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. 2023 Dec 1;6(12):e2346999.
doi: 10.1001/jamanetworkopen.2023.46999.

Urban Living Environment and Myopia in Children

Xiaotong Li  1   2 , Lihua Li  2   3 , Wen Qin  2   4 , Qing Cao  2   3 , Xin Mu  2   3 , Tiange Liu  1   2 , Zhen Li  1   2 , Wei Zhang  1   2
Affiliations

Urban Living Environment and Myopia in Children

Xiaotong Li et al. JAMA Netw Open. .

Abstract

Importance: The global prevalence of myopia has shown a steady increase over recent decades, with urban areas seemingly experiencing a more significant impact.

Objective: To assess the association between urbanization and the prevalence, incidence, progression, and severity of myopia.

Design, setting, and participants: This cohort study included students in grades 1 to 6 in Tianjin, China, who underwent 3 vision examinations conducted over a 2-year period, from March 1, 2021, to March 31, 2023. Participants from grades 1 to 4 completed the 2-year follow-up.

Exposures: Urban living environment.

Main outcomes and measures: The association of urbanization with the incidence, progression, prevalence, and severity of myopia. To quantify urbanization, an urban score was constructed using satellite data and an iterative exploratory factor analysis.

Results: Of 177 894 students (51.7% male; mean [SD] age, 10.27 [1.75] years) included in the study, 137 087 students (52.3% male; mean [SD] age, 8.97 [1.21] years) were followed up for 2 years. A positive association was identified between myopia incidence and urbanization. Specifically, each 1-unit increment in the urban score was associated with an increased risk of myopia over a 1-year period (odds ratio [OR], 1.09; 95% CI, 1.01-1.15; P = .02) and a 2-year period (OR, 1.53; 95% CI, 1.50-1.57; P < .001). Conversely, each 1-unit increase in the urban score was associated with a significant decrease in myopia progression at 1 year (OR, 0.84; 95% CI, 0.82-0.86; P < .001) and 2 years (OR, 0.73; 95% CI, 0.70-0.75, P < .001). In a cross-sectional data analysis, the urban score was positively associated with myopia prevalence (OR, 1.62; 95% CI, 1.08-2.42; P = .02) and negatively associated with myopia severity, as indicated by spherical equivalent refraction (OR, 1.46; 95% CI, 1.07-1.99; P = .02).

Conclusions and relevance: This study exploring urban living environments and myopia revealed dual associations of urban living with both the incidence and the progression of myopia. The observed patterns emphasize the urgency of promptly implementing myopia control strategies in less urbanized regions, where myopia progression may be accentuated.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flowchart
Longitudinal and cross-sectional analyses were conducted for elementary school students in grades 1 to 4 and grades 1 to 6, respectively.
Figure 2.
Figure 2.. Prevalence and Severity of Myopia by High and Low Urbanization
SER indicates spherical equivalent refraction.
See this image and copyright information in PMC

References

    1. Fan Q, Verhoeven VJ, Wojciechowski R, et al. ; Consortium for Refractive Error and Myopia . Meta-analysis of gene-environment-wide association scans accounting for education level identifies additional loci for refractive error. Nat Commun. 2016;7:11008. doi:10.1038/ncomms11008 - DOI - PMC - PubMed
    1. Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012;379(9827):1739-1748. doi:10.1016/S0140-6736(12)60272-4 - DOI - PubMed
    1. Morgan IG, French AN, Ashby RS, et al. . The epidemics of myopia: aetiology and prevention. Prog Retin Eye Res. 2018;62:134-149. doi:10.1016/j.preteyeres.2017.09.004 - DOI - PubMed
    1. Morgan IG, Rose KA. Myopia: is the nature-nurture debate finally over? Clin Exp Optom. 2019;102(1):3-17. doi:10.1111/cxo.12845 - DOI - PubMed
    1. Holden BA, Fricke TR, Wilson DA, et al. . Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042. doi:10.1016/j.ophtha.2016.01.006 - DOI - PubMed

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