{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:23:06Z","timestamp":1788538986464,"version":"build-2803163510"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"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":"\n Purpose<\/jats:title>\n This study aimed to characterize the changes in choroidal thickness (ChT) in response to optical approaches using the distant-image screen (DIS) device and defocus-incorporated multiple segments (DIMS) lenses.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n This is a prospective, randomized, controlled, crossover trial.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n A total of 40 children (8\u201313\u202fyears of age) with spherical equivalent refraction (SER) ranging from \u22120.50 to \u22126.00 diopters (D) were recruited and randomized into 4 groups: children who watched videos using either a DIS or a tablet computer (TC) and those wearing DIMS or single-vision lenses (SVL).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In their assigned groups, children watched videos for 90\u202fmin in stage I, followed by a 3\u20137-day recovery period. After this recovery period, the children in the TC group were crossed over to the DIS group, and those in the DIS group were crossed over to the TC group for an additional 90\u202fmin in stage II. The SER was measured before and after watching videos using an open-field autorefractor. The ChT in the central (1\u202f\u00d7\u202f1\u202fmm), superior, inferior, nasal, and temporal regions in 1\u20133\u202fmm (S3, I3, N3, and T3) and 3\u20136\u202fmm (S6, I6, N6, and T6) were measured before and after watching videos using full-range swept-source optical coherence tomography (SS-OCT).<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n The main outcome measure was the changes in regional ChT.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n After 90\u202fmin of video watching, the SER in the TC group significantly increased after viewing 90-min videos (\u22122.14\u202f\u00b1\u202f1.15 D vs.-2.26\u202f\u00b1\u202f1.16 D,\n p<\/jats:italic>\n \u202f=\u202f0.036), whereas no significant difference was observed in the DIS group. Among the participants wearing SVL, the ChT changes in the DIS group were significantly higher than those in the TC group at I3 (\n p<\/jats:italic>\n \u202f=\u202f0.036) and T3 (\n p<\/jats:italic>\n \u202f=\u202f0.032), and the changes in other regions were not significantly different between the two groups. For participants using TC, the DIMS group showed greater ChT thickening at C (9.54\u202f\u00b1\u202f3.19\u202f\u03bcm,\n p<\/jats:italic>\n \u202f=\u202f0.005), I3 (6.44\u202f\u00b1\u202f3.04\u202f\u03bcm,\n p<\/jats:italic>\n \u202f=\u202f0.043), N3 (9.10\u202f\u00b1\u202f3.17\u202f\u03bcm,\n p<\/jats:italic>\n \u202f=\u202f0.007), and T3 (8.00\u202f\u00b1\u202f3.17\u202f\u03bcm,\n p<\/jats:italic>\n \u202f=\u202f0.017) than the SVL group. The combination of DIMS and DIS exhibited greater ChT thickening at I3 (11.23\u202f\u00b1\u202f4.07\u202f\u03bcm,\n p<\/jats:italic>\n \u202f=\u202f0.009) compared to the SVL and TC groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Short-term long-distance working mode and myopic defocus may exert beneficial effects on choroidal variation in myopic children.<\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration Number<\/jats:title>\n \n https:\/\/www.chictr.org.cn\/showproj.html?proj=184978<\/jats:ext-link>\n , Identifier ChiCTR2200065741.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1884932","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:05:56Z","timestamp":1788537956000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Short-term effects of distant-image screen and myopic defocus on choroidal thickness in children: a randomized pilot clinical trial"],"prefix":"10.3389","volume":"14","author":[{"given":"Xingyi","family":"Guo","sequence":"first","affiliation":[{"name":"Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science","place":["Tianjin, China"]},{"name":"Tianjin Eye Hospital Optometric Center","place":["Tianjin, China"]},{"name":"Nankai University Optometry & Vision Science Institute","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanli","family":"Zhang","sequence":"additional","affiliation":[{"name":"Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science","place":["Tianjin, China"]},{"name":"Tianjin Eye Hospital Optometric Center","place":["Tianjin, China"]},{"name":"Nankai University Optometry & Vision Science Institute","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science","place":["Tianjin, China"]},{"name":"Tianjin Eye Hospital Optometric Center","place":["Tianjin, China"]},{"name":"Nankai University Optometry & Vision Science Institute","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanliang","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics, Tianjin Medical University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenli","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics, Tianjin Medical University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqin","family":"Chen","sequence":"additional","affiliation":[{"name":"Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science","place":["Tianjin, China"]},{"name":"Tianjin Eye Hospital Optometric Center","place":["Tianjin, China"]},{"name":"Nankai University Optometry & Vision Science Institute","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Li","sequence":"additional","affiliation":[{"name":"Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science","place":["Tianjin, China"]},{"name":"Tianjin Eye Hospital Optometric Center","place":["Tianjin, China"]},{"name":"Nankai University Optometry & Vision Science Institute","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref1","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":"ref2","doi-asserted-by":"publisher","first-page":"100837","DOI":"10.1016\/j.lanwpc.2023.100837","article-title":"Implementing a digital comprehensive myopia prevention and control strategy for children and adolescents in China: a cost-effectiveness analysis","volume":"38","author":"Li","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"560378","DOI":"10.3389\/fpubh.2020.560378","article-title":"The relationship between screen and outdoor time with rates of myopia in Spanish children","volume":"8","author":"Alvarez-Peregrina","year":"2020","journal-title":"Front Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.ophtha.2020.07.017","article-title":"Evolution of the prevalence of myopia among Taiwanese schoolchildren: a review of survey data from 1983 through 2017","volume":"128","author":"Tsai","year":"2021","journal-title":"Ophthalmology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"875","DOI":"10.3390\/ijerph20010875","article-title":"Myopia and near work: a systematic review and Meta-analysis","volume":"20","author":"Dutheil","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1111\/aos.15043","article-title":"A systematic review of near work and myopia: measurement, relationships, mechanisms and clinical corollaries","volume":"100","author":"Gajjar","year":"2022","journal-title":"Acta Ophthalmol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e0140419","DOI":"10.1371\/journal.pone.0140419","article-title":"The association between near work activities and myopia in children-a systematic review and meta-analysis","volume":"10","author":"Huang","year":"2015","journal-title":"PLoS One"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.3760\/cma.j.cn112142-20220106-00004","article-title":"The clinical value of using a distant-image screen for reading and learning","volume":"58","author":"Zhen","year":"2022","journal-title":"Zhonghua Yan Ke Za Zhi"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1136\/bjophthalmol-2018-313739","article-title":"Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial","volume":"104","author":"Lam","year":"2020","journal-title":"Br J Ophthalmol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.1097\/IAE.0000000000002090","article-title":"Longitudinal changes in choroidal and retinal thicknesses in children with myopic shift","volume":"39","author":"Jin","year":"2019","journal-title":"Retina"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1111\/opo.12218","article-title":"Effect of retinal image defocus on the thickness of the human choroid","volume":"35","author":"Chiang","year":"2015","journal-title":"Ophthalmic Physiol Opt"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e0161535","DOI":"10.1371\/journal.pone.0161535","article-title":"Optical defocus rapidly changes choroidal thickness in schoolchildren","volume":"11","author":"Wang","year":"2016","journal-title":"PLoS One"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"6262","DOI":"10.1167\/iovs.10-5457","article-title":"Human optical axial length and defocus","volume":"51","author":"Read","year":"2010","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"E010","DOI":"10.1017\/S0952523816000067","article-title":"Novel method using 3-dimensional segmentation in spectral domain-optical coherence tomography imaging in the chick reveals defocus-induced regional and time-sensitive asymmetries in the choroidal thickness","volume":"33","author":"Nava","year":"2016","journal-title":"Vis Neurosci"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"8528315","DOI":"10.1155\/2018\/8528315","article-title":"Effect of atropine eye drops on choroidal thinning induced by hyperopic retinal defocus","volume":"2018","author":"Chiang","year":"2018","journal-title":"J Ophthalmol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1097\/OPX.0000000000000894","article-title":"Effects of orthokeratology on choroidal thickness and axial length","volume":"93","author":"Chen","year":"2016","journal-title":"Optometry Vision Sci"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"247","DOI":"10.18240\/ijo.2024.02.04","article-title":"Impact of multifocal gas-permeable lens designs on short-term choroidal response, axial length, and retinal defocus profile","volume":"17","author":"Alanazi","year":"2024","journal-title":"Int J Ophthalmol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s40662-023-00356-z","article-title":"Defocus incorporated multiple segments (DIMS) spectacle lenses increase the choroidal thickness: a two-year randomized clinical trial","volume":"10","author":"Chun","year":"2023","journal-title":"Eye Vis (Lond)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"M31","DOI":"10.1167\/iovs.18-25967","article-title":"IMI - report on experimental models of emmetropization and myopia","volume":"60","author":"Troilo","year":"2019","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"6765","DOI":"10.1167\/iovs.14-14524","article-title":"Axial eye growth and refractive error development can be modified by exposing the peripheral retina to relative myopic or hyperopic defocus","volume":"55","author":"Benavente-Perez","year":"2014","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.preteyeres.2009.12.002","article-title":"The multifunctional choroid","volume":"29","author":"Nickla","year":"2010","journal-title":"Prog Retin Eye Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"108402","DOI":"10.1016\/j.visres.2024.108402","article-title":"Mechanisms of emmetropization and what might go wrong in myopia","volume":"220","author":"Schaeffel","year":"2024","journal-title":"Vis Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2942","DOI":"10.3390\/ijerph19052942","article-title":"Effects of extended viewing distance on accommodative response and pupil size of myopic adults by using a double-Mirror system","volume":"19","author":"Lin","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"9951","DOI":"10.3390\/ijerph18199951","article-title":"Reduction in accommodative response of schoolchildren by a double-Mirror system","volume":"18","author":"Yeh","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1080\/08164622.2023.2228810","article-title":"Influence of a long-distance optical imaging workbench on accommodation and choroidal response in myopic children","volume":"107","author":"Ma","year":"2024","journal-title":"Clin Exp Optom"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s40662-024-00382-5","article-title":"Differences in choroidal responses to near work between myopic children and young adults","volume":"11","author":"Liu","year":"2024","journal-title":"Eye Vis (Lond)."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1080\/02713683.2023.2222234","article-title":"Investigation of choroidal blood flow and thickness changes induced by near work in young adults","volume":"48","author":"Liang","year":"2023","journal-title":"Curr Eye Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"6414","DOI":"10.1167\/iovs.15-17102","article-title":"Regional changes in choroidal thickness associated with accommodation","volume":"56","author":"Woodman-Pieterse","year":"2015","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"8322","DOI":"10.1038\/s41598-020-65151-5","article-title":"The time course of the onset and recovery of axial length changes in response to imposed defocus","volume":"10","author":"Delshad","year":"2020","journal-title":"Sci Rep"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1186\/s13063-023-07696-0","article-title":"Clinical evaluation of MyoCare in Europe (CEME): study protocol for a prospective, multicenter, randomized, double-blinded, and controlled clinical trial","volume":"24","author":"Alvarez-Peregrina","year":"2023","journal-title":"Trials"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3847","DOI":"10.1038\/s41433-023-02629-2","article-title":"Association between choriocapillaris perfusion and axial elongation in children using defocus incorporated multiple segments (DIMS) spectacle lenses","volume":"37","author":"Li","year":"2023","journal-title":"Eye (Lond)"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1167\/iovs.61.8.48","article-title":"Astigmatic defocus leads to short-term changes in human choroidal thickness","volume":"61","author":"Hoseini-Yazdi","year":"2020","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1111\/opo.12609","article-title":"Regional alterations in human choroidal thickness in response to short-term monocular hemifield myopic defocus","volume":"39","author":"Hoseini-Yazdi","year":"2019","journal-title":"Ophthalmic Physiol Opt"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1111\/opo.12450","article-title":"The interaction between homatropine and optical blur on choroidal thickness","volume":"38","author":"Sander","year":"2018","journal-title":"Ophthalmic Physiol Opt"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"22690","DOI":"10.1038\/s41598-021-02043-2","article-title":"Effect of short-term peripheral myopic defocus on ocular biometrics using Fresnel \"press-on\" lenses in humans","volume":"11","author":"Kubota","year":"2021","journal-title":"Sci Rep"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1167\/iovs.65.4.22","article-title":"Short-term myopic defocus and choroidal thickness in children and adults","volume":"65","author":"Ostrin","year":"2024","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1167\/iovs.62.3.14","article-title":"Emmetropic, but not myopic human eyes distinguish positive defocus from calculated blur","volume":"62","author":"Swiatczak","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"109564","DOI":"10.1016\/j.exer.2023.109564","article-title":"Defocus-induced spatial changes in choroidal thickness of chicks observed by wide-field swept-source OCT","volume":"233","author":"Huang","year":"2023","journal-title":"Exp Eye Res"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3390\/jcm12113618","article-title":"Changes in choroidal thickness and retinal activity with a myopia control contact Lens","volume":"12","author":"Amorim-de-Sousa","year":"2023","journal-title":"J Clin Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1884932\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:05:58Z","timestamp":1788537958000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1884932\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":39,"alternative-id":["10.3389\/fpubh.2026.1884932"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1884932","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"article-number":"1884932"}}