1.Expert recommendations on vision friendly built environments for myopia prevention and control in children and adolescents
Chinese Journal of School Health 2026;47(1):1-5
Abstract
The prevention and control of myopia in Chinese children and adolescents has become a major public health issue. While maintaining increased outdoor activity as a cornerstone intervention, there is an urgent need to explore new complementary approaches that can be effectively implemented in both indoor and outdoor settings. In recent years, environmental spatial frequency has gained increasing attention as one of the key environmental factors influencing the development and progression of myopia. Both animal studies and human research have confirmed that indoor environments lacking mid to high spatial frequency components, often characterized as "visually impoverished", can promote axial elongation and myopia through mechanisms such as disruption of retinal neural signaling, impaired accommodative function, and altered expression of related molecules. Based on the scientific consensus, it is recommended that "enriching of environmental spatial frequency" should be integrated into the myopia prevention and control framework. Following the principles of schoolled organization, family cooperation, community involvement, and student participation, specific measures are put forward in three areas:optimizing school visual settings, improving home spatial environments, and promoting healthy visual behavior. The aim is to create "visually friendly" indoor environments as an important supplement to outdoor activity, thereby providing a novel perspective and strategy for comprehensively advancing myopia prevention and control among children and adolescents.
2.Research progress on the application of behavioral interventions in promoting outdoor activities among children and adolescents
NI Zihan, JING Guangzhuang, HE Xiangui
Chinese Journal of School Health 2025;46(11):1668-1672
Abstract
The effectiveness of outdoor activities in promoting health in children and adolescents has been validated. However, outdoor activity time among children and adolescents has gradually decreased, posing a significant challenge to children s physical and mental health. Current research suggests that behavioral interventions can effectively increase outdoor activity time among children and adolescents. The study reviews the decline in outdoor activity time, insufficient outdoor activity time, and low compliance, and expounds on the research progress of increasing outdoor activity time through multi level behavioral interventions at the individual, interpersonal, and school levels. It provides a scientific basis for the formulation and implementation of relevant policies and measures for outdoor activities.
3.Hyperopia reserve among 6‒8-year-old primary school students in Jing’an District, Shanghai
Limeng WANG ; Wenyan XU ; Xiangdong WANG ; Yawen GUO ; Zhou ZHOU ; Xiangui HE
Shanghai Journal of Preventive Medicine 2025;37(5):458-460
ObjectiveTo understand the uncorrected visual acuity, spherical equivalent and hyperopia reserve of 6‒8-year-old primary school students in Jing’an District of Shanghai, and to provide a scientific basis for further myopia prevention and control. MethodsA total of 619 children aged between 6‒8 years old from three primary schools in Jing’an District were selected by cluster sampling method for uncorrected eye visual acuity examination and diopter examination after cycloplegia (mydriasis). ResultsThe mean uncorrected visual acuity of the619 students aged 6‒8 years old was (4.9±0.2), and the mean spherical equivalent was (0.84±1.11) D. The difference in uncorrected visual acuity was not statistically significant as the age increased (F=0.057, P=0.812), but the spherical equivalent decreased with the increase of age, showing a statistically significant difference (F=26.533, P
4.Association of outdoor activity level and myopia among children and adolescents in Shanghai
Chinese Journal of School Health 2025;46(1):18-23
Objective:
To analyze the status of outdoor activities on weekends among children and adolescents of different educational stages in Shanghai and their impact on myopia, so as to provide a basis for formulating more specific prevention and control protocol of myopia.
Methods:
From September to October 2022, a stratified cluster random sampling method was employed to select 84 schools (27 kindergartens, 21 primary schools, 15 junior high schools and 21 high schools) across Shanghai, enrolling a total of 28 654 children and adolescents aged 4 to 18 for the study. Ophthalmic examinations were conducted to ascertain the prevalence of myopia among children and adolescents. Additionally, a questionnaire survey was administered to collect data on outdoor activity duration and associated factors. Multivariate Logistic regression analysis was utilized to investigate the associated factors of outdoor activity levels on weekends.
Results:
The overall myopia detection rate among children and adolescents was 58.4%, with a higher rate observed in girls (59.2%) compared to boys (57.6%). The myopia detection rates for children and adolescents with an average daily outdoor activity duration of ≥2 h and <2 h on weekends were 54.6% and 68.8%, and the differences were statistically significant ( χ 2=8.12,460.89, P <0.01). Multivariable Logistic regression analysis revealed that girls ( OR =0.80), those with a myopic parent ( OR =0.68), schools from urban districts ( OR =0.72), higher education stages (primary school: OR =0.65, junior high school: OR =0.24, high school: OR =0.14) and spending≥2 h/d on homework during weekends ( OR =0.57) among children and adolescents were less likely to engage in outdoor activities for ≥2 h on weekends ( P <0.01). After incorporating gender, parental myopia status, educational stage, school location, average daily duration on weekends for spending on homework, electronic product usage and outdoor activities as dependent variables in a multivariate Logistic regression analysis, the results showed that children and adolescents with an average outdoor activity duration for ≥2 h on weekends had a lower risk of myopia ( OR =0.86, P < 0.01).
Conclusions
The level of outdoor activity among children and adolescents on weekends needs to be improved. Outdoor activities on weekends is an associated factor for myopia among children and adolescents. Particularly, girls, those with myopic parents, schools from urban districts, and spending long hours on homework during weekends among children and adolescents require increased attention.
5.Visual acuity and corrected visual acuity of children and adolescents in Shanghai City
Chinese Journal of School Health 2025;46(1):24-28
Objective:
To investigate the visual acuity and correction conditions of children and adolescents in Shanghai, so as to provide a scientific basis for developing intervention measures to prevent myopia and protect vision among children and adolescents.
Methods:
From October to December 2022, a stratified cluster random sampling survey was conducted, involving 47 034 students from 16 municipal districts in Shanghai, covering kindergartens (≥5 years), primary schools, middle schools, general high schools and vocational high schools. According to the Guidelines for Screening Refractive Errors in Primary and Secondary School Students, the Standard Logarithmic Visual acuity Chart was used to examine naked vision and corrected vision of students, and general information was collected. The distribution and severity of visual impairment in different age groups were analyzed, and χ 2 tests and multivariate Logistic regression were used to explore factors associated with visual impairment.
Results:
The detection rate of visual impairment among children and adolescents was 76.2%, with a higher rate among females (78.8%) than males ( 73.8 %), higher among Han ethic students ( 76.2 %) than minority students (71.2%), and higher among urban students (76.7%) than suburban students (75.8%), all with statistically significant differences ( χ 2=162.6, 10.4, 5.5, P <0.05). The rate of visual impairment initially decreased and then increased with age, reaching its lowest at age 7 (53.8%) and peaking at age 17 (89.6%) ( χ 2 trend = 3 467.0 , P <0.05). Severe visual impairment accounted for the majority, at 56.6%, and there was a positive correlation between the severity of visual impairment and age among children and adolescents ( r =0.45, P <0.05). Multivariate Logistic regression showed that age, BMI, gender, ethnicity and urban suburban status were associated with visual impairment ( OR =1.18, 1.01, 1.38 , 0.79, 0.88, P <0.05). Among those with moderate to severe visual impairment, the rate of spectacle lens usage was 62.8%, yet only 44.8 % of those who used spectacle lens had fully corrected visual acuity. Females (64.9%) had higher spectacle lens usage rates than males (60.6%), and general high school students had the highest spectacle lens usage (83.9%), and there were statistically significant differences in gender and academic stages ( χ 2=57.7, 4 592.8, P <0.05).
Conclusions
The rate of spectacle lens usage among students with moderate to severe visual impairment is relatively low, and even after using spectacle lens, some students still do not achieve adequate corrected visual acuity. Efforts should focus on enhancing public awareness of eye health and refractive correction and improving the accessibility of related health services.
6.Comparison of the agreement of measurements between the ARK Biometer Combo and OA 2000 in patients wearing orthokeratology lenses
Li DING ; Linlin DU ; Xiaoyu ZHU ; Meng CHEN ; Wenbo YAO ; Xiangui HE ; Mengjun ZHU
International Eye Science 2025;25(9):1541-1546
AIM: To compare the agreement between the ARK Biometer Combo and OA 2000 in patients wearing orthokeratology lenses.METHODS: A prospective study. A total of 148 patients(148 eyes)who were wearing orthokeratology lenses and returned for follow-up at the Shanghai Eye Disease Prevention and Treatment Center from August to September 2024 were included. Biometric measurements were performed using both the ARK Biometer Combo and OA 2000. Parameters including axial length(AL), corneal central thickness(CCT), anterior chamber depth(ACD), lens thickness(LT), corneal curvature(Kf and Ks), astigmatism(AST), white-to-white corneal diameter(WTW)and pupil diameter(PD)were obtained. Differences in measurement parameters between the two biometers were compared, and agreement was assessed.RESULTS: There were no statistically significant differences in the measurements of Kf, Ks and AST between the two biometers(P>0.05). Statistically significant differences were found in the measurements of AL, CCT, ACD, LT, WTW and PD(t=2.559, P=0.012; t=16.771, P<0.0001; t=4.749, P<0.0001; t=-15.212, P<0.0001; t=-14.915, P<0.0001; t=-2.402, P=0.018). ICC ranged from 0.615 to 0.999. Bland-Altman analysis showed that the maximum absolute values of the 95% limits of agreement(LoA)of AL, CCT, ACD, LT, Kf, Ks, AST, WTW and PD were 0.07 mm, 35.07 μm, 0.07 mm, 0.12 mm, 0.66 D, 1.14 D, 1.00 D, 0.76 mm, and 0.98 mm, respectively.CONCLUSION: In orthokeratology patients, the ARK Biometer Combo and OA 2000 showed good agreement in measuring AL, CCT, ACD, Kf and LT, and can be used interchangeably.
7.Reflections on the current state of diagnosis and treatment for peritoneal metastasis in colorectal cancer
Jian WANG ; Xiangui HE ; Yeting HU ; Lifeng SUN ; Kefeng DING
Chinese Journal of Gastrointestinal Surgery 2025;28(5):465-472
Peritoneal metastasis of colorectal cancer is the second most common metastatic pattern after liver metastasis, clinically common and associated with a poor prognosis. Refractory subtypes such as mucinous adenocarcinoma, signet-ring cell carcinoma, and BRAF V600E-mutated colorectal cancers account for a relatively high proportion in peritoneal metastasis. While previous diagnosis and treatment faced significant challenges, recent advances in new technologies and evolving therapeutic concepts have achieved progress in management. Many patients with colorectal cancer peritoneal metastasis have obtained favorable treatment outcomes, though numerous challenges persist. This article provides an in-depth analysis of current status and advancements in the diagnosis and treatment of colorectal cancer peritoneal metastasis, examines existing clinical difficulties and unresolved issues, and explores the application of advanced technologies in clinical practice. Through promoting individualized, precise, and standardized treatment concepts, we aim to enhance survival benefits for more patients.
8.From evidence to practice: key elements for effective prevention of myopia in children and adolescents
Chinese Journal of Experimental Ophthalmology 2025;43(4):301-307
The prevention and control of myopia in children and adolescents has become a strategic health task in China, with the important goals of preventing myopia onset and reducing the incidence of myopia in adolescents.Currently, it is urgent to implement a strategy that emphasizes both prevention and control, advances the prevention checkpoint, and focuses on key populations.At present, how to accurately assess individual risks, how to meet differentiated prevention needs, how to optimize group and individual prevention technology solutions to maximize resource utilization, etc., are still key issues that urgently need to be addressed to improve the effectiveness and efficiency of myopia prevention.Based on current evidence, this paper discusses key elements of myopia prevention in children and adolescents.These include the assessment of individual hyperopia reserve to identify high-risk individuals at an early stage, the development of simplified methods to measure hyperopia reserve and classify refractive status, and the establishment and refinement of risk prediction models by integrating genetic, environmental, and behavioral factors.Additionally, personalized prevention strategies should be tailored to different age groups and risk levels, with appropriate and comprehensive interventions-such as outdoor activities, optical correction, and pharmaceutical treatments-at both the individual and population levels.This paper aims to provide a reference for research directions in myopia prevention, promote personalized and precise myopia prevention and control practices, and accelerate the reduction of myopia rates in children and adolescents.
9.Does repeated low-level red light therapy affect cone density in the macula of myopic children?
Hongmei ZHANG ; Xiangui HE ; Ying JIE ; Ruihua WEI ; Mingguang HE
Chinese Journal of Experimental Ophthalmology 2025;43(6):496-498
The increasing prevalence of myopia has become one of the major global public health issues.Current myopia control measures, such as orthokeratology lenses, defocus spectacles, soft defocus contact lenses, low-concentration atropine eye drops all have limitations.Repeated low-level red light (RLRL) therapy emerging in recent years has become one of the treatments for childhood myopia.Multiple clinical studies have shown that RLRL irradiation can inhibit the rapid progression of myopia in children and adolescents.Recently, a research report titled Cone Density Changes After Repeated Low- Level Red Light Treatment in Children With Myopia, which has sparked widespread discussion among parents of myopic children.The main purpose of this article is to conduct a detailed analysis of the research methods and results, and to explore whether the conclusion can be drawn that RLRL affects the density of macular cone cells in myopic children.
10.Analysis of differences between subjective and objective refraction results in myopic children and adolescents under different ciliary muscle functional states
Xinhui HUANG ; Haotian WU ; Bo ZHANG ; Zhijian AI ; Jun CHEN ; Xiangui HE
Chinese Journal of Experimental Ophthalmology 2025;43(2):138-143
Objective:To analyze the differences between subjective refraction and autorefraction in myopic children and adolescents under different ciliary muscle functional states.Methods:A cohort study was conducted.A total of 98 myopic children and adolescents (196 eyes) aged 7-15 years who visited the Shanghai Eye Disease Prevention and Treatment Center from November 2023 to February 2024 were included by random sampling.All participants underwent cycloplegia with 1.0% cyclopentolate and completed both subjective refraction and autorefraction before cycloplegia, after cycloplegia and after recovery from cycloplegia.The spherical equivalent (SE) differences and differences in SE(ΔSE) between different conditions were compared.Proportion of ΔSE, differences in spherical power (ΔS), and differences in cylindrical power (ΔC) of objective and subjective refraction between different conditions within the clinically acceptable error range (-0.25 to 0.25 D) was calculated and compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shanghai Eye Diseases Prevention & Treatment Center (No.2021SQ021).Written informed consent was obtained from guardian of each subject before any medical examination.Results:The SE values obtained from autorefraction before cycloplegia, after cycloplegia, and after recovery from cycloplegia were -2.44(-3.47, -1.63), -2.13(-3.25, -1.50), and -2.38(-3.50, -1.66)D, respectively, with a statistically significant overall difference ( χ2=148.36, P<0.001) and statistically significant differences in pairwise comparisons at different time points (all P<0.001); for subjective refraction, the SE values were -2.25(-3.50, -1.50), -2.19(-3.47, -1.45), and -2.28(-3.50, -1.50)D, respectively, with a statistically significant overall difference ( χ2=43.48, P<0.001) and statistically significant differences in pairwise comparisons at different time points (all P<0.001).Subjective refraction ΔSE between before and after cycloplegia, after cycloplegia and after recovery from cycloplegia were significantly smaller than those of autorefraction ( t=2.84, 1.82; both P<0.001).There was no significant difference in ΔSE between subjective refraction and autorefraction between before cycloplegia and after recovery from cycloplegia ( t=-0.43, P=0.070).The proportions of subjective refraction ΔSE within the acceptable error range between before and after cycloplegia, before cycloplegia and after recovery from cycloplegia, and after cycloplegia and after recovery from cycloplegia were significantly higher than those of autorefraction ( χ2=28.32, 11.82, 25.55; all P<0.001).The proportion of subjective refraction ΔS and ΔC both within the acceptable error range between before cycloplegia and after recovery from cycloplegia was 81.63%(160/196) and 79.59%(156/196) between after cycloplegia and after recovery from cycloplegia. Conclusions:Subjective refraction is less affected by different ciliary muscle functional states.The differences in subjective refraction results under different ciliary muscle functional states are mostly within the acceptable error range.The subjective refraction results before or after cycloplegia can be used to better predict the subjective refraction results after recovery from cycloplegia.


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