Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial
Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial
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DOI：
10.1016/j.ophtha.2017.12.011
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发表时间：
2018-08-01
期刊：
影响因子：
13.7
通讯作者：
Yang, Yi-Hsin
中科院分区：
文献类型：
--
作者：
Wu, Pei-Chang;Chen, Chueh-Tan;Yang, Yi-Hsin
目的：探讨以学校为基础，推广户外活动预防近视的效果，并确定防护性光线强度。设计：多地区、整群随机干预对照试验。参与者：16所学校的693名一年级学生。方法：首先将24所学校随机分为干预组和对照组，但干预组和对照组分别有5所和3所学校在入学前退学。干预组实施了以学校为基础的课外休息试验，鼓励小学生每周户外活动长达11小时。主要观察指标：1年后球镜当量和眼轴长度的变化，以及户外光线暴露的强度和持续时间。结果：与对照组相比，干预组近视移位和眼轴伸长显著减少(0.35D比0.47D；0.28vs.0.33 mm；P=0.002和P=0.003)，快速近视进展的风险降低54%(优势比0.46D；95%可信区间[CI]，0.28-0.77；P=0.003)。与对照组相比，近视儿童和非近视儿童的近视保护效果均显著。关于每周至少11小时户外活动，暴露在1000勒克斯或以上的光线下，干预组的参与者明显多于对照组(49.79%vs.22.73%；P<；0.001)。在学校户外活动时间越长(>；=200min)的学龄儿童近视漂移显著减少(用测光仪测量；>；=1000lux：0.14D；95%CI，0.02e0.27；P=0.02；>；=3000lux：0.16D；95%CI，0.002~0.32；P=0.048)。对于预防近视来说，有强烈阳光照射的户外活动可能并不是必要的。也可以考虑户外光照强度相对较低、户外时间较长的活动，如在走廊或树下。(C)2018年美国眼科学会
Purpose: To investigate the effectiveness of a school-based program promoting outdoor activities in Taiwan for myopia prevention and to identify protective light intensities.Design: Multi-area, cluster-randomized intervention controlled trial.Participants: A total 693 grade 1 schoolchildren in 16 schools participated. Two hundred sixty-seven schoolchildren were in the intervention group and 426 were in the control group.Methods: Initially, 24 schools were randomized into the intervention and control groups, but 5 and 3 schools in the intervention and control groups, respectively, withdrew before enrollment. A school-based Recess Outside Classroom Trial was implemented in the intervention group, in which schoolchildren were encouraged to go outdoors for up to 11 hours weekly. Data collection included eye examinations, cycloplegic refraction, noncontact axial length measurements, light meter recorders, diary logs, and questionnaires.Main Outcome Measures: Change in spherical equivalent and axial length after 1 year and the intensity and duration of outdoor light exposures.Results: The intervention group showed significantly less myopic shift and axial elongation compared with the control group (0.35 diopter [D] vs. 0.47 D; 0.28 vs. 0.33 mm; P = 0.002 and P = 0.003) and a 54% lower risk of rapid myopia progression (odds ratio, 0.46; 95% confidence interval [CI], 0.28-0.77; P = 0.003). The myopic protective effects were significant in both nonmyopic and myopic children compared with controls. Regarding spending outdoor time of at least 11 hours weekly with exposure to 1000 lux or more of light, the intervention group had significantly more participants compared with the control group (49.79% vs. 22.73%; P < 0.001). Schoolchildren with longer outdoor time in school (>= 200 minutes) showed significantly less myopic shift (measured by light meters; >= 1000 lux: 0.14 D; 95% CI, 0.02e0.27; P = 0.02; >= 3000 lux: 0.16 D; 95% CI, 0.002-0.32; P = 0.048).Conclusions: The school-based outdoor promotion program effectively reduced the myopia change in both nonmyopic and myopic children. Outdoor activities with strong sunlight exposure may not be necessary for myopia prevention. Relatively lower outdoor light intensity activity with longer time outdoors, such as in hallways or under trees, also can be considered. (C) 2018 by the American Academy of Ophthalmology