{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T23:30:30Z","timestamp":1784590230037,"version":"3.55.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T00:00:00Z","timestamp":1665619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012669","name":"Natural Science Foundation Project of Chongqing, Chongqing Science and Technology Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012669","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007957","name":"Chongqing Municipal Education Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007957","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011933","name":"Chongqing Science and Technology Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011933","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate myopia progression and associated factors of refractive status among children and adolescents in Tibet and Chongqing in China during the COVID-19 pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A population-based cross-sectional study was conducted to compare rates of myopia and high myopia, axial length (AL), spherical equivalent (SE), outdoor activity time, digital device use, and frequency of visual examinations for children and adolescents affected by myopia in Chongqing and Tibet in 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 2,303 students from Chongqing and 1,687 students from Tibet were examined. The overall prevalence of myopia and high myopia in these two groups were 53.80 and 7.04% vs. 43.86 and 1.30%, respectively in each case. The Chongqing students had a longer AL than the group from Tibet (23.95 vs. 23.40 mm, respectively; <jats:italic>p<\/jats:italic> &amp;lt; 0.001). The mean SE of the students with myopic parents in Tibet was lower than that of the students in Chongqing with myopic parents (\u22122.57 \u00b1 2.38 diopters (D) vs. \u22122.30 \u00b1 2.34 D, respectively) (<jats:italic>p<\/jats:italic> &amp;lt; 0.001). Conversely, the mean SE of the students from urban areas in Chongqing was lower than that of the students in Tibet (\u22122.26 \u00b1 2.25 D vs. \u22121.75 \u00b1 1.96 D, respectively; <jats:italic>p<\/jats:italic> &amp;lt; 0.001). The Chongqing students exhibited lower SE (\u22122.44 \u00b1 2.22 D) than their Tibetan counterparts (mean SE: \u22121.78 \u00b1 1.65 D (<jats:italic>p<\/jats:italic> = 0.0001) when spending more than 2.5 h outdoors. For example, 61.35% of the students in Tibet spent more than 2.5 h outdoors daily, compared with 43.04% of the students in Chongqing. Correspondingly, the proportion of students using digital devices in Tibet (64.43%) was lower than that in Chongqing (100%). For the latter, 38.62% of the students in Chongqing spent more than 2.5 h online using digital devices compared to 10.49% of the students in Tibet. Greater monitoring of visual status was observed for the Chongqing students (mean SE: \u22121.90 \u00b1 1.98 D) compared with students in Tibet (mean SE: \u22122.68 \u00b1 1.85 D) (<jats:italic>p<\/jats:italic> = 0.0448), with the frequency of optimal examinations being every 6 months. Outdoor activity time was identified as a common risk factor for myopia in both of the populations examined, with odds ratios (ORs) of 1.84 (95% CI: 1.79\u20131.90) in Chongqing and 0.84 (95% CI: 0.73\u20130.96) in Tibet. Digital screen time was associated with myopia and high myopia in Chongqing, with ORs of 1.15 (95% CI: 1.08\u20131.22) and 1.06 (95% CI: 0.94\u20131.77), respectively. Digital screen time was also found to be a risk factor for high myopia in Tibet (OR: 1.21, 95% CI: 0.77\u20131.61). The type of digital devices used was also associated with myopia and high myopia in Tibet (OR: 1.33, 95% CI: 1.06\u20131.68 and OR: 1.49, 95% CI: 0.84\u20132.58, respectively). Finally, examination frequency was found to correlate with high myopia in the Tibet group (OR: 1.79, 95% CI: 0.66\u20132.71).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Based on our data, we observed that the prevalence of refractive errors in children and adolescents was significantly lower in Tibet than in Chongqing. These results are potentially due to prolonged outdoor activity time, and the type and time of use for digital devices that characterize the group of children and adolescents from Tibet. It is recommended that parents and children in Chongqing would benefit from increased awareness regarding myopia progression and its prevention.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.993728","type":"journal-article","created":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T08:24:11Z","timestamp":1665649451000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Myopia progression and associated factors of refractive status in children and adolescents in Tibet and Chongqing during the COVID-19 pandemic"],"prefix":"10.3389","volume":"10","author":[{"given":"Wujiao","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongguo","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijie","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingjing","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhouyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenglan","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyun","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangli","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjuan","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050","volume":"123","author":"Holden","year":"2016","journal-title":"Ophthalmology."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e682","DOI":"10.1016\/S2468-2667(20)30254-1","article-title":"Prevalence and causes of vision loss in China from 1990 to 2019: findings from the Global Burden Of Disease Study 2019","volume":"5","author":"Xu","year":"2020","journal-title":"Lancet Public Health."},{"key":"B3","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":"B4","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":"B5","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.preteyeres.2017.09.004","article-title":"The epidemics of myopia: aetiology and prevention","volume":"62","author":"Morgan","year":"2018","journal-title":"Prog Retin Eye Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/IAE.0000000000002590","article-title":"Prevalence and time trends of myopia in children and adolescents in china: a systemic review and meta-analysis","volume":"40","author":"Dong","year":"2020","journal-title":"Retina."},{"key":"B7","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.jfma.2019.03.004","article-title":"Ethnic disparity in prevalence and associated risk factors of myopia in adolescents","volume":"119","author":"Chiang","year":"2020","journal-title":"J Formos Med Assoc."},{"key":"B8","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1038\/519276a","article-title":"The myopia boom","volume":"519","author":"Dolgin","year":"2015","journal-title":"Nature."},{"key":"B9","volume-title":"How Many Students Are at Risk of Not Returning to School?","year":"2020"},{"key":"B10","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1001\/jamaophthalmol.2020.6239","article-title":"Progression of myopia in school-aged children after COVID-19 home confinement","volume":"139","author":"Wang","year":"2021","journal-title":"JAMA Ophthalmol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"646770","DOI":"10.3389\/fpubh.2021.646770","article-title":"Survey on the progression of myopia in children and adolescents in Chongqing during COVID-19 pandemic","volume":"9","author":"Wang","year":"2021","journal-title":"Front Public Health."},{"key":"B12","doi-asserted-by":"publisher","first-page":"918182","DOI":"10.3389\/fpubh.2022.918182","article-title":"The association between environmental and social factors and myopia: a review of evidence from COVID-19 pandemic","volume":"10","author":"Limwattanayingyong","year":"2022","journal-title":"Front Public Health."},{"key":"B13","doi-asserted-by":"publisher","first-page":"111","DOI":"10.4103\/0301-4738.111207","article-title":"Impact of low vision care on reading performance in children with multiple disabilities and visual impairment","volume":"62","author":"Ramani","year":"2014","journal-title":"Indian J Ophthalmol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.1016\/S0140-6736(12)60272-4","article-title":"Myopia","volume":"379","author":"Morgan","year":"2012","journal-title":"Lancet."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1017\/S1047951117000567","article-title":"Prevalence and composition of CHD at different altitudes in Tibet: a cross-sectional study","volume":"27","author":"Zheng","year":"2017","journal-title":"Cardiol Young."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e031337","DOI":"10.1136\/bmjopen-2019-031337","article-title":"Prevalence and service assessment of cataract in Tibetan areas of Sichuan Province, China: population-based study","volume":"9","author":"Jiachu","year":"2019","journal-title":"BMJ Open."},{"key":"B17","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1186\/s12886-018-0780-8","article-title":"Prevalence of refractive errors in Tibetan adolescents","volume":"18","author":"Qian","year":"2018","journal-title":"BMC Ophthalmol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"5795","DOI":"10.2147\/IJGM.S326046","article-title":"Prevalence of refractive error and visual acuity among school children in the plateau region of Qinghai, China","volume":"14","author":"Wu","year":"2021","journal-title":"Int J Gen Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1159\/000522548","article-title":"Distribution, progression, and associated factors of refractive status of children in Lhasa, Tibet, after COVID-19 quarantine","volume":"65","author":"Yao","year":"2022","journal-title":"Ophthalmic Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1080\/09286586.2019.1616774","article-title":"Using decision curve analysis to evaluate common strategies for myopia screening in school-aged children","volume":"26","author":"Lin","year":"2019","journal-title":"Ophthalmic Epidemiol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"M20","DOI":"10.1167\/iovs.18-25957","article-title":"IMI\u2013defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies","volume":"60","author":"Flitcroft","year":"2019","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B22","doi-asserted-by":"publisher","first-page":"607911","DOI":"10.3389\/fpubh.2021.607911","article-title":"Combination effect of outdoor activity and screen exposure on risk of preschool myopia: findings from longhua child cohort study","volume":"9","author":"Lihua","year":"2021","journal-title":"Front Public Health."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1038\/s41433-021-01655-2","article-title":"The effect of home education on myopia progression in children during the COVID-19 pandemic","volume":"36","author":"Aslan","year":"2022","journal-title":"Eye (Lond)."},{"key":"B24","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/cxo.12453","article-title":"Viewing distance and eyestrain symptoms with prolonged viewing of smartphones","volume":"100","author":"Long","year":"2017","journal-title":"Clin Exp Optom."},{"key":"B25","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/s12886-020-01763-9","article-title":"Longitudinal association between myopia and parental myopia and outdoor time among students in Wenzhou: a 2.5-year longitudinal cohort study.","volume":"21","author":"Jiang","year":"2021","journal-title":"BMC Ophthalmol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"662984","DOI":"10.3389\/fped.2021.662984","article-title":"Adolescent vision health during the outbreak of COVID-19: association between digital screen use and myopia progression","volume":"9","author":"Liu","year":"2021","journal-title":"Front Pediatr."},{"key":"B27","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.pnpbp.2010.09.014","article-title":"Sunshine-exposure variation of human striatal dopamine D(2)\/D(3) receptor availability in healthy volunteers","volume":"35","author":"Tsai","year":"2011","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry."},{"key":"B28","doi-asserted-by":"publisher","first-page":"2073","DOI":"10.3760\/cma.j.issn.0366-6999.20133232","article-title":"Study of preferred background luminanc in watching computer screen in children","volume":"127","author":"Shen","year":"2014","journal-title":"Chin Med J (Engl)."},{"key":"B29","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.exer.2013.05.004","article-title":"Light levels, refractive development, and myopia\u2013a speculative review","volume":"114","author":"Norton","year":"2013","journal-title":"Exp Eye Res."},{"key":"B30","doi-asserted-by":"publisher","first-page":"4846","DOI":"10.1167\/iovs.07-0101","article-title":"Variation of the contribution from axial length and other oculometric parameters to refraction by age and ethnicity","volume":"48","author":"Jenny","year":"2007","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B31","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s12886-015-0052-9","article-title":"Effect of outdoor activity on myopia onset and progression in school-aged children in northeast China: the Sujiatun eye care study","volume":"15","author":"Jin","year":"2015","journal-title":"BMC Ophthalmol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1001\/jama.2015.10803","article-title":"Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial","volume":"314","author":"He","year":"2015","journal-title":"JAMA."},{"key":"B33","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1167\/iovs.62.1.28","article-title":"Ambient light regulates retinal dopamine signaling and myopia susceptibility","volume":"62","author":"Landis","year":"2021","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B34","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1167\/iovs.62.10.36","article-title":"Myopia progression as a function of sex, age, and ethnicity","volume":"62","author":"Jones-Jordan","year":"2021","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1016\/j.ophtha.2004.10.048","article-title":"Refractive error and visual impairment in school-age children in Gombak District, Malaysia","volume":"112","author":"Goh","year":"2005","journal-title":"Ophthalmology."},{"key":"B36","doi-asserted-by":"publisher","first-page":"2590","DOI":"10.1167\/iovs.13-11725","article-title":"Prevalence of refractive errors in a multiethnic Asian population: the Singapore epidemiology of eye disease study","volume":"54","author":"Pan","year":"2013","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B37","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1186\/s12886-021-01996-2","article-title":"Prevalence and risk factors of refractive error in Qinghai, China: a cross-sectional study in Han and Tibetan adults in Xining and surrounding areas","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Ophthalmol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1722","DOI":"10.1038\/s41433-019-0469-0","article-title":"Prevalence of and risk factors for refractive error: a cross-sectional study in Han and Mongolian adults aged 40-80 years in Inner Mongolia, China","volume":"33","author":"Wang","year":"2019","journal-title":"Eye (Lond)."},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.envpol.2019.113031","article-title":"PM2.5 and NOx exposure promote myopia: clinical evidence and experimental proof.","author":"Wei","year":"2019","journal-title":"Environ Pollut."},{"key":"B40","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.ajo.2012.02.027","article-title":"Variation in prevalence of myopia between generations of migrant Indians living in Singapore","volume":"154","author":"Pan","year":"2012","journal-title":"Am J Ophthalmol."},{"key":"B41","doi-asserted-by":"publisher","first-page":"2813","DOI":"10.1007\/s00417-021-05305-x","article-title":"Progression of myopia in a natural cohort of Chinese children during COVID-19 pandemic","volume":"259","author":"Ma","year":"2021","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1167\/iovs.62.10.37","article-title":"COVID-19 home quarantine accelerated the progression of myopia in children aged 7 to 12 years in China","volume":"62","author":"Ma","year":"2021","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B43","doi-asserted-by":"publisher","first-page":"k2022","DOI":"10.1136\/bmj.k2022","article-title":"Education and myopia: assessing the direction of causality by mendelian randomisation","volume":"361","author":"Mountjoy","year":"2018","journal-title":"BMJ."},{"key":"B44","doi-asserted-by":"publisher","first-page":"e048450","DOI":"10.1136\/bmjopen-2020-048450","article-title":"Prevalence of myopia and high myopia, and the association with education: Shanghai Child and adolescent large-scale eye study (SCALE): a cross-sectional study","volume":"11","author":"He","year":"2021","journal-title":"BMJ Open."},{"key":"B45","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/OPX.0b013e3181940719","article-title":"Prevalence of myopia in urban and rural children in mainland China","volume":"86","author":"He","year":"2009","journal-title":"Optom Vis Sci."},{"key":"B46","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1186\/s12886-018-0808-0","article-title":"Low prevalence of myopia among school children in rural China","volume":"18","author":"Pan","year":"2018","journal-title":"BMC Ophthalmol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"e430","DOI":"10.1111\/aos.14980","article-title":"Associations of near work time, watching TV, outdoors time, and parents' myopia with myopia among school children based on 38-year-old historical data","volume":"100","author":"P\u00e4rssinen","year":"2022","journal-title":"Acta Ophthalmol."},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1111\/opo.12455","article-title":"Parental attitudes to myopia: a key agent of change for myopia control?","author":"McCrann","year":"2018","journal-title":"Ophthalmic Physiol Opt."},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1097\/APO.0000000000000236","article-title":"Epidemiology of myopia","author":"Wu","year":"2016","journal-title":"Asia Pac J Ophthalmol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1001\/archophthalmol.2010.73","article-title":"Attitudes of students, parents, and teachers toward glasses use in rural China","volume":"128","author":"Li","year":"2010","journal-title":"Arch Ophthalmol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"2903903","DOI":"10.1167\/iovs.07-0804","article-title":"Role of near work in myopia: findings in a sample of Australian school children","volume":"49","author":"Jenny","year":"2008","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1026026","DOI":"10.1167\/iovs.12-10480","article-title":"What factors are associated with myopia in young adults?","volume":"54","author":"Lee","year":"2013","journal-title":"A survey study in Taiwan military conscripts. Invest Opthalmol Vis Sci."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.993728\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T10:03:13Z","timestamp":1666000993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.993728\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,13]]},"references-count":52,"alternative-id":["10.3389\/fpubh.2022.993728"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.993728","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,13]]},"article-number":"993728"}}