Abstract Myopia is a complex disease influenced by multiple factors, and its prevention and control require a thorough identification and monitoring of its risk factors. The paper examines the defocus characteristics of the visual environment and their association with myopia among children and adolescents, and further describes their role in the prevention and control of myopia, as well as analyses the limitations of the current study and proposes directions for further research. Finally, the paper calls attention to the etiological significance of the defocus characteristics in the visual environment during the development of myopia among children and adolescents, which could provide a scientific basis for optimizing the learning environment and designing other measures to promote myopia prevention and control among children and adolescents.

Objective: To explore the association between sleep quality and dry eye symptoms in adolescents,so as to provide the evidence for reducing the prevalence of dry eye symptoms. Methods: The study population was adolescents aged 12-24 years from the Psychology and Behavior Investigation of Chinese Residents (PBICR) survey, which was conducted from 20 June to 31 August 2022. A stratified random sampling and quota sampling method was used to select 6 456 adolescents within mainland China. The Ocular Surface Disease Index (OSDI) and Brief version of the Pittsburgh Sleep Quality Index (B-PSQI) were used to assess dry eye symptoms and sleep quality. Multiple Logistic regression model was used to explore the relationship between sleep quality and dry eye symptoms in adolescents. The influence of gender on the association was explored by using interaction terms. Results: A total of 2 815 adolescents reported having dry eye symptoms, with a prevalence of 43.6%. Logistic regression analysis results showed an increased risk of exacerbation of dry eye symptoms in adolescents with poor sleep quality. The OR (95% CI ) for mild, moderate, and severe dry eye symptoms groups were 1.39(1.16-1.67), 1.52(1.28-1.81), and 2.35(2.02-2.72), respectively, compared with the ocularly normal group ( P <0.05). There was a significant interaction between sleep quality and gender on dry eye symptoms in adolescents ( P <0.01). Conclusions Sleep quality is associated with dry eye symptoms in adolescents, and those with poor sleep quality have a higher risk of dry eye symptoms. The effect of sleep quality on dry eye symptoms is greater in boys.

Abstract The choroid is a multifunctional dynamic structure located between the sclera and the Bruch membrane, which may be involved in the regulation of eye growth and the development of myopia. Choroidal thickness may serve as an important biomarker for predicting the development of myopia and the effectiveness of myopia control treatments in children and adolescents. The study reviews and summarizes the physiological structure and measuring methods of the choroid, and discusses its influencing factors including age, physiological changes, refractive status, axial length, drug effects, optical environment and so on. The review points out the potential applications of choroidal thickness in myopia research among children and adolescents.

To summarize the nursing experience of 5 patients with severe ARDS complicated with hypercapnia who underwent extracorporeal carbon dioxide removal(ECCO2R).Key points of nursing care included:establishing a rapid emergency response nursing team for ECCO2R;PETCO2 real-time monitoring to grasp the timing of the machine;ensuring continuity of treatment and improving the removal efficiency;respiratory-related monitoring;prevention of complications of blood coagulation and hypothermia;and weaning from extracorporeal carbon dioxide removal.After careful treatment and care,all the 5 patients were successfully removed from ECCO2R treatment.

Abstract The prevalence of myopia among children and adolescents in China remains high. Currently, the prevention and control of myopia among children and adolescents has risen to the level of national health strategy and has attracted extensive attention from the society. Although the role of outdoor activities in preventing myopia is significant, it also has many limitations. Therefore, it is necessary to explore more effective methods for comprehensive intervention. Based on current evidence, in addition to ongoing investigatation of the role of daytime outdoor activities in myopia prevention, emerging controllable environmental and behavioral factors, e.g. increase of indoor high frequency visual information, regulation of sleep and biological rhythm and dietary supplement of polyunsaturated fatty acids ω-3, warrents further attention and active transformation into appropriate technologies for myopia prevention and control.

Objective: To analyze research hot spots and trends on myopia in children and adolescents in China, and to provide a reference for the future development of this research field. Methods: Using CiteSpace software, 725 eligible Chinese documents published over a 22 year period were sourced from CNKI, VIP and Wanfang Chinese databases, were analyzed during 2000-2021. The data were visualized by a keyword co occurrence map, and clustering, as well as burst and author cooperative networks. Results: The research field of myopia in children and adolescents in China had undergone three stages:an initial formation period, development period and rapid growth period, and it was expected that the annual number of papers will maintain an increasing trend in the future. "Myopia" "adolescents" "children" and "students" were the most frequent keywords(667, 535, 288, 47). The keyword burst "adolescents" started the earliest, and "students" had the largest burst strength and duration. Zhang Ning, Tang Wenting, Tao Fangbiao, Yang Xiao and others have made important contributions to this research field. Conclusion In recent years, the research focus in this field has gradually shifted toward the influencing factors, as well as prevention and treatment measures of child and adolescent myopia. The trend of myopia in young children and adolescents is obvious. In the future, research on the prevention, control and treatment of myopia in children and adolescents will become a hot spot.

Objective: Based on observational, longitudinal and intervention study of common diseases among students in Jiangsu Province, this paper presents the current progress of two year follow up of myopia cohort regarding the association between growth parameters with progression of myopia among children and adolescents in areas with rapid economic growth. Methods: This survey adopted the stratified cluster sampling method for school selection. The full automatic computer optometry (TOPCON RM800) was used to track myopia related parameters for all participants from 2019 to 2020 under the condition of mydriasis (compound topicamide eye drops). Relationship between growth parameters of children and adolescents and the incidence and progression of myopia was analyzed by using Cox regression multiple statistical model. Results: The myopia rates of students from grade 1 to grade 3 in 2019 were 5.4%, 21.5% and 37.3% respectively. After one year, the myopia rates of all school stages increased to 25.3%, 43.3% and 58.1% respectively( χ 2=53.59, 49.63, 32.52, P <0.01). The mean diopter of right eye and left eye after mydriasis were ( 0.30± 1.24/0.39±1.26)D in 2019 and (-0.33±1.54/-0.19±1.55)D in 2020, respectively based on Cox multiple regression results, age ( HR =1.21, 95% CI =1.09-1.34), naked eye vision ( HR =0.08, 95% CI =0.07-0.11), height ( HR =0.98, 95% CI =0.97-0.99) showed a strong correlation with the incidence and progression of myopia( P <0.05). Conclusion Myopia is growing rapidly in the central region of Jiangsu Province. It is suggested that diopter, axial length, naked eye vision, age, height and other indicators should be included in the refractive archives of children and adolescents in the region.

Objective: To understand the referral rate in children with abnormal refractive error in screening programs and associated factors, aiming to provide evidence for improving the rate and myopia prevention and control in the future. Methods: Using cluster sampling, three primary schools and three junior middle schools in Huangpu District, Shanghai were selected. All students were archived for refractive development, including examinations such as visual acuity, non cycloplegic autorefraction and axial length. The follow up visit and related factor information were collected through questionnaire, and the influencing factors of referral rate were analyzed by multivariate Logistic regression. Results: A total of 2 104 high risk children and adolescents with suspected refractive abnormalities were suggested follow up visit, and the actual referral rate was estimated to be 60.4%; the rate of referral to designated hospitals was estimated to be 58.8%. Nonconditional Logistic regression analysis showed that myopic status before the screening( OR=1.37, 95%CI =1.08-1.72), wearing spectacles or ortho contact lens( OR=2.05, 95%CI =1.62-2.59), myopic degree ( OR below -0.5 D =2.08, 95% CI =1.48-2.92, OR -3.0~-0.5 D =1.86, 95% CI =1.47-2.36), parents familiarity with screening results( OR=2.92, 95%CI =1.89-4.50), parents satisfaction with suggestions after screening ( OR=3.54, 95%CI =1.16-10.79) were significant factors associated with the referral rate( P <0.05). Conclusion The actual referral rate among children and adolescents needs to be improved. It is necessary to further optimize the informatization of refractive archives, strengthen popular science education for key population, standardize the professional interpretation of preliminary screening refractive examination results, improve parents awareness, participation and satisfaction through health education, and achieve the whole process management of refractive archives.

Objective: To investigate the refractive progression and associated factors of children of different ages and refractive status, and to provide guidance on myopia prevention and control program formulation and work practice. Methods: A total of 20 kindergartens, primary schools, and secondary schools in 2 districts of Shanghai were selected based on the existing cohort, and baseline data in 2015 and one year follow up data in 2016 were collected from 1 510 children aged 4 to 14, including cycloplegic spherical equivalent refraction (SER), axial length (AL), and corneal curvature. The distribution and progression of SER and AL in children of different ages and refractive status were analyzed, and the influencing factors of SER progression (ΔSER) were explored using multiple linear regression. Results: ΔSER remained relatively stable at age 4 and 5 (average -0.08 to -0.07 D/year), and SER drifted significantly towards myopia (average -0.50 to -0.31 D/year) in all groups older than 6 years, dropping back to -0.44 to -0.33 D/year after age 11; Elongation of AL (ΔAL) was 0.27 to 0.35 mm/year in 4 to 10 years group, and decreased to 0.15 to 0.22 mm/year in 11 to 14 years group. The ΔSER and ΔAL were greatest in the new onset myopes [(-0.90± 0.05 )D, (0.51±0.02)mm], followed by the low myopia group [(-0.68±0.04)D, (0.36±0.02)mm], then followed by the moderate to high myopia group[(-0.49±0.06)D，(0.23±0.03)mm] and the lowest in the hyperopia group[(-0.21±0.02)D, ( 0.26 ±0.01)mm], with a statistically significant difference among these groups ( P <0.05). Age ( β =-0.07), baseline SER ( β = 0.05 ) and ΔAL ( β =-0.78) were independent influencing factors for refractive progression in the 4 to 10 years old group, while ΔAL( β =-1.55) was the only independent influencing factor in the 11 to 14 years old group ( P <0.05). Conclusion The elongation of AL in preschoolers is mostly physiologically and should be prevented from growing beyond the physiological range by increasing outdoor activities. The primary students, as well as students with pre myopia or low myopia are the priority groups for dynamic monitoring and intervention in myopia prevention and control.

Abstract The incidence of myopia in children and adolescents has increased in recent years, with an earlier onset trend. During the same time, sleep problems are prevalent in children and adolescents, including insufficient sleep duration and delayed sleep timing. Sleep, as a cyclical life activity influenced by the circadian rhythm, plays an important role in eye growth and refractive development. This review examines the associations between sleep, circadian rhythm, and occurrence of myopia in children and adolescents across human and animal studies, and discusses the underlying biological processes, so as to offer scientific justification for the prevention of myopia in children and adolescents.