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

Author:

He Xiangui,Sankaridurg Padmaja,Xiong Shuyu,Li Wayne,Naduvilath Thomas,Lin Senlin,Weng Rebecca,Lv Minzhi,Ma YingyanORCID,Lu Lina,Wang Jingjing,Zhao Rong,Resnikoff SergeORCID,Zhu Jianfeng,Zou HaidongORCID,Xu XunORCID

Abstract

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.

Funder

Three-year Action Program of Shanghai Municipality for Strengthening the Construction of the Public Health System

High-end Research Team–Eye Health in Shanghai

Key Discipline of Public Health –Eye health in Shanghai

Brien Holden Vision Institute

Municipal Human Resources Development Program for Outstanding Young Talents in Medical and Health Sciences in Shanghai

Publisher

BMJ

Subject

General Medicine

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