Prevalence of myopia and high myopia, and the association with education: Shanghai Child and Adolescent Large-scale Eye Study (SCALE): a cross-sectional study

ObjectivesTo report on: (a) overall myopia and high myopia prevalence, and (b) the impact of education on the spherical equivalent refractive error in children across Shanghai.DesignCross-sectional study.SettingAcross all 17 districts of Shanghai.Participants910 245 children aged 4–14 years from a s...

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Published in:BMJ open Vol. 11; no. 12; p. e048450
Main Authors: He, Xiangui, Sankaridurg, Padmaja, Xiong, Shuyu, Li, Wayne, Naduvilath, Thomas, Lin, Senlin, Weng, Rebecca, Lv, Minzhi, Ma, Yingyan, Lu, Lina, Wang, Jingjing, Zhao, Rong, Resnikoff, Serge, Zhu, Jianfeng, Zou, Haidong, Xu, Xun
Format: Journal Article
Language:English
Published: England British Medical Journal Publishing Group 23.12.2021
BMJ Publishing Group LTD
BMJ Publishing Group
Series:Original research
Subjects:
Adolescence
Adolescent
Age
Child
Child, Preschool
Children & youth
China - epidemiology
Cross-Sectional Studies
Education
epidemiology
Gender
Humans
Infant
Multivariate analysis
Myopia
Myopia - epidemiology
Ophthalmology
Pediatrics
Prevalence
Public health
Questionnaires
Refraction, Ocular
Teenagers
China
Japan
epidemiology
ophthalmology
public health
ISSN:2044-6055, 2044-6055
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Summary:ObjectivesTo report on: (a) overall myopia and high myopia prevalence, and (b) the impact of education on the spherical equivalent refractive error in children across Shanghai.DesignCross-sectional study.SettingAcross all 17 districts of Shanghai.Participants910 245 children aged 4–14 years from a school-based survey conducted between 2012 and 2013.Main outcome measuresData of children with non-cycloplegic autorefraction, visual acuity assessment and questionnaire were analysed (67%, n=6 06 476). Prevalence of myopia (≤−1.0 D) and high myopia (≤−5.0 D) was determined. We used a regression discontinuity design to determine the impact of school entry cut-off date (1 September) by comparing refractive errors at each age, for children born pre-September to post-1 September, and performed a multivariate analysis to explore risk factors associated with myopia. Data analysis was performed in 2017–2018.ResultsPrevalence rates of myopia and high myopia were 32.9% (95% CI: 32.8% to 33.1%) and 4.2% (95% CI: 4.1% to 4.2%), respectively. From 6 years of age onwards, children born pre-September were more myopic compared with those born post-1 September (ahead in school by 1 year, discontinuity at 6 years: −0.19 D (95% CI: −0.09 to −0.30 D); 14 years: −0.67 D (95% CI: −0.21 to −1.14 D)).ConclusionsOur findings suggest that myopia is associated with education, that is primarily focused on near-based activities. Efforts to reduce the burden should be directed to public awareness, reform of education and health systems.
Bibliography:Original research
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XH and PS are joint first authors.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2020-048450