osteoarthritis and low back pain and evaluate them against the International Patient Decision Aids Standards Inventory (IPDASi). Data Sources. Google Australia. Study selection. Two reviewers independently screened websites for inclusion and assessed the quality of included online decision aids between April and May 2018. Included online decision aids were free, provided information about knee osteoarthritis or low back pain, and written in English. Online decision aids that required payment, targeted health professionals, addressed rheumatoid arthritis, or addressed a screening decision were excluded. Data Extraction. IPDASi Version 4. Data Synthesis. Twenty-five online decision aids were identified: 15 knee osteoarthritis and 10 low back pain. Only 3 online decision aids (12%) provided a "wait-and-see" option. Nineteen (75%) met IPDASi criteria to be considered a decision aid and 3 (12%) met IPDASi criteria to state that the online decision aid was unbiased. Limitations. Dynamic nature of Google searches may not be replicable easily. Conclusions. Few good-quality online decision aids are available for people with knee osteoarthritis or low back pain. Most online decision aids failed to explicitly provide a wait-and-see option, suggesting a bias toward intervention. These online decision aids would benefit from explicitly highlighting a wait-and-see option to support informed choice.