{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:54:09Z","timestamp":1791284049980,"version":"4.1.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Myopia is a multifactorial condition driven by an interplay of genetic predisposition and environmental triggers. This study aims to harmonize and analyze risk predictors from two distinct datasetsone historical and clinical, the other contemporary and behavioralto develop an integrated framework for myopia risk prediction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed two datasets: the Orinda Longitudinal Study of Myopia (OLSM), a 1995 US cohort (n\u2248500) with detailed ocular biometrics (e.g., spherical equivalent refraction, axial length) and lifestyle factors, and a 2022-2023 Chinese cross-sectional study (n=100,000) highlighting modern behaviors (e.g., screen time, posture). We employed multiple machine learning modelsincluding logistic regression, Explainable Boosting Machine (EBM), gradient boosting decision trees (GBDT) on OLSM, and deep neural networks (DNN) and XGBoost on the Chinese datasetto identify key predictors. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). We also tested three ensemble strategies (sequential, averaging, transfer learning) to merge insights across the structurally divergent datasets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both datasets confirmed parental myopia as a universal risk factor and time spent outdoors as a protective factor. In the OLSM dataset, spherical equivalent refraction and parental myopia were the top predictors, with models achieving an AUC of up to 0.92. In the Chinese dataset, the DNN model achieved 71% accuracy, identifying screen time, posture, and parental history as major risk factors. Cross-dataset integration via transfer learning proved most effective, successfully amplifying features like outdoor activity and posture while retaining core behavioral predictors like screen time. This approach bridged the clinical depth of OLSM with the granular, modern lifestyle insights from the Chinese dataset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Our analysis confirms the multifactorial nature of myopia, blending historical biological mechanisms with contemporary behavioral drivers. The study demonstrates a scalable strategy for global myopia risk prediction by adaptively integrating diverse datasets. While not yet a turnkey clinical tool, this work lays the groundwork for future multimodal risk-prediction frameworks that can bridge era-specific biases and harness machine learning to capture the evolving profile of myopia risk.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1595320","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T05:37:36Z","timestamp":1761025056000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Uncovering predictors of myopia in youth: a secondary data analysis using a machine learning approach"],"prefix":"10.3389","volume":"12","author":[{"given":"Jiajia","family":"Liao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijie","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanqing","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1136\/bjo-2024-325427","article-title":"Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis","volume":"109","author":"Liang","year":"2025","journal-title":"Br J Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2788","DOI":"10.4103\/ijo.IJO_2415_21","article-title":"Myopia, its prevalence, current therapeutic strategy and recent developments: a review","volume":"70","author":"Singh","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1038\/s41572-020-00231-4","article-title":"Myopia","volume":"6","author":"Baird","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12886-019-1220-0","article-title":"A review on the epidemiology of myopia in school children worldwide","volume":"20","author":"Grzybowski","year":"2020","journal-title":"BMC Ophthalmol"},{"key":"ref5","first-page":"27","volume-title":"Global epidemiology of myopia. Updates on myopia: a clinical perspective","author":"Matsumura","year":"2019"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"100113","DOI":"10.1016\/j.apjo.2024.100113","article-title":"Is there an impending epidemic of myopia in Southeast Asia? An appraisal of the evidence","volume":"13","author":"Morgan","year":"2024","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"771","DOI":"10.3390\/children12060771","article-title":"Child myopia prevalence in Europe: a systematic review and Meta-analysis","volume":"12","author":"Ruiz-Pomeda","year":"2025","journal-title":"Children"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0263335","DOI":"10.1371\/journal.pone.0263335","article-title":"Systematic review and meta-analysis of myopia prevalence in African school children","volume":"17","author":"Ovenseri-Ogbomo","year":"2022","journal-title":"PLoS One"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/978-981-13-8491-2_2","volume-title":"Global epidemiology of myopia. Updates on myopia: a clinical perspective","author":"Matsumura","year":"2020"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1167\/iovs.61.4.49","article-title":"The complications of myopia: a review and meta-analysis","volume":"61","author":"Haarman","year":"2020","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1097\/j.jcrs.0000000000000664","article-title":"Efficacy and complications of cataract surgery in high myopia","volume":"47","author":"Yao","year":"2021","journal-title":"J Cataract Refract Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1001\/jamaophthalmol.2021.5347","article-title":"Insights into the global epidemic of high myopia and its implications","volume":"140","author":"Ng","year":"2022","journal-title":"JAMA Ophthalmol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1007\/s00417-020-04891-6","article-title":"Rural-urban differences in myopia prevalence among myopes presenting to Bhutanese retinal clinical services: a 3-year national study","volume":"259","author":"Rai","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1070984","DOI":"10.3389\/fpubh.2022.1070984","article-title":"Increasing prevalence of myopia and the impact of education in primary-school students in Xi'an, north-western of China","volume":"10","author":"Ye","year":"2022","journal-title":"Front Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"970751","DOI":"10.3389\/fpubh.2022.970751","article-title":"Trends of myopia development among primary and junior school students in the post-COVID-19 epidemic period","volume":"10","author":"Zhou","year":"2022","journal-title":"Front Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1007\/s10654-024-01163-z","article-title":"Gender issues in myopia: a changing paradigm in generations","volume":"39","author":"Enthoven","year":"2024","journal-title":"Eur J Epidemiol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1007\/s10571-022-01309-1","article-title":"The role of retinal dysfunction in myopia development","volume":"43","author":"Huang","year":"2023","journal-title":"Cell Mol Neurobiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1486139","DOI":"10.3389\/fneur.2024.1486139","article-title":"Update on central factors in myopia development beyond intraocular mechanisms","volume":"15","author":"Tian","year":"2024","journal-title":"Front Neurol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.exer.2013.02.007","article-title":"An updated view on the role of dopamine in myopia","volume":"114","author":"Feldkaemper","year":"2013","journal-title":"Exp Eye Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1007\/s00417-023-06276-x","article-title":"Circadian rhythm, ipRGCs, and dopamine signalling in myopia","volume":"262","author":"Li","year":"2024","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"382","DOI":"10.3390\/children9030382","article-title":"Myopia genetics and heredity","volume":"9","author":"Wang","year":"2022","journal-title":"Children"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s12967-024-04886-5","article-title":"Clinical and genetic risk factors underlying severe consequence identified in 75 families with unilateral high myopia","volume":"22","author":"Jiang","year":"2024","journal-title":"J Transl Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1167\/iovs.62.5.3","article-title":"IMI risk factors for myopia","volume":"62","author":"Morgan","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref24","first-page":"156","article-title":"Review on the myopia pandemic: epidemiology, risk factors, and prevention","volume":"118","author":"Landreneau","year":"2021","journal-title":"Mo Med"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40101-024-00354-7","article-title":"The influence of the environment and lifestyle on myopia","volume":"43","author":"Biswas","year":"2024","journal-title":"J Physiol Anthropol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09286586.2019.1659979","article-title":"Geographical variation in likely myopia and environmental risk factors: a multilevel cross classified analysis of a UK cohort","volume":"27","author":"Morris","year":"2020","journal-title":"Ophthalmic Epidemiol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"E503","DOI":"10.1097\/OPX.0b013e31819f9bc5","article-title":"Correlation between myopia and major biometric parameters of the eye: a retrospective clinical study","volume":"86","author":"Xie","year":"2009","journal-title":"Optom Vis Sci"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1186\/s12886-023-03222-7","article-title":"Correlation between refractive errors and ocular biometric parameters in children and adolescents: a systematic review and meta-analysis","volume":"23","author":"Zhang","year":"2023","journal-title":"BMC Ophthalmol"},{"key":"ref29","first-page":"1936","article-title":"Ocular predictors of the onset of juvenile myopia","volume":"40","author":"Zadnik","year":"1999","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"17289","DOI":"10.1038\/s41598-024-68076-5","article-title":"Prevalence and associated factors of myopia among adolescents aged 12\u201315 in Shandong Province, China: a cross-sectional study","volume":"14","author":"Huang","year":"2024","journal-title":"Sci Rep"},{"key":"ref31","volume-title":"A benchmark of ocular disease intelligent recognition: One shot for multi-disease detection. Benchmarking, Measuring, and Optimizing: Third BenchCouncil International Symposium, Bench 2020, Virtual Event","author":"Li","year":"2021"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"e0260993","DOI":"10.1371\/journal.pone.0260993","article-title":"Temporal trends in frequency, type and severity of myopia and associations with key environmental risk factors in the UK: findings from the UK biobank study","volume":"17","author":"Cumberland","year":"2022","journal-title":"PLoS One"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e0291470","DOI":"10.1371\/journal.pone.0291470","article-title":"Global risk factor analysis of myopia onset in children: a systematic review and meta-analysis","volume":"18","author":"Yu","year":"2023","journal-title":"PLoS One"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e049846","DOI":"10.1136\/bmjopen-2021-049846","article-title":"Prevalence, incidence, and risk factors for myopia among urban and rural children in southern China: protocol for a school-based cohort study","volume":"11","author":"Chen","year":"2021","journal-title":"BMJ Open"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e2346999","DOI":"10.1001\/jamanetworkopen.2023.46999","article-title":"Urban living environment and myopia in children","volume":"6","author":"Li","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e077735","DOI":"10.1136\/bmjopen-2023-077735","article-title":"Prevalence of and risk factors for myopia among urban and rural children in Northeast China: protocol for a school-based cross-sectional study","volume":"14","author":"Zheng","year":"2024","journal-title":"BMJ Open"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1136\/bjo-2022-322773","article-title":"Risk factors for myopia among children and adolescents: an umbrella review of published meta-analyses and systematic reviews","volume":"108","author":"Ying","year":"2024","journal-title":"Br J Ophthalmol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s00417-020-05010-1","article-title":"A longitudinal study of the effect of ocular biometrics measures on myopia onset","volume":"259","author":"Tao","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/s12886-022-02440-9","article-title":"Development pattern of ocular biometric parameters and refractive error in young Chinese adults: a longitudinal study of first-year university students","volume":"22","author":"Bai","year":"2022","journal-title":"BMC Ophthalmol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"728","DOI":"10.4103\/ijo.IJO_1564_21","article-title":"Physical activity, time spent outdoors, and near work in relation to myopia prevalence, incidence, and progression: an overview of systematic reviews and meta-analyses","volume":"70","author":"Karthikeyan","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1038\/s41746-024-01204-7","article-title":"A deep learning system for myopia onset prediction and intervention effectiveness evaluation in children","volume":"7","author":"Qi","year":"2024","journal-title":"NPJ Digit Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1167\/tvst.11.2.38","article-title":"Application of artificial intelligence and deep learning for choroid segmentation in myopia","volume":"11","author":"Chen","year":"2022","journal-title":"Transl Vis Sci Technol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"105920","DOI":"10.1016\/j.cmpb.2020.105920","article-title":"Pathological myopia classification with simultaneous lesion segmentation using deep learning","volume":"199","author":"Hemelings","year":"2021","journal-title":"Comput Methods Prog Biomed"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1595320\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T05:37:39Z","timestamp":1761025059000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1595320\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":43,"alternative-id":["10.3389\/fmed.2025.1595320"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1595320","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]},"article-number":"1595320"}}