Lifestyle and environmental threat elements for myopia in kids: Evidence from a large-scale cross-sectional research in Shandong, China

Introduction

Myopia is a refractive error characterised primarily by pathological axial elongation of the eyeball, clinically manifested as lowered distance imaginative and prescient. It has grow to be a significant international public well being concern affecting the visible well being of kids [1]. Epidemiological proof signifies that kids aged 9–12 years are in a important developmental window for the onset and development of myopia. During this era, the attention undergoes fast progress and the refractive system reveals excessive plasticity [2,3]. Concurrently, kids on this age group are transitioning into secondary schooling, dealing with growing educational calls for and extended close to work publicity [4]. Moreover, visible conduct patterns are nonetheless forming at this stage and are inclined to each genetic predispositions and environmental influences. These traits render this age group an optimum goal for early intervention, the place well timed and evidence-based myopia management methods can successfully sluggish development and scale back the danger of excessive myopia [5].

In current years, the worldwide prevalence of myopia has risen sharply. A meta-analysis by Holden and colleagues projected that by 2050, roughly 50% of the worldwide inhabitants can be affected by myopia, with 10% experiencing excessive myopia [6]. The state of affairs is especially extreme in East Asia, the place estimated the regional prevalence of myopia throughout all age teams to succeed in 51.6% in 2020, 56.9% in 2030, 61.4% in 2040, and 65.3% by 2050 [6]. In China, the present prevalence of myopia amongst kids and adolescents has reached 53.6%, with charges exceeding 80% amongst highschool college students [7,8]. Shandong Province, an economically developed coastal area in japanese China, is dealing with comparable challenges in pediatric myopia prevention. Of specific concern is excessive myopia (outlined as a spherical equal ≤ −6.00 D), which is strongly related to an elevated threat of irreversible vision-threatening circumstances reminiscent of retinal detachment [9,10], glaucoma [11,12], and myopic maculopathy [13]. These issues considerably impair high quality of life and might result in everlasting visible loss. Beyond its medical implications, myopia is linked to broader social and developmental points, together with elevated educational strain, lowered outside exercise, and adverse results on psychological well being, forming a detrimental suggestions loop that hinders the general well-being of kids and adolescents. Moreover, the financial burden of myopia is substantial. It has been estimated that uncorrected myopia and myopic macular degeneration end in annual international productiveness losses of USD 244 billion and USD 6 billion, respectively [14].

Previous research have demonstrated that the event and development of myopia are influenced by a mixture of genetic [15,16], environmental [17,18], and behavioral elements [19]. Among these, environmental contributors reminiscent of elevated near-work length [20], lowered outside exercise [21], and heightened educational strain are thought-about key drivers behind the rising prevalence of myopia [22].

Childhood myopia has emerged as a urgent international public well being problem that necessitates multidisciplinary collaboration and systematic analysis approaches. This research employed a cross-sectional design to comprehensively assess the prevalence and related threat elements of myopia amongst kids aged 9–12 years in Shandong Province, China. The goal was to characterize the epidemiological patterns of myopia on this inhabitants and supply proof to help the event of efficient, evidence-based prevention methods.

Materials and strategies

Results

In the legitimate survey, the pattern exhibited a balanced gender distribution, with 39,230 male members (50.54%) and 38,399 feminine members (49.46%). The age distribution was as follows: 16,007 members have been 9 years previous (20.62%), 18,910 have been 10 years previous (24.36%), 19,803 have been 11 years previous (25.51%), and 22,909 have been 12 years previous (29.51%). The common age of the research members was 10.6 ± 1.1 years.

Discussion

This research, primarily based on information from the 2024 survey on myopia prevalence amongst kids in Shandong Province, examined the associations of demographic traits, visible behaviors, and way of life elements with myopia. Among kids aged 9–12 years, the general prevalence of myopia was 41.24%. This estimate is corresponding to current studies from Eastern China, which vary between 41% and 46%, however differs markedly from findings in neighboring East and Central Asian nations [27,28]. For instance, in Almaty, Kazakhstan, the prevalence of myopia amongst schoolchildren aged 6–16 years was 28.3% (95% CI: 26.5–30.1), considerably decrease than in our research inhabitants [29]. In the Ural area of Russia, the prevalence reached 46.2% (95% CI: 44.8–48.6) amongst kids aged 6.2–18.8 years, barely greater than the extent noticed in our 9–12 12 months age group [30]. In distinction, nationwide information from South Korea indicated a prevalence of roughly 65.4% amongst kids and adolescents aged 5–18 years, with excessive myopia (spherical equal ≤ –6.0 D) reported in 6.9% [31], reflecting the affect of intense academic strain and near-work actions. These comparisons spotlight substantial interregional variation within the prevalence of myopia, which is unlikely to be defined by genetic background alone. Rather, environmental influences, academic techniques, outside exercise ranges [32], and near-work behaviors in early childhood seem to play important roles [33]. Moreover, these findings improve the exterior validity of our research throughout the East Asian context, suggesting that though the prevalence of myopia amongst school-aged kids in China is excessive, it’s broadly in step with regional patterns [34].

Sex was discovered to be considerably related to the event of myopia, with a barely greater prevalence noticed in ladies in comparison with boys. This discovering is in step with epidemiological proof from a number of nations and areas. For occasion, a large-scale cohort research within the United States recognized feminine intercourse as an necessary predictor of myopia development in kids [35]. Similarly, the Generation R cohort within the Netherlands reported that ladies aged 9–13 years tended to develop myopia sooner than boys [36]. In China, information from the nationwide Chinese National Survey on Students’ Constitution and Health (CNSSCH) have persistently indicated greater charges of myopia amongst ladies throughout grades and areas [37]. A believable rationalization for this intercourse distinction lies within the earlier onset of puberty amongst ladies. Rapid pubertal progress has been proven to correlate with axial elongation and refractive modifications, which can speed up myopia development, thereby contributing to the upper prevalence noticed in feminine kids [38,39].

Age was additionally recognized as an necessary issue influencing childhood myopia. In this research, the prevalence of myopia elevated considerably with advancing age, a sample in step with findings from a number of East Asian nations. A cohort research with a 4-year follow-up of main schoolchildren in Baoshan District, Shanghai, demonstrated a considerable enhance in myopia prevalence and progressive modifications in refractive parameters in the course of the transition from decrease to greater grades. [40] Similarly, information from South Korea indicated that myopia is extremely prevalent in the course of the college years and enters a part of fast development between 12 and 15 years of age [41]. This age-related impact could also be attributable to a number of elements, together with growing educational calls for, extended near-work actions, and the continued immaturity of ocular growth [42]. These findings counsel that the early college years might signify a important window for efficient intervention.

Parental myopia can also be an necessary issue influencing the event of myopia in kids. In the current research, parental myopia was considerably related to an elevated threat of myopia in offspring, in step with earlier analysis. Several research have reported that kids with two myopic mother and father are at considerably greater threat of growing myopia in comparison with these with just one or no myopic mother or father [43,44]. Moreover, the interplay between genetic and environmental elements warrants consideration. For instance, findings from the UK ALSPAC cohort point out that polygenic threat scores can considerably predict the danger of myopia in kids, whereas environmental exposures, reminiscent of near-work and outside actions, play a important position in modulating this threat [45]. These outcomes counsel that parental myopia might affect the susceptibility of kids to environmental exposures, thereby affecting the onset and development of myopia.

Environmental and behavioral elements are main exterior drivers of the onset and development of myopia in kids. In the current research, inadequate outside exercise and extreme use of digital gadgets have been each related to an elevated threat of myopia. These findings are supported by a number of research. A randomized managed trial in Taiwan demonstrated that a further 40 minutes of every day outside exercise considerably lowered the incidence of myopia amongst main college kids [46]. Furthermore, a scientific overview and meta-analysis confirmed the protecting impact of out of doors exercise in opposition to myopia growth [47]. Outdoor publicity is assumed to advertise ocular well being by elevated daylight publicity, which stimulates vitamin D synthesis, whereas vivid outside gentle induces pupillary constriction and will increase depth of discipline, thereby slowing the onset and development of myopia [48,49]. Conversely, extended near-work actions, reminiscent of studying, writing, and the usage of digital gadgets, have been persistently related to myopia growth [50]. This impact is assumed to contain retinal signaling pathways and lowered dopamine launch, which promote axial elongation, in addition to the biomechanical penalties of sustained lodging and convergence, additional growing the danger of myopia [51,52]. Furthermore, present research have established a hyperlink between myopia and lowered time spent outside in kids [53,54]. This behavioral sample is hypothesized to kind a adverse suggestions loop, whereby restricted outside publicity contributes to myopia growth, which in flip might additional discourage outside actions [55].

Sleep has more and more been acknowledged as an necessary way of life consider myopia analysis. In the current research, inadequate sleep was related to an elevated threat of myopia in kids, in step with findings from a number of epidemiological investigations. For occasion, a research carried out in Guangzhou, China, reported that college students who slept lower than 8 hours per night time had a considerably greater prevalence of myopia in comparison with these with sufficient sleep [56]. Similarly, a nationwide cross-sectional research in South Korea discovered that shorter sleep length was considerably related to myopia amongst adolescents [57]. The underlying mechanisms might contain disruption of circadian rhythms affecting ocular growth, in addition to elevated near-work publicity because of staying up late [58,59]. Additionally, sleep might exert a protecting impact on myopia by leisure and restoration of the ciliary muscle tissue, thereby mitigating myopia development. These findings counsel that making certain enough sleep might play a important position within the prevention and management of myopia in kids.

Urban–rural disparities signify an necessary social environmental issue within the growth of myopia. In the current research, the prevalence of myopia was barely decrease amongst rural kids in comparison with their city counterparts, in step with findings from nationwide and regional surveys [60,61]. Urban kids are extra inclined to myopia because of greater educational pressures, lowered outside exercise, and extra frequent use of digital gadgets [62]. In distinction, though rural kids have skilled enhancements in dietary standing, they often have extra alternatives for outside exercise, which can confer some protecting impact [63]. However, as way of life patterns in rural areas grow to be more and more “urbanized,” this city–rural hole in myopia prevalence is regularly narrowing [64].

Despite offering useful insights for the prevention and management of myopia in kids, this research has a number of limitations. First, the reliance on self-reported questionnaires might introduce measurement bias, notably for subjective indicators reminiscent of visible conduct. Second, non-cycloplegic refraction was used for refractive error evaluation, which can result in an overestimation of myopia prevalence, particularly in youthful kids with stronger accommodative responses. Third, though stratified sampling was employed, the representativeness of the pattern should be affected by regional disparities. Fourth, as a result of cross-sectional design, causal relationships can’t be established, and reverse causation is feasible—for instance, kids with present myopia might have interaction in numerous behaviors, reminiscent of elevated display time or lowered outside exercise, which might affect the noticed associations. Future research ought to incorporate goal monitoring instruments to acquire extra correct behavioral information, undertake longitudinal designs to trace the trajectory of myopia development, and think about broader contextual elements—reminiscent of academic environments—to strengthen the proof base for understanding the mechanisms underlying myopia growth.

The findings align with the United Nations Sustainable Development Goal 3, which emphasizes making certain wholesome lives and selling well-being for all in any respect ages [65]. By offering scientific insights into bettering kids’s visible well being and total high quality of life, this research holds each theoretical significance and sensible worth. Furthermore, it contributes to the worldwide discourse on myopia management by providing data-driven proof from China, thereby facilitating worldwide collaboration and data alternate in pediatric ophthalmic well being. Clinically, our findings underscore the significance of creating a faculty–community-based common imaginative and prescient screening system to allow early detection and well timed intervention of myopia in kids. In addition, implementing public well being teaching programs to disseminate scientific data on eye care and promote wholesome visible habits is important. Personalized prevention and management methods needs to be developed, with specific consideration to high-risk populations. Such an built-in prevention framework not solely helps curb the rising prevalence of myopia but additionally helps the broader aim of enhancing kids’s total well being and growth.

Conclusion

This research highlights the multifactorial nature of myopia growth amongst kids, encompassing demographic traits, genetic predisposition, behavioral patterns, and environmental exposures. Among kids aged 9–12 years in Shandong Province, the general prevalence of myopia was 41.24%, which is corresponding to current studies from Eastern China (41–46%) and customarily in step with regional patterns in neighboring nations, although notable interregional variation exists. These findings underscore the significance of adopting a multidimensional perspective in understanding elements related to myopia growth. Factors probably associated to a decrease threat of myopia, as urged by observational proof, embody larger time spent on outside actions, adoption of correct visible habits, optimum viewing distance and length of display use, balanced educational workload, and enough sleep. Particular consideration needs to be given to high-risk populations, reminiscent of ladies, older age teams, city college students, and people with a household historical past of myopia. Incorporating each population-level interventions and focused methods for high-risk teams might present useful insights for mitigating the burden of myopia and selling visible well being in youth.