This web page was created programmatically, to learn the article in its unique location you possibly can go to the hyperlink bellow: https://journals.plos.org/plosone/article%3Fid%3D10.1371/journal.pone.0342658and if you wish to take away this text from our web site please contact us [ad_1] AbstractMyopia has emerged as a urgent international public well being challenge, with a very sharp rise noticed amongst school-aged kids. This interval represents a important window for implementing well timed, evidence-based interventions to sluggish myopia development and mitigate the danger of excessive myopia. This research aimed to research the prevalence and related threat elements of myopia amongst kids aged 9–12 years in Shandong Province, China, with a particular give attention to the roles of demographic traits, environmental exposures, and behavioral patterns. A cross-sectional survey was carried out in 2024 utilizing a stratified cluster sampling design. A complete of 77,629 kids from 16 cities have been enrolled. Data assortment included standardized visible acuity assessments and structured questionnaires. Multivariate logistic regression fashions have been used to look at the associations between behavioral elements and myopia. Only variables that confirmed important associations in univariate (chi-square) analyses have been included within the fashions, with out further adjustment for different potential confounders. The total prevalence was 41.24%, growing with age and reaching 44.34% at 12 years. Significant demographic threat elements included feminine intercourse (OR=1.030,95%Cl = 1.001–1.060), city residency (OR=1.045,95%Cl = 1.014–1.077), and parental myopia, notably when each mother and father have been affected (OR=1.320,95%Cl = 1.270–1.372). Behavioral threat elements included studying whereas mendacity down (OR=1.093,95%Cl = 1.035–1.154), display publicity exceeding three hours per day (OR=1.058,95%Cl = 1.010–1.109), and homework length over three hours per day (OR=1.072,95%Cl = 1.033–1.112). Protective elements comprised outside exercise 5 or extra occasions per week (OR=0.898,95%Cl = 0.865–0.932), sustaining correct posture throughout studying and writing (OR=0.925,95%Cl = 0.898–0.952), display viewing distance over three meters (OR=0.933,95%Cl = 0.905–0.961), and sleeping at the least eight hours per night time (OR=0.918,95%Cl = 0.876–0.961). These findings underscore the multifactorial etiology of myopia, formed by environmental, and behavioral influences. They spotlight the pressing want for complete and focused interventions, notably for high-risk teams. This research supplies sturdy empirical proof to tell region-specific myopia management methods and helps the event of public well being insurance policies aimed toward bettering pediatric imaginative and prescient well being. Citation: Wang W, Gong J, Yan L, Xu B, Shi Y, Ge R (2026) Lifestyle and environmental threat elements for myopia in kids: Evidence from a large-scale cross-sectional research in Shandong, China. PLoS One 21(2): e0342658. https://doi.org/10.1371/journal.pone.0342658Editor: Nader Hussien Lotfy Bayoumi, Alexandria University Faculty of Medicine, EGYPTReceived: June 3, 2025; Accepted: January 27, 2026; Published: February 13, 2026Copyright: © 2026 Wang et al. This is an open entry article distributed below the phrases of the Creative Commons Attribution License, which allows unrestricted use, distribution, and copy in any medium, offered the unique creator and supply are credited.Data Availability: All related information are throughout the paper and its Supporting Information information.Funding: This research was supported by the next funding sources: 1. The National Natural Science Foundation of China (NSFC) to GRK (32260216) 2. Doctoral Research Start-up Fund to GRK. 3. The Postgraduate Innovation Special Fund Project to WWC (YC2025-S511). The funders had no position in research design, information assortment and evaluation, resolution to publish, or preparation of the manuscript.Competing pursuits: The authors have declared that no competing pursuits exist.Abbreviations: OR, odds ratio; CI, confidence interval IntroductionMyopia 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 Study design and members This research was carried out in strict accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tips for cross-sectional research [23]. To comprehensively assess the prevalence of myopia amongst kids aged 9–12 years in Shandong Province, a large-scale cross-sectional survey was carried out from February to May 2024. A scientifically designed sampling technique was employed to pick members from 143 main colleges throughout 16 cities in Shandong Province, making certain that the pattern was consultant of the goal inhabitants. A two-stage sampling process was carried out to boost the representativeness and reliability of the information. In the primary stage, stratified sampling was carried out primarily based on college grade to make sure balanced illustration throughout age teams (9–12 years). In the second stage, a cluster sampling method was utilized, whereby intact lessons inside every grade stage have been outlined as sampling models, and randomly chosen utilizing a probabilistic methodology. This multi-stage sampling framework ensured a broad demographic protection and sturdy population-level illustration of school-aged kids in Shandong Province. A complete of 77,629 college students aged 9–12 years have been finally included within the research. Exclusion standards comprised the presence of extreme ocular illnesses, evident visible impairments or deformities, and acute ocular infections or different circumstances that might intrude with visible assessments. All eligible members accomplished each visible acuities testing and a structured questionnaire, yielding a participation fee of 100%. The efficient response fee, outlined because the proportion of members with full and legitimate information, was 98.11%. Myopia measurement and questionnaire survey A standardized protocol was employed for each visible acuity evaluation and questionnaire administration. All investigators and members underwent unified, systematic coaching to make sure constant adherence to visible testing procedures and discipline epidemiological practices. Prior to information assortment, the research aims, significance, and participation procedures have been totally defined to college students and their authorized guardians. Following the completion of the visible acuity assessments, structured questionnaires have been distributed to the scholars. To accommodate their cognitive growth stage, the questionnaires have been accomplished with the help of mother and father or guardians. All accomplished questionnaires have been collected centrally, systematically reviewed, and subjected to a double-entry process by two impartial information clerks to make sure accuracy previous to statistical evaluation. The uncorrected visible acuity (UCVA) of scholars was evaluated utilizing an ordinary logarithmic visible acuity chart. Refractive error was measured with an autorefractor (HRK-7000A, HUVITZ Corporation, Anshan, Republic of Korea) with out cycloplegia. Myopia was outlined as a UCVA of lower than 5.0 (Snellen equal 24]. The questionnaire used on this research was developed by the authors particularly for the goal inhabitants and was administered anonymously. It included questions on demographic traits (e.g., gender, age, household revenue, residential space, parental schooling stage, and parental myopia standing) in addition to every day behavioral habits (e.g., frequency of utilizing eyes whereas mendacity down or reclining, Eye use whereas strolling or touring (i.e., how typically the kid focuses on close to objects, reminiscent of studying or utilizing a telephone, whereas strolling or using in a automobile), frequency of out of doors bodily exercise, correct posture throughout studying and writing, distance to TV display, distance to laptop display, every day display time on smartphones and computer systems, every day TV viewing time, time spent on homework, and sleep length). Prior to questionnaire administration, every merchandise was defined intimately to the respondents to make sure readability and keep away from potential misunderstandings in the course of the survey course of. Before conducting the survey, the reliability and validity of the questionnaire have been evaluated. To assess reliability, the questionnaire was administered twice with a two-week interval to a subsample. The outcomes confirmed no important variations between the 2 administrations, indicating passable temporal stability. Content validity was confirmed by professional opinions by specialists in pediatric well being and epidemiology, who evaluated the relevance, readability, and comprehensiveness of every merchandise to make sure its appropriateness for the goal inhabitants. In accordance with the STROBE tips, information integrity was rigorously checked previous to evaluation. Questionnaires with greater than 10% lacking information have been excluded. For these with minimal lacking information, a number of imputation was utilized [23]. Independent samples t-tests (for age) and chi-square assessments (for gender) have been used to check lacking and full information teams, and no important variations have been discovered (p > 0.05), suggesting that the lacking information have been randomly distributed and that the pattern remained consultant. Statistical evaluation Data have been entered right into a database created utilizing EpiData 3.1 software program and subjected to double information entry verification. Statistical analyses have been carried out utilizing SPSS model 27.0. Continuous variables have been expressed as imply ± normal deviation (±s), whereas categorical variables have been introduced as frequencies (n) and percentages (%). Descriptive statistics have been used to summarize the information. To establish potential threat elements and associations, chi-square (χ²) assessments and multivariable logistic regression analyses have been employed, with a significance stage set at α = 0.05. Variables that confirmed important variations (P 25]. To assess the goodness-of-fit and calibration of the ultimate logistic regression mannequin, the Hosmer-Lemeshow take a look at was utilized to make sure the robustness of the analytical framework [26]. Ethical assertion All procedures on this research have been carried out in strict accordance with related tips and rules. Written knowledgeable consent was obtained from all members. For minors below 16 years of age, knowledgeable consent was obtained from their mother and father or authorized guardians. Moreover, the authorized guardians of all members offered assurance of knowledgeable consent, and signed hardcopy consent types have been collected. This research acquired moral approval from the Ethics Committee of Shandong Institute of Petroleum and Chemical Technology (registration quantity: KY-2024–008). ResultsIn 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. Univariate evaluation of myopia prevalence throughout completely different demographic traits According to the 2024 survey information on myopia prevalence in kids from Shandong Province (Table 1), the general myopia fee was 41.24%. Gender, age, residential space, household revenue, father’s schooling stage, mom’s schooling stage, and parental myopia standing have been discovered to considerably affect the myopia fee in kids (P The affect of household revenue on the myopia fee was not statistically important (P > 0.05); equally, the schooling ranges of each fathers and moms weren't considerably related to the myopia fee (P > 0.05). Children whose fathers had an schooling stage of center college or under exhibited the bottom myopia fee (40.73%), whereas these whose fathers had an schooling stage of highschool or above had the very best myopia fee (41.39%). Likewise, kids whose moms had an schooling stage of center college or under confirmed the bottom myopia fee (40.71%), whereas these whose moms had an schooling stage of highschool or above had the very best myopia fee (41.53%). Parental myopia standing had essentially the most important impact on the myopia fee (χ² = 209.717, P Univariate evaluation of things related to myopia prevalence Univariate evaluation outcomes are introduced in Table 2. Several behavioral elements have been considerably related to the myopia fee in kids (P Additionally, larger distances to the tv (≥3 m) and laptop screens (≥50 cm) have been linked to barely decrease myopia charges (40.67% and 40.97%) in comparison with shorter distances (42.33% and 41.87%). Longer every day display time on smartphones and computer systems (>3 h) and longer homework length (>3 h) have been related to elevated myopia charges (41.81% and 41.98%), whereas longer sleep length (>8 h) was linked to a decrease myopia fee (40.23%). Daily tv viewing time didn't present a big affiliation with myopia (P > 0.05). Overall, these outcomes counsel that each visible behaviors and way of life elements, together with outside exercise, display use, posture, and sleep, are related to variations in myopia prevalence amongst kids, highlighting potential targets for preventive methods. Multivariable logistic regression evaluation of myopia prevalence in kids The outcomes of the multivariate logistic regression evaluation (Table 3) point out that, following the predefined inclusion and exclusion standards and utilizing a significance threshold of P = 0.05, the 13 impartial variables that have been important within the univariate evaluation have been rigorously included within the multivariate logistic regression mannequin. Demographic elements reminiscent of gender, age, and residence confirmed important associations: ladies had a better threat than boys (OR = 1.030, 95% CI: 1.001–1.060), threat elevated progressively with age from 9 to 12 years (ORs: 10 vs. 9 years = 1.045, 95% CI: 1.001–1.092; 11 vs. 9 years = 1.100, 95% CI: 1.054–1.148; 12 vs. 9 years = 1.260, 95% CI: 1.209–1.313), and youngsters from city areas had greater threat in comparison with rural areas (OR = 1.045, 95% CI: 1.014–1.077). Parental myopia additionally influenced threat, with one myopic mother or father barely growing threat (OR = 1.036, 95% CI: 1.033–1.070) and each mother and father myopic markedly growing threat (OR = 1.320, 95% CI: 1.270–1.372). Behavioral elements have been considerably related to myopia threat. Frequent near-eye actions whereas mendacity down or bending over (OR = 1.093, 95% CI: 1.035–1.154) and whereas strolling or using in a automobile (OR = 1.224, 95% CI: 1.167–1.283) elevated threat. Conversely, frequent outside actions (>5 occasions/week) lowered threat (OR = 0.898, 95% CI: 0.865–0.932), and sustaining correct studying and writing posture was protecting (OR = 0.925, 95% CI: 0.898–0.952). Screen-related elements additionally affected threat. Greater distance from the tv (≥3 m, OR = 0.933, 95% CI: 0.905–0.961) and laptop screens (≥50 cm, OR = 0.963, 95% CI: 0.934–0.994) lowered threat. Longer every day display time (>3 h, OR = 1.058, 95% CI: 1.010–1.109) and homework length (>3 h, OR = 1.072, 95% CI: 1.033–1.112) elevated threat. Sleep length was inversely related to myopia, with >8 h of sleep per day decreasing threat (OR = 0.918, 95% CI: 0.876–0.961). DiscussionThis 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. ConclusionThis 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. References1. Baird PN, Saw S-M, Lanca C, Guggenheim JA, Smith Iii EL, Zhou X, et al. Myopia. Nat Rev Dis Primers. 2020;6(1):99. pmid:33328468 2. Salari N, Molaeefar S, Abdolmaleki A, Beiromvand M, Bagheri M, Rasoulpoor S, et al. Global prevalence of myopia in kids utilizing digital gadgets: a scientific overview and meta-analysis. BMC Pediatr. 2025;25(1):325. pmid:40275173 3. Surico PL, Parmar UPS, Singh RB, Farsi Y, Musa M, Maniaci A, et al. Myopia in Children: Epidemiology, Genetics, and Emerging Therapies for Treatment and Prevention. Children (Basel). 2024;11(12):1446. pmid:39767875 4. Xu J, Li Y, Ma S, Dai S, Xu W, Sang M, et al. The relationship between imaginative and prescient standing and its influencing elements amongst main and secondary college college students: The masking impact of bodily exercise stage and the moderating impact of educational stress. BMC Public Health. 2025;25(1):476. pmid:39910514 5. Tariq F, Mobeen R, Wang X, Lin X, Bao Q, Liu J, et al. Advances in myopia prevention methods for school-aged kids: a complete overview. Front Public Health. 2023;11:1226438. pmid:37655278 6. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 by 2050. Ophthalmology. 2016;123(5):1036–42. pmid:26875007 7. Li R, Zhang Okay, Li S-M, Zhang Y, Tian J, Lu Z, et al. Implementing a digital complete myopia prevention and management technique for youngsters and adolescents in China: a cost-effectiveness evaluation. Lancet Reg Health West Pac. 2023;38:100837. pmid:37520278 8. Gebru EA, Mekonnen KA. Prevalence and Factors Associated with Myopia Among High School Students in Hawassa City, South Ethiopia, 2019. Clin Optom (Auckl). 2022;14:35–43. pmid:35299899 9. Jindachomthong KK, Cabral H, Subramanian ML, Ness S, Siegel NH, Chhablani J, et al. Incidence and Risk Factors for Delayed Retinal Tears after an Acute, Symptomatic Posterior Vitreous Detachment. Ophthalmol Retina. 2023;7(4):318–24. pmid:36307014 10. Shah R, Vlasak N, Evans BJW. High myopia: Reviews of myopia management methods and myopia issues. Ophthalmic Physiol Opt. 2024;44(6):1248–60. pmid:39082137 11. Chang P-Y, Wang J-Y, Wang J-Okay, Huang T-L, Hsu Y-R. Optical Coherence Tomography Angiography Compared With Optical Coherence Tomography for Detection of Early Glaucoma With High Myopia. Front Med (Lausanne). 2022;8:793786. pmid:35087847 12. Fan X, Xu H, Zhai R, Sheng Q, Sun Y, Shao T, et al. Peripapillary Vascular Reactivity in Primary Open-Angle Glaucoma With High Myopia by Using Optical Coherence Tomography Angiography. Front Med (Lausanne). 2022;9:850483. pmid:35372433 13. Sakata R, Miyata M, Ooto S, Tamura H, Ueda-Arakawa N, Muraoka Y, et al. Ten-year visible final result and alter in chorioretinal atrophy after intravitreal ranibizumab for macular neovascularization in pathologic myopia. Retina. 2023;43(11):1863–71. pmid:37339449 14. Modjtahedi BS, Abbott RL, Fong DS, Lum F, Tan D, Task Force on Myopia. Reducing the Global Burden of Myopia by Delaying the Onset of Myopia and Reducing Myopic Progression in Children: The Academy’s Task Force on Myopia. Ophthalmology. 2021;128(6):816–26. pmid:33388160 15. Széll N, Fehér T, Maróti Z, Kalmár T, Latinovics D, Nagy I, et al. Myopia-26, the female-limited type of early-onset excessive myopia, occurring in a European household. Orphanet J Rare Dis. 2021;16(1):45. pmid:33482870 16. Yu X, Yuan J, Chen ZJ, Li Okay, Yao Y, Xing S, et al. Whole-Exome Sequencing Among School-Aged Children With High Myopia. JAMA Netw Open. 2023;6(12):e2345821. pmid:38039006 17. Yang Y, Liao H, Zhao L, Wang X, Yang X, Ding X, et al. Green Space Morphology and School Myopia in China. JAMA Ophthalmol. 2024;142(2):115–22. pmid:38175641 18. Yuan T, Zou H. Effects of air air pollution on myopia: an replace on medical proof and organic mechanisms. Environ Sci Pollut Res Int. 2022;29(47):70674–85. pmid:36031679 19. Li Y, Xu C, Liu Z, Qu Z, Xi W, Zhang X, et al. Effects of bodily exercise patterns on myopia amongst kids and adolescents: A latent class evaluation. Child Care Health Dev. 2024;50(4):e13296. pmid:38895956 20. Guan H, Yu NN, Wang H, Boswell M, Shi Y, Rozelle S, et al. Impact of assorted sorts of close to work and time spent outside at completely different occasions of day on visible acuity and refractive error amongst Chinese school-going kids. PLoS One. 2019;14(4):e0215827. pmid:31026279 21. Karthikeyan SK, Ashwini DL, Priyanka M, Nayak A, Biswas S. Physical exercise, time spent outside, and close to work in relation to myopia prevalence, incidence, and development: An overview of systematic opinions and meta-analyses. Indian J Ophthalmol. 2022;70(3):728–39. pmid:35225506 22. Zhang S, Rehman S, Zhao Y, Rehman E, Yaqoob B. Exploring the interaction of educational stress, motivation, emotional intelligence, and mindfulness in greater schooling: a longitudinal cross-lagged panel mannequin method. BMC Psychol. 2024;12(1):732. pmid:39696514 23. Skrivankova VW, Richmond RC, Woolf BAR, Yarmolinsky J, Davies NM, Swanson SA, et al. Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization: The STROBE-MR Statement. JAMA. 2021;326(16):1614–21. pmid:34698778 24. Zhang D, Sun B, Wu M, Liu H, Zhou L, Guo L. Prevalence and related elements of myopia amongst college college students in Shenyang, China: a cross-sectional research. Front Public Health. 2023;11:1239158. pmid:37711238 25. Bzovsky S, Phillips MR, Guymer RH, Wykoff CC, Thabane L, Bhandari M, et al. The clinician’s information to deciphering a regression evaluation. Eye (Lond). 2022;36(9):1715–7. pmid:35102247 26. Nattino G, Pennell ML, Lemeshow S. Assessing the goodness of match of logistic regression fashions in giant samples: A modification of the Hosmer-Lemeshow take a look at. Biometrics. 2020;76(2):549–60. pmid:32134502 27. Jia X, Wang S, Zhu J, Yao D, Shi Y, Lin C. Prevalence of Myopia Among Children and Adolescents Aged 5-17: A Cross-Sectional Study in Haishu District, Ningbo City, China. Br J Hosp Med (Lond). 2025;86(7):1–15. pmid:40705550 28. Liang J, Pu Y, Chen J, Liu M, Ouyang B, Jin Z, et al. Global prevalence, pattern and projection of myopia in kids and adolescents from 1990 to 2050: a complete systematic overview and meta-analysis. Br J Ophthalmol. 2025;109(3):362–71. pmid:39317432 29. Mukazhanova A, Aldasheva N, Iskakbayeva J, Bakhytbek R, Ualiyeva A, Baigonova Okay, et al. Prevalence of refractive errors and threat elements for myopia amongst schoolchildren of Almaty, Kazakhstan: A cross-sectional research. PLoS One. 2022;17(6):e0269474. pmid:35657822 30. Bikbov MM, Kazakbaeva GM, Fakhretdinova AA, Tuliakova AM, Iakupova EM, Panda-Jonas S, et al. Prevalence and related elements of myopia in kids and adolescents in Russia: the Ural Children Eye Study. Br J Ophthalmol. 2024;108(4):593–8. pmid:37019624 31. Kim H, Seo JS, Yoo W-S, Kim G-N, Kim RB, Chae JE, et al. Factors related to myopia in Korean kids: Korea National Health and diet examination survey 2016-2017 (KNHANES VII). BMC Ophthalmol. 2020;20(1):31. pmid:31959143 32. Deng L, Pang Y. Effect of Outdoor Activities in Myopia Control: Meta-analysis of Clinical Studies. Optom Vis Sci. 2019;96(4):276–82. pmid:30907857 33. Philipp D, Vogel M, Brandt M, Rauscher FG, Hiemisch A, Wahl S, et al. The relationship between myopia and close to work, time outside and socioeconomic standing in kids and adolescents. BMC Public Health. 2022;22(1):2058. pmid:36357862 34. Pan W, Saw S-M, Wong TY, Morgan I, Yang Z, Lan W. Prevalence and temporal developments in myopia and excessive myopia kids in China: a scientific overview and meta-analysis with projections from 2020 to 2050. Lancet Reg Health West Pac. 2025;55:101484. pmid:39931228 35. French AN, Morgan IG, Mitchell P, Rose KA. Risk elements for incident myopia in Australian schoolchildren: the Sydney adolescent vascular and eye research. Ophthalmology. 2013;120(10):2100–8. pmid:23672971 36. Tideman JWL, Snabel MCC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RWAM, et al. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016;134(12):1355–63. pmid:27768171 37. Ma Y, Qu X, Zhu X, Xu X, Zhu J, Sankaridurg P, et al. Age-Specific Prevalence of Visual Impairment and Refractive Error in Children Aged 3-10 Years in Shanghai, China. Invest Ophthalmol Vis Sci. 2016;57(14):6188–96. pmid:27842160 38. Yip VC-H, Pan C-W, Lin X-Y, Lee Y-S, Gazzard G, Wong T-Y, et al. The relationship between progress spurts and myopia in Singapore kids. Invest Ophthalmol Vis Sci. 2012;53(13):7961–6. pmid:23150611 39. Kim H, Shahraki Okay, Suh DW. Myopia developments amongst kids and adolescents: a nationwide research in South Korea. J AAPOS. 2024;28(4):103969. pmid:38997085 40. Ma Y, Zou H, Lin S, Xu X, Zhao R, Lu L, et al. Cohort research with 4-year follow-up of myopia and refractive parameters in main schoolchildren in Baoshan District, Shanghai. Clin Exp Ophthalmol. 2018;46(8):861–72. pmid:29577563 41. Surl D, Seo Y, Han J. Trends in myopia prevalence amongst late adolescents in South Korea: a population-level research and future projections as much as 2050. BMJ Open Ophthalmol. 2024;9(1):e001748. pmid:39663140 42. Li F, Li Y, Liu Z, Xu C, Li H, Sun Y, et al. Influence of eye-related conduct on myopia amongst junior center college college students below the background of double discount in the course of the COVID-19 pandemic. BMC Public Health. 2024;24(1):1531. pmid:38844910 43. Jiang X, Tarczy-Hornoch Okay, Cotter SA, Matsumura S, Mitchell P, Rose KA, et al. Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age. JAMA Ophthalmol. 2020;138(5):501–9. pmid:32191277 44. Yu M, Hu Y, Han M, Song J, Wu Z, Xu Z, et al. Global threat issue evaluation of myopia onset in kids: A scientific overview and meta-analysis. PLoS One. 2023;18(9):e0291470. pmid:37729320 45. Pozarickij A, Enthoven CA, Ghorbani Mojarrad N, Plotnikov D, Tedja MS, Haarman AEG, et al. Evidence That Emmetropization Buffers Against Both Genetic and Environmental Risk Factors for Myopia. Invest Ophthalmol Vis Sci. 2020;61(2):41. pmid:32097480 46. He M, Xiang F, Zeng Y, Mai J, Chen Q, Zhang J, et al. Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial. JAMA. 2015;314(11):1142–8. pmid:26372583 47. Li D, Min S, Li X. Is Spending More Time Outdoors Able to Prevent and Control Myopia in Children and Adolescents? A Meta-Analysis. Ophthalmic Res. 2024;67(1):393–404. pmid:38710180 48. Shu Z, Chen Okay, Wang Q, Wu H, Zhu Y, Tian R, et al. The Role of Retinal Dopamine D1 Receptors in Ocular Growth and Myopia Development in Mice. J Neurosci. 2023;43(48):8231–42. pmid:37751999 49. Liu R, Hu M, He JC, Zhou X-T, Dai J-H, Qu X-M, et al. The results of monochromatic illumination on early eye growth in rhesus monkeys. Invest Ophthalmol Vis Sci. 2014;55(3):1901–9. pmid:24576875 50. Wu F, Tham Y-C, Sabanayagam C, Saw S-M. From proof to motion: Public well being approaches to decreasing display time and mitigating myopia threat. Asia Pac J Ophthalmol (Phila). 2025;14(2):100177. pmid:40021087 51. Torii H, Kurihara T, Seko Y, Negishi Okay, Ohnuma Okay, Inaba T, et al. Violet Light Exposure Can Be a Preventive Strategy Against Myopia Progression. EBioMedicine. 2017;15:210–9. pmid:28063778 52. Zhou S, Yang L, Lu B, Wang H, Xu T, Du D, et al. Association between mother and father’ attitudes and behaviors towards kids’s visible care and myopia threat in school-aged kids. Medicine (Baltimore). 2017;96(52):e9270. pmid:29384911 53. Deere Okay, Williams C, Leary S, Mattocks C, Ness A, Blair SN, et al. Myopia and later bodily exercise in adolescence: a potential research. Br J Sports Med. 2009;43(7):542–4. pmid:19581405 54. Chen D, Wang J, Chen J, Lu M, Du Y, Zhu Z, et al. Smartwatch-monitored bodily exercise and myopia in kids: a 2-year potential cohort research. BMC Med. 2025;23(1):294. pmid:40399891 55. Smith L, Jackson SE, Pardhan S, López-Sánchez GF, Hu L, Cao C, et al. Visual impairment and objectively measured bodily exercise and sedentary behaviour in US adolescents and adults: a cross-sectional research. BMJ Open. 2019;9(4):e027267. pmid:30987991 56. Lin S, Gong Q, Wang J, Gao H, Hong J, Guo Y, et al. The affiliation between sleep length and threat of myopia in Chinese school-aged kids: a cross-sectional research. Sleep Breath. 2023;27(5):2041–7. pmid:36797552 57. Jee D, Morgan IG, Kim EC. Inverse relationship between sleep length and myopia. Acta Ophthalmol. 2016;94(3):e204-10. pmid:26031352 58. Hussain A, Gopalakrishnan A, Scott H, Seby C, Tang V, Ostrin L, et al. Associations between systemic melatonin and human myopia: A scientific overview. Ophthalmic Physiol Opt. 2023;43(6):1478–90. pmid:37568264 59. Zhou X, An J, Wu X, Lu R, Huang Q, Xie R, et al. Relative axial myopia induced by extended gentle publicity in C57BL/6 mice. Photochem Photobiol. 2010;86(1):131–7. pmid:19912561 60. Fu A, Watt Okay, M Junghans B, Delaveris A, Stapleton F. Prevalence of myopia amongst deprived Australian schoolchildren: A 5-year cross-sectional research. PLoS One. 2020;15(8):e0238122. pmid:32853278 61. Wang Y, Liu L, Lu Z, Qu Y, Ren X, Wang J, et al. Rural-urban variations in prevalence of and threat elements for refractive errors amongst college kids and adolescents aged 6-18 years in Dalian, China. Front Public Health. 2022;10:917781. pmid:36106164 62. Zong Z, Zhang Y, Qiao J, Tian Y, Xu S. The affiliation between display time publicity and myopia in kids and adolescents: a meta-analysis. BMC Public Health. 2024;24(1):1625. pmid:38890613 63. Ding H, Jiang L, Lin X, Ye C, Chun B. Association of bodily exercise, sedentary behaviour, sleep and myopia in kids and adolescents: a scientific overview and dose-response meta-analysis. BMC public well being. 2025;25(1):1231. 64. Morgan IG, French AN, Ashby RS, Guo X, Ding X, He M, et al. The epidemics of myopia: Aetiology and prevention. Prog Retin Eye Res. 2018;62:134–49. pmid:28951126 65. Organization WH. Targets of Sustainable Development Goal 3. https://www.who.int/europe/about-us/our-work/sustainable-development-goals/targets-of-sustainable-development-goal-3. 2015. [ad_2] This web page was created programmatically, to learn the article in its unique location you possibly can go to the hyperlink bellow: https://journals.plos.org/plosone/article%3Fid%3D10.1371/journal.pone.0342658and if you wish to take away this text from our web site please contact us