{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:50:04Z","timestamp":1792515004395,"version":"4.5.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005270","name":"Fujian Provincial Department of Science and Technology","doi-asserted-by":"publisher","award":["2023RKB012"],"award-info":[{"award-number":["2023RKB012"]}],"id":[{"id":"10.13039\/501100005270","id-type":"DOI","asserted-by":"publisher"}]}],"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>Despite rapid economic development in coastal China, the alignment between socioeconomic growth and pediatric eye health remains poorly understood. School-based screening may provide an opportunity to bridge this knowledge gap, yet large-scale, real-world evidence from diverse urban-rural gradients is scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study analyzed 4.47 million valid screening encounters from Xiamen, Quanzhou, and Zhangzhou (2021\u20132024). Visual acuity (VA) and spherical equivalent (SE) were assessed. Two-way ANOVA and multivariate logistic regression were employed to identify drivers of visual impairment and uncorrected refractive error, with screening year as a covariate. Generalized Estimating Equations (GEE) with student-level clustering were applied to account for repeated measures. Sensitivity analyses confirmed dataset robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Age was the predominant driver of VA variance (\u03b7\n                      <jats:sup>2<\/jats:sup>\n                      = 0.1132), exceeding city-level effects fivefold. Xiamen exhibited the best refractive profile but the highest uncorrected rate (94.0% in primary school), illustrating the \u201cXiamen Paradox\u201d\u2014where affluence fosters a \u201cvisibility-over-correction\u201d bias. Conversely, Quanzhou demonstrated a \u201cpain-driven\u201d model with high correction adherence despite a severe myopia burden (19.0% high myopia). Crucially, county-level SE disparities (up to 1.66 D) eclipsed inter-city gaps. The 5\u20137-year window marked a critical refractive shift, with myopia prevalence doubling. Among primary school records, only 22.6% of visually impaired children wore spectacles, and merely half achieved adequate correction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Economic prosperity does not automatically translate to optimal visual health. Significant \u201ccorrection gaps\u201d and intra-regional disparities necessitate a shift from uniform strategies to precision governance. Future interventions must prioritize the 5\u20137-year window, emphasize correction quality over mere screening volume, and tailor approaches to local socioeconomic contexts to transform economic capital into sustainable ocular health dividends effectively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1938109","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:19:51Z","timestamp":1787584791000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Real-world evidence on childhood refractive errors in a developed coastal region of China: a multi-center analysis of 4.47 million school-based screening encounters in Southern Fujian"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiao-feng","family":"Li","sequence":"first","affiliation":[{"name":"Xiamen Eye Center and Eye Institute of Xiamen University, School of Medicine","place":["Xiamen, 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