目的评估3种不同户外活动干预方案对中国学龄儿童近视患病率的长期影响。
方法以儿童屈光不正研究的横断面数据作为近视原始患病率，广州双生子眼病研究的10年纵向数据作为近视原始发病率，并基于广州户外活动纵向研究数据得出户外活动干预的效应量。提出3种不同的干预方案，即对1~6年级儿童进行户外活动干预(方案a)、对1~3年级儿童进行户外活动干预(方案b)和对幼儿园最后1年至小学3年级儿童进行户外活动干预(方案c)，不同干预方案中户外活动干预均指每日增加40 min的户外活动时间。模拟分析假设患病率随发病率下降和儿童就读年级的升高而递减，高度近视儿童的近视程度也随着近视发病的延迟而下降。
结果随着干预时间的延长，儿童整体近视患病率有明显下降趋势，其中方案a实施5年后人群近视患病率由34.67%降至25.71%，实施10年后降至24.89%，平均每年下降0.98%；方案b和方案c对儿童近视患病率的长期影响相似，实施10年后近视患病率分别降至26.00%和26.20%，平均每年下降0.87%和0.85%。方案a带来的近视度数降幅最大，实施5年后原15岁高度近视人群的平均屈光度为－5.94 D，实施10年后为－5.88 D；其次为方案b，实施第5年和第10年的屈光度分别为－6.08 D和－6.02 D。
结论对小学1~6年级儿童实施强化户外活动干预可能是降低近视高发地区人群总体患病率的较佳策略。
ObjectiveTo evaluate the long-term impact of three different outdoor activity intervention strategies on the prevalence of myopia among school-aged children in China.
MethodsCross-sectional data from the Refractive Error Study in Children (RESC) on the baseline prevalence of myopia and 10-year longitudinal data from the Guangzhou Twin Eye Study (GTES) on the baseline incidence of myopia were utilized.The effect size of outdoor activity intervention was derived from longitudinal data of the Guangzhou Outdoor Activity Longitudinal Study (GOALS). Three intervention strategies were proposed: intervention for children in grades 1 to 6 (Strategy A), intervention for children in grades 1 to 3 (Strategy B), and intervention for children from the last year of kindergarten to grade 3 (Strategy C). Outdoor activity interventions across all strategies included an extra 40 minutes of daily outdoor activity time.Simulated analyses assumed that the prevalence of myopia would decrease with declining incidence and increasing school grade, and the degree of myopia among highly myopic children would decrease with delayed myopia onset.This study was approved by the Ethics Committee of Zhongshan Ophthalmic Center (No.2006-5).
ResultsWith prolonged intervention time, the overall prevalence of myopia in children showed a significant declining trend.After 5 years of implementation, Strategy A resulted in a decrease in myopia prevalence from 34.67% to 25.71%, which decreased to 24.89% after 10 years, with an average annual reduction of 0.98%.Strategies B and C had similar long-term effects, with myopia prevalence after 10 years being 26.00% and 26.20% respectively, with an average annual reductions of 0.87% and 0.85%.Strategy A yielded the greatest reduction in myopia severity, with a decrease of -5.94 D after 5 years and -5.88 D after 10 years in the initial 15-year-old highly myopic individuals.Strategy B followed with -6.08 D and -6.02 D after 5 and 10 years, respectively.
ConclusionsImplementing intensified outdoor activity intervention among children in grades 1 to 6 may be the recommended strategy to reduce the overall prevalence of myopia in regions with high rates of myopia among school-aged children.
陈燕先,张健,韩晓彤,等. 不同户外活动干预方案对中国儿童近视患病率长期影响的模拟分析[J]. 中华实验眼科杂志,2023,41(12)：1203-1207.
DOI:10.3760/cma.j.cn115989-20220624-00294版权归中华医学会所有。
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陈燕先：参与选题、酝酿和设计试验、采集数据、分析及解释数据、起草文章；张健：酝酿和设计试验、采集数据、分析及解释数据；韩晓彤：起草文章；胡音、王丽丽：对文章知识性内容的审阅和智力性内容的修改及定稿；何明光：参与选题、对文章知识性内容的审阅和智力性内容的修改及定稿
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