{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:40:27Z","timestamp":1793313627672,"version":"4.5.0"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In recent years, the prevalence of myopia has increased significantly and caused great concern. Nevertheless, an estimate of myopia in the student population in Shenyang, Liaoning Province, China is still lacking. This study aims to determine the prevalence of myopia among students in Shenyang and investigate the associated factors affecting myopia development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Standard logarithmic visual acuity chart and automatic computerized optometry under non-ciliary muscle paralysis were used to test the students\u2019 naked visual acuity of their right and left eyes. The included students were organized to fill in questionnaires on WeChat to collect the factors affecting myopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 34,644 students with a median age of 11.9\u2009years were examined, including 17,563 males and 17,081 females. The overall prevalence of myopia was 60%, with a prevalence of 45% for mild myopia, 13% for moderate myopia, and 1.9% for high myopia. The sex, high educational stage, family history of myopia, doing homework after school or reading and writing for more than 2\u2009h were associated with a higher risk of myopia, while doing eye exercises twice a day or more, going outdoors during recess, reading and writing with eyes more than one foot from books, and sleeping more than 8\u2009h a day were associated factors for preventing myopia. The associated factors influencing myopia vary among different subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of myopia in Shenyang is at a high level. In addition to sex, high educational stage and genetic factors, environmental factors including length of eye usage, eye exercises, outdoor activities, eye working distance, and sleep duration are associated with myopia prevalence. Therefore, it is recommended that the occurrence and development of myopia can be prevented by controlling the above environmental factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2023.1239158","type":"journal-article","created":{"date-parts":[[2023,8,31]],"date-time":"2023-08-31T02:49:05Z","timestamp":1693450145000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":43,"title":["Prevalence and associated factors of myopia among school students in Shenyang, China: a cross-sectional study"],"prefix":"10.3389","volume":"11","author":[{"given":"Dan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baijun","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiying","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianying","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1038\/eye.2013.256","article-title":"Myopia, an underrated global challenge to vision: where the current data takes us on myopia control","volume":"28","author":"Holden","year":"2014","journal-title":"Eye"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1136\/bjophthalmol-2017-311266","article-title":"Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: systematic review, meta-analysis and modelling","volume":"102","author":"Fricke","year":"2018","journal-title":"Br J Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1111\/j.1475-1313.2005.00298.x","article-title":"Myopia and associated pathological complications","volume":"25","author":"Saw","year":"2005","journal-title":"Ophthalmic Physiol Opt"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1016\/j.ophtha.2008.05.030","article-title":"Prevalence and causes of low vision and blindness in a rural Chinese adult population: the Handan eye study","volume":"115","author":"Liang","year":"2008","journal-title":"Ophthalmology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/j.preteyeres.2012.06.004","article-title":"The complex interactions of retinal, optical and environmental factors in myopia aetiology","volume":"31","author":"Flitcroft","year":"2012","journal-title":"Prog Retin Eye Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.mehy.2016.02.006","article-title":"Is myopia another clinical manifestation of insulin resistance?","volume":"90","author":"Galvis","year":"2016","journal-title":"Med Hypotheses"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e1524","DOI":"10.1111\/aos.14826","article-title":"Prevalence of fundus tessellation and its associated factors in Chinese children and adolescents with high myopia","volume":"99","author":"Cheng","year":"2021","journal-title":"Acta Ophthalmol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1167\/iovs.63.1.8","article-title":"Annual incidences and progressions of myopia and high myopia in Chinese schoolchildren based on a 5-year cohort study","volume":"63","author":"Li","year":"2022","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref9","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":"ref10","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1167\/iovs.62.5.6","article-title":"IMI prevention of myopia and its progression","volume":"62","author":"Jonas","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"08006","DOI":"10.7189\/jogh.11.08006","article-title":"Prevalence and time trends of refractive error in Chinese children: a systematic review and meta-analysis","volume":"11","author":"Tang","year":"2021","journal-title":"J Glob Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1001\/jamaophthalmol.2019.3103","article-title":"Current prevalence of myopia and association of myopia with environmental factors among schoolchildren in Japan","volume":"137","author":"Yotsukura","year":"2019","journal-title":"JAMA Ophthalmol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"713377","DOI":"10.3389\/fpubh.2022.713377","article-title":"Associations between reading and writing postures and myopia among school students in Ningbo, China","volume":"10","author":"Jiang","year":"2022","journal-title":"Front Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/9781987","article-title":"Prevalence and related factors for myopia in school-aged children in Qingdao","volume":"2018","author":"Sun","year":"2018","journal-title":"J Ophthalmol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"828298","DOI":"10.3389\/fpubh.2022.828298","article-title":"Sleep patterns and myopia among school-aged children in Singapore","volume":"10","author":"Li","year":"2022","journal-title":"Front Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1236","DOI":"10.1177\/11206721211008040","article-title":"Sleep time and homework hours\/daily are associated with reduced visual acuity among school students aged 9-18 in Shenyang in 2016","volume":"32","author":"Liu","year":"2021","journal-title":"Eur J Ophthalmol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1015138","DOI":"10.3389\/fpubh.2022.1015138","article-title":"Association between sleep duration and myopia among Chinese children during the COVID-19 pandemic: a cross-sectional study","volume":"10","author":"Huang","year":"2022","journal-title":"Front Public Health"},{"key":"ref18","article-title":"Overall myopia rate of 52.7% among children and youth in China by 2020[N]","volume-title":"Chinese Women\u2019s Newspaper","author":"Chen","year":"2021"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1136\/bjophthalmol-2018-312573","article-title":"Refractive error and visual impairment in Ireland schoolchildren","volume":"103","author":"Harrington","year":"2019","journal-title":"Br J Ophthalmol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"855","DOI":"10.3238\/arztebl.2020.0855","article-title":"Prevalence and time trends in myopia among children and adolescents: results of the German KiGGS study","volume":"117","author":"Schuster","year":"2020","journal-title":"Dtsch Arztebl Int"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2520","DOI":"10.1167\/iovs.06-0716","article-title":"Ethnic differences in the impact of parental myopia: findings from a population-based study of 12-year-old Australian children","volume":"48","author":"Ip","year":"2007","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1136\/bjo.2006.093450","article-title":"Ethnicity-specific prevalences of refractive errors vary in Asian children in neighbouring Malaysia and Singapore","volume":"90","author":"Saw","year":"2006","journal-title":"Br J Ophthalmol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.47102\/https:\/\/doi.org\/10.47102\/annals-acadmedsg.V33N1p27","article-title":"Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000","volume":"33","author":"Lin","year":"2004","journal-title":"Ann Acad Med Singap"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1080\/13816810.2023.2191709","article-title":"Evaluation of myopia-associated genes in a Han Chinese population with high myopia","volume":"44","author":"Liu","year":"2023","journal-title":"Ophthalmic Genet"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1159\/000439446","article-title":"Association between ocular axial length-related genes and high myopia in a Han Chinese population","volume":"235","author":"Li","year":"2016","journal-title":"Ophthalmologica"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1001\/archopht.126.4.527","article-title":"Myopia, lifestyle, and schooling in students of Chinese ethnicity in Singapore and Sydney","volume":"126","author":"Rose","year":"2008","journal-title":"Arch Ophthalmol"},{"key":"ref27","year":""},{"key":"ref28","year":""},{"key":"ref29","year":""},{"key":"ref30","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1111\/j.1475-1313.1989.tb00907.x","article-title":"Myopia in optometry students: family history, age of onset and personality","volume":"9","author":"Bullimore","year":"1989","journal-title":"Ophthalmic Physiol Opt"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3524","DOI":"10.1167\/iovs.06-1118","article-title":"Parental history of myopia, sports and outdoor activities, and future myopia","volume":"48","author":"Jones","year":"2007","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref32","first-page":"3633","article-title":"Parental myopia, near work, school achievement, and children\u2019s refractive error","volume":"43","author":"Mutti","year":"2002","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref33","doi-asserted-by":"publisher","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":"ref34","doi-asserted-by":"publisher","first-page":"1621","DOI":"10.3760\/cma.j.cn112338-20201118-01338","article-title":"Effects of eye exercises on axial eye elongation in junior students","volume":"42","author":"Tian","year":"2021","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2793","DOI":"10.2147\/RMHP.S281289","article-title":"The effect of eye exercises of acupoints on myopia progression: a 3-year cohort report from the Beijing myopia progression study","volume":"13","author":"Liang","year":"2020","journal-title":"Risk Manage Healthc Policy"},{"key":"ref36","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":"ref37","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.exer.2013.04.018","article-title":"Time outdoors and the prevention of myopia","volume":"114","author":"French","year":"2013","journal-title":"Exp Eye Res"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"0300060519893866","DOI":"10.1177\/0300060519893866","article-title":"Protective effects of increased outdoor time against myopia: a review","volume":"48","author":"Zhang","year":"2020","journal-title":"J Int Med Res"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11325-023-02794-4","article-title":"The association between sleep duration and risk of myopia in Chinese school-aged children: a cross-sectional study","volume":"27","author":"Lin","year":"2023","journal-title":"Sleep Breath"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1167\/iovs.61.3.37","article-title":"Sleep duration, bedtime, and myopia progression in a 4-year follow-up of Chinese children: the Anyang Childhood Eye Study","volume":"61","author":"Wei","year":"2020","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref41","first-page":"99","article-title":"Study of myopia in Chinese children","volume-title":"Afterschool Education in China","author":"DONG","year":"2022"},{"key":"ref42","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":"ref43","doi-asserted-by":"publisher","first-page":"9748576","DOI":"10.1155\/2019\/9748576","article-title":"Role of gender in the prevalence of myopia among polish schoolchildren","volume":"2019","author":"Czepita","year":"2019","journal-title":"J Ophthalmol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.3760\/cma.j.issn.0376-2491.2014.17.004","article-title":"Analysis on the relationship between adolescent myopia and serum sex hormone","volume":"94","author":"Xie","year":"2014","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12886-017-0483-6","article-title":"The increasing prevalence of myopia in junior high school students in the Haidian District of Beijing, China: a 10-year population-based survey","volume":"17","author":"Li","year":"2017","journal-title":"BMC Ophthalmol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1001\/archopht.120.5.620","article-title":"Near-work activity, night-lights, and myopia in the Singapore-China study","volume":"120","author":"Saw","year":"2002","journal-title":"Arch Ophthalmol"},{"key":"ref47","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":"ref48","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.ophtha.2006.08.020","article-title":"Refractive error and visual impairment in school children in rural southern China","volume":"114","author":"He","year":"2007","journal-title":"Ophthalmology"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1239158\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T12:17:42Z","timestamp":1703074662000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1239158\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,30]]},"references-count":48,"alternative-id":["10.3389\/fpubh.2023.1239158"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1239158","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,30]]},"article-number":"1239158"}}