{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:23:05Z","timestamp":1787638985896,"version":"build-2736575974"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"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>Purpose<\/jats:title>\n                    <jats:p>To develop a predictive model based on school-based vision screening programs for evaluating hyperopic reserve status in children aged 5\u201310 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study included 8,035 students aged 5\u201310 years from senior kindergarten and primary school in Guangdong Province, China. Participants underwent ocular biometric measurements, autorefraction, and questionnaire assessment before cycloplegia, after which autorefraction was repeated. An ensemble learning model was constructed to predict low hyperopic reserve (LHR), a refractive status below age-appropriate norms but not yet myopic, using NCR ocular parameters and questionnaire data. Model performance was evaluated and compared through nested 5-fold cross-validation. Sensitivity and robustness analyses were conducted to verify the comprehensive model performance. SHapley Additive exPlanations (SHAP) was utilized to interpret feature contributions and model logic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On the test set, the ensemble learning model achieved an area under the curve (AUC) of 0.807, an accuracy of 0.737, and a precision of 0.747, outperforming all the single machine learning models. Compared to the direct NCR-based assessment and the +0.50 D \/ +0.75 D fixed-offset benchmarks (accuracy = 0.614\u20130.669, precision = 0.593\u20130.683), the ensemble learning model improved accuracy by 0.068\u20130.123 and precision by 0.064\u20130.154. SHAP analysis identified axial length to corneal radius ratio (SHAP value = 0.652), spherical equivalent (SHAP value = 0.514), and school type (SHAP value = 0.312) as the most three important predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The proposed ensemble learning model offers a noncycloplegic, convenient approach for school-based vision programs to predict LHR in children aged 5\u201310 years. This model and its risk-assessment tool may support existing school-based vision programs in preserving children's hyperopic reserve.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1910531","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:36:29Z","timestamp":1787636189000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting hyperopic reserve in children based on school-based vision programs with ensemble learning"],"prefix":"10.3389","volume":"14","author":[{"given":"Jing","family":"Jiang","sequence":"first","affiliation":[{"name":"Environmental and School Health Department, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Lu","sequence":"additional","affiliation":[{"name":"Environmental and School Health Department, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Li","sequence":"additional","affiliation":[{"name":"Environmental and School Health Department, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Sun","sequence":"additional","affiliation":[{"name":"School Health Department, Guangzhou Center for Disease Control and Prevention, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Lin","sequence":"additional","affiliation":[{"name":"School Health Department, Guangzhou Center for Disease Control and Prevention, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Liu","sequence":"additional","affiliation":[{"name":"Environmental and School Health Department, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Qin","sequence":"additional","affiliation":[{"name":"School Health Department, Beijing Center for Disease Prevention and Control","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuxia","family":"Chen","sequence":"additional","affiliation":[{"name":"Environmental and School Health Department, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Yang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yabin","family":"Qu","sequence":"additional","affiliation":[{"name":"Environmental and School Health Department, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1038\/s41433-021-01805-6","article-title":"Myopia prediction: a systematic review","volume":"36","author":"Han","year":"2022","journal-title":"Eye"},{"key":"B2","doi-asserted-by":"publisher","first-page":"101484","DOI":"10.1016\/j.lanwpc.2025.101484","article-title":"Prevalence and temporal trends in myopia and high myopia children in China: a systematic review and meta-analysis with projections from 2020 to 2050","volume":"55","author":"Pan","year":"2025","journal-title":"Lancet Reg Health West Pac"},{"key":"B3","doi-asserted-by":"publisher","first-page":"M20","DOI":"10.1167\/iovs.18-25957","article-title":"IMI - defining 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":"B4","doi-asserted-by":"publisher","first-page":"2481","DOI":"10.1007\/s40123-025-01214-y","article-title":"Zhao Q. 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