{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T20:48:12Z","timestamp":1789678092396,"version":"4.0.1"},"reference-count":90,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CHA Bundang Medical Center","award":["BDCHA RND2025-010"],"award-info":[{"award-number":["BDCHA RND2025-010"]}]},{"award":["BDCHA RND2025-010"],"award-info":[{"award-number":["BDCHA RND2025-010"]}],"id":[{"id":"https:\/\/ror.org\/04nbqb988","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Childhood myopia is increasingly discussed in relation to digital device use, yet total screen duration is biologically nonspecific (not tied to a single biological cause) and may combine outdoor-light deficit, near work intensity, educational routines, and sleep\/circadian timing. This critical narrative review used structured database searches to support transparent source identification, not systematic completeness, quantitative pooling, or formal risk-of-bias grading. We narratively appraised evidence by design, exposure specificity, outcome specificity, temporality, and clinical directness, then derived a measurement framework. Outdoor light exposure has the strongest support for preventing incident myopia. Near work and the visual demands of schooling are important, but they are measured in inconsistent ways. Sleep and circadian timing remain biologically plausible, albeit lower-certainty modifiers. Digital device metrics are best interpreted as contextual measurement markers that can recover timing, bout structure, task context, substitution, and adherence, rather than as standalone causal surrogates (stand-ins for a true cause). The proposed framework prioritizes direct measurement of outdoor light, near work intensity, sleep\/circadian timing, and axial-growth outcomes, using device-related behavior only when it clarifies daily exposure patterns. This is a narrative review of previously described behavioral factors; it does not identify new risk factors or propose a novel causal model. For measurement, it groups these behaviors by how they occur together across a single day and separates substitution, mediation, interaction, and temporal clustering as distinct estimands (the specific quantities to be estimated). Its purpose is to improve exposure measurement and hypothesis testing, not to establish digital device use, sleep timing, or clustered routines as independent causal risk factors.<\/jats:p>","DOI":"10.3390\/life16071178","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:55:59Z","timestamp":1784249759000},"page":"1178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond Screen Time: A Measurement Framework for Behavioral Exposures in Childhood Myopia"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6764-6266","authenticated-orcid":false,"given":"Jeong Jun","family":"Park","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0141-4286","authenticated-orcid":false,"given":"Gwi Eun","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam 13590, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youra","family":"Kim","sequence":"additional","affiliation":[{"name":"Green Forest Eye Clinic, Busan 48111, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3717-2223","authenticated-orcid":false,"given":"Joonhyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1136\/bjo-2024-325427","article-title":"Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: A comprehensive systematic review and meta-analysis","volume":"109","author":"Liang","year":"2025","journal-title":"Br. J. Ophthalmol."},{"key":"ref_2","doi-asserted-by":"crossref","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":"ref_3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1167\/iovs.62.4.5","article-title":"IMI Pathologic Myopia","volume":"62","author":"Wu","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.ophtha.2018.10.029","article-title":"Potential Lost Productivity Resulting from the Global Burden of Myopia: Systematic Review, Meta-analysis, and Modeling","volume":"126","author":"Naidoo","year":"2019","journal-title":"Ophthalmology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1167\/iovs.62.5.3","article-title":"IMI Risk Factors for Myopia","volume":"62","author":"Morgan","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"M20","DOI":"10.1167\/iovs.18-25957","article-title":"IMI\u2014Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies","volume":"60","author":"Flitcroft","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1111\/aos.14942","article-title":"Near work, screen time, outdoor time and myopia in schoolchildren in the Sunflower Myopia AEEC Consortium","volume":"100","author":"Lanca","year":"2022","journal-title":"Acta Ophthalmol."},{"key":"ref_8","first-page":"1542","article-title":"Objectively measured near work, outdoor exposure and myopia in children","volume":"104","author":"Wen","year":"2020","journal-title":"Br. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2460026","DOI":"10.1001\/jamanetworkopen.2024.60026","article-title":"Digital Screen Time and Myopia: A Systematic Review and Dose-Response Meta-Analysis","volume":"8","author":"Ha","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e2424595","DOI":"10.1001\/jamanetworkopen.2024.24595","article-title":"Smartwatch Measures of Outdoor Exposure and Myopia in Children","volume":"7","author":"Chen","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_11","doi-asserted-by":"crossref","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":"ref_12","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.ophtha.2012.11.009","article-title":"Outdoor activity during class recess reduces myopia onset and progression in school children","volume":"120","author":"Wu","year":"2013","journal-title":"Ophthalmology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2141","DOI":"10.1016\/j.ophtha.2012.04.020","article-title":"The association between time spent outdoors and myopia in children and adolescents: A systematic review and meta-analysis","volume":"119","author":"Sherwin","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1111\/aos.13403","article-title":"Time spent in outdoor activities in relation to myopia prevention and control: A meta-analysis and systematic review","volume":"95","author":"Xiong","year":"2017","journal-title":"Acta Ophthalmol."},{"key":"ref_15","first-page":"Cd013549","article-title":"Interventions to increase time spent outdoors for preventing incidence and progression of myopia in children","volume":"6","author":"Kido","year":"2024","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Huang, H.M., Chang, D.S., and Wu, P.C. (2015). The Association between Near Work Activities and Myopia in Children-A Systematic Review and Meta-Analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0140419"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"zsad162","DOI":"10.1093\/sleep\/zsad162","article-title":"Myopia and sleep in children-a systematic review","volume":"46","author":"Liu","year":"2023","journal-title":"Sleep"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1007\/s00417-023-06338-0","article-title":"Association between sleep and myopia in children and adolescents: A systematic review and meta-analysis","volume":"262","author":"Jin","year":"2024","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.2147\/NSS.S472748","article-title":"Effects of Insufficient Sleep on Myopia in Children: A Systematic Review and Meta-Analysis","volume":"16","author":"Zhao","year":"2024","journal-title":"Nat. Sci. Sleep"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1073\/pnas.1418490112","article-title":"Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness","volume":"112","author":"Chang","year":"2015","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1152\/japplphysiol.00165.2011","article-title":"Evening exposure to a light-emitting diodes (LED)-backlit computer screen affects circadian physiology and cognitive performance","volume":"110","author":"Cajochen","year":"2011","journal-title":"J. Appl. Physiol. (1985)"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kiefer, A.K., Tung, J.Y., Do, C.B., Hinds, D.A., Mountain, J.L., Francke, U., and Eriksson, N. (2013). Genome-wide analysis points to roles for extracellular matrix remodeling, the visual cycle, and neuronal development in myopia. PLoS Genet., 9.","DOI":"10.1371\/journal.pgen.1003299"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/gepi.21936","article-title":"Assessing the Genetic Predisposition of Education on Myopia: A Mendelian Randomization Study","volume":"40","author":"Lu","year":"2016","journal-title":"Genet. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1038\/s41588-018-0127-7","article-title":"Genome-wide association meta-analysis highlights light-induced signaling as a driver for refractive error","volume":"50","author":"Tedja","year":"2018","journal-title":"Nat. Genet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1001\/jamaophthalmol.2019.4421","article-title":"Association Between Polygenic Risk Score and Risk of Myopia","volume":"138","author":"Plotnikov","year":"2020","journal-title":"JAMA Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.hlc.2018.03.027","article-title":"An Introduction to Writing Narrative and Systematic Reviews\u2014Tasks, Tips and Traps for Aspiring Authors","volume":"27","author":"Gregory","year":"2018","journal-title":"Heart Lung Circ."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Dumuid, D., Pedi\u0161i\u0107, \u017d., Palarea-Albaladejo, J., Mart\u00edn-Fern\u00e1ndez, J.A., Hron, K., and Olds, T. (2020). Compositional Data Analysis in Time-Use Epidemiology: What, Why, How. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17072220"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1093\/ije\/dyr218","article-title":"Recommendations for presenting analyses of effect modification and interaction","volume":"41","author":"Knol","year":"2012","journal-title":"Int. J. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Bhandari, K.R., Mirhajianmoghadam, H., and Ostrin, L.A. (2021). Wearable Sensors for Measurement of Viewing Behavior, Light Exposure, and Sleep. Sensors, 21.","DOI":"10.3390\/s21217096"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1136\/jech-2020-214259","article-title":"Overview of retrospective data harmonisation in the MINDMAP project: Process and results","volume":"75","author":"Wey","year":"2021","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_32","first-page":"103","article-title":"Maelstrom Research guidelines for rigorous retrospective data harmonization","volume":"46","author":"Fortier","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1167\/iovs.64.6.5","article-title":"IMI-Nonpathological Human Ocular Tissue Changes With Axial Myopia","volume":"64","author":"Jonas","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"M132","DOI":"10.1167\/iovs.18-25955","article-title":"IMI\u2014Clinical Myopia Control Trials and Instrumentation Report","volume":"60","author":"Wolffsohn","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"l6890","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline","volume":"368","author":"Campbell","year":"2020","journal-title":"BMJ"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jclinepi.2018.08.019","article-title":"Lack of transparency in reporting narrative synthesis of quantitative data: A methodological assessment of systematic reviews","volume":"105","author":"Campbell","year":"2019","journal-title":"J. Clin. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Mei, Z., Zhang, Y., Jiang, W., Lam, C., Luo, S., Cai, C., and Luo, S. (2024). Efficacy of outdoor interventions for myopia in children and adolescents: A systematic review and meta-analysis of randomized controlled trials. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1452567"},{"key":"ref_38","first-page":"393","article-title":"Is Spending More Time Outdoors Able to Prevent and Control Myopia in Children and Adolescents? A Meta-Analysis","volume":"67","author":"Li","year":"2024","journal-title":"Ophthalmic Res."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Dutheil, F., Oueslati, T., Delamarre, L., Castanon, J., Maurin, C., Chiambaretta, F., Baker, J.S., Ugbolue, U.C., Zak, M., and Lakbar, I. (2023). Myopia and Near Work: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20010875"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1080\/08164622.2021.1971049","article-title":"Objective measures of viewing behaviour in children during near tasks","volume":"105","author":"Bhandari","year":"2022","journal-title":"Clin. Exp. Optom."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1111\/opo.13457","article-title":"Validation of real-time viewing distance and ambient illumination measurement with two wearable sensors","volume":"45","author":"Sarkar","year":"2025","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1111\/opo.13523","article-title":"A novel wearable sensor for objective measurement of distance and illumination","volume":"45","author":"Sah","year":"2025","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1167\/iovs.64.14.38","article-title":"Time Spent Outdoors Partly Accounts for the Effect of Education on Myopia","volume":"64","author":"Clark","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/OPX.0000000000001975","article-title":"Myopia and Its Association with Near Work, Outdoor Time, and Housing Type among Schoolchildren in South India","volume":"100","author":"Gopalakrishnan","year":"2023","journal-title":"Optom. Vis. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"04274","DOI":"10.7189\/jogh.15.04274","article-title":"Combined and interaction effects of outdoor and reading time on myopia onset: Evidence from over 210\u2009000 schoolchildren in China","volume":"15","author":"Li","year":"2025","journal-title":"J. Glob. Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1038\/s42003-019-0387-5","article-title":"Quantile regression analysis reveals widespread evidence for gene-environment or gene-gene interactions in myopia development","volume":"2","author":"Pozarickij","year":"2019","journal-title":"Commun. Biol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1093\/hmg\/ddac004","article-title":"Whole exome sequence analysis in 51\u2009624 participants identifies novel genes and variants associated with refractive error and myopia","volume":"31","author":"Guggenheim","year":"2022","journal-title":"Hum. Mol. Genet."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1093\/hmg\/ddt431","article-title":"Education influences the association between genetic variants and refractive error: A meta-analysis of five Singapore studies","volume":"23","author":"Fan","year":"2014","journal-title":"Hum. Mol. Genet."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"25853","DOI":"10.1038\/srep25853","article-title":"Childhood gene-environment interactions and age-dependent effects of genetic variants associated with refractive error and myopia: The CREAM Consortium","volume":"6","author":"Fan","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"M89","DOI":"10.1167\/iovs.18-25965","article-title":"IMI\u2014Myopia Genetics Report","volume":"60","author":"Tedja","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1167\/iovs.66.13.22","article-title":"IMI-Myopia Genetics Report","volume":"66","author":"Voogelaar","year":"2025","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","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":"ref_53","doi-asserted-by":"crossref","first-page":"M31","DOI":"10.1167\/iovs.18-25967","article-title":"IMI\u2014Report on Experimental Models of Emmetropization and Myopia","volume":"60","author":"Troilo","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/opo.12633","article-title":"Twenty-four hour ocular and systemic diurnal rhythms in children","volume":"39","author":"Ostrin","year":"2019","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"7071801","DOI":"10.1155\/2022\/7071801","article-title":"Relationships between Sleep Duration, Timing, Consistency, and Chronotype with Myopia among School-Aged Children","volume":"2022","author":"Li","year":"2022","journal-title":"J. Ophthalmol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Guan, H., Yu, N.N., Wang, H., Boswell, M., Shi, Y., Rozelle, S., and Congdon, N. (2019). Impact of various types of near work and time spent outdoors at different times of day on visual acuity and refractive error among Chinese school-going children. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215827"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1167\/iovs.66.15.5","article-title":"IMI: The Role of Light in Refractive Development and Myopia: Evidence from Animal and Human Studies","volume":"66","author":"Ashby","year":"2025","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1167\/iovs.64.6.4","article-title":"IMI-The Dynamic Choroid: New Insights, Challenges, and Potential Significance for Human Myopia","volume":"64","author":"Ostrin","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ruamviboonsuk, V., Lanca, C., and Grzybowski, A. (2024). Biomarkers: Promising Tools Towards the Diagnosis, Prognosis, and Treatment of Myopia. J. Clin. Med., 13.","DOI":"10.3390\/jcm13226754"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Li, H.Y., Shi, X.H., Dong, L., Yu, C.Y., Li, Y.T., Zhang, R.H., Zhou, W.D., Wu, H.T., Jonas, J.B., and Wei, W.B. (2025). Transcriptomic and proteomic analyses of sclera in lens-induced myopic guinea pigs. BMC Genom., 26.","DOI":"10.1186\/s12864-025-11422-2"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Grochowski, E.T., Pietrowska, K., Kowalczyk, T., Mariak, Z., Kretowski, A., Ciborowski, M., and Dmuchowska, D.A. (2020). Omics in Myopia. J. Clin. Med., 9.","DOI":"10.3390\/jcm9113464"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"nwae291","DOI":"10.1093\/nsr\/nwae291","article-title":"Multi-omics analysis reveals a novel NFE2L3 variant impairing choroidal vasculature development in high myopia and myopic maculopathy","volume":"12","author":"He","year":"2025","journal-title":"Natl. Sci. Rev."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"108866","DOI":"10.1016\/j.exer.2021.108866","article-title":"Melanopsin modulates refractive development and myopia","volume":"214","author":"Chakraborty","year":"2022","journal-title":"Exp. Eye Res."},{"key":"ref_64","doi-asserted-by":"crossref","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":"ref_65","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/opo.13107","article-title":"The outdoor environment affects retinal and choroidal thickness","volume":"43","author":"Lou","year":"2023","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_66","doi-asserted-by":"crossref","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":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/0042-6989(94)E0049-Q","article-title":"Moving the retina: Choroidal modulation of refractive state","volume":"35","author":"Wallman","year":"1995","journal-title":"Vis. Res."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Hesse, J., Malhan, D., Yal\u00e7in, M., Aboumanify, O., Basti, A., and Rel\u00f3gio, A. (2020). An Optimal Time for Treatment-Predicting Circadian Time by Machine Learning and Mathematical Modelling. Cancers, 12.","DOI":"10.3390\/cancers12113103"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"3826","DOI":"10.1172\/JCI120874","article-title":"High-accuracy determination of internal circadian time from a single blood sample","volume":"128","author":"Wittenbrink","year":"2018","journal-title":"J. Clin. Investig."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Skubic, C., Zevnik, U., Nahtigal, K., Dolenc Gro\u0161elj, L., and Rozman, D. (2025). Circadian Biomarkers in Humans: Methodological Insights into the Detection of Melatonin and Cortisol. Biomolecules, 15.","DOI":"10.20944\/preprints202506.0293.v1"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Ding, H., Jiang, L., Lin, X., Ye, C., and Chun, B. (2025). Association of physical activity, sedentary behaviour, sleep and myopia in children and adolescents: A systematic review and dose-response meta-analysis. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-22434-8"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s10654-011-9554-9","article-title":"Estimating measures of interaction on an additive scale for preventive exposures","volume":"26","author":"Knol","year":"2011","journal-title":"Eur. J. Epidemiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12966-024-01590-x","article-title":"Validation of actigraphy sleep metrics in children aged 8 to 16 years: Considerations for device type, placement and algorithms","volume":"21","author":"Haszard","year":"2024","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/iovs.66.9.7","article-title":"IMI-Instrumentation for Myopia Management","volume":"66","author":"Jones","year":"2025","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1146\/annurev-publhealth-082516-012802","article-title":"Assessing the Exposome with External Measures: Commentary on the State of the Science and Research Recommendations","volume":"38","author":"Turner","year":"2017","journal-title":"Annu. Rev. Public Health"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Zhu, G., Wen, Y., Cao, K., He, S., and Wang, T. (2024). A review of common statistical methods for dealing with multiple pollutant mixtures and multiple exposures. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1377685"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s41256-025-00445-7","article-title":"The need to address the myopia pandemic: Summary report of the global myopia public health summit 2024","volume":"10","author":"Pan","year":"2025","journal-title":"Glob. Health Res. Policy"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/iovs.62.5.7","article-title":"IMI 2021 Yearly Digest","volume":"62","author":"Jong","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1167\/iovs.66.12.27","article-title":"IMI-2025 Digest","volume":"66","author":"Tahhan","year":"2025","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1159\/000216538","article-title":"Adolescent changes in the homeostatic and circadian regulation of sleep","volume":"31","author":"Hagenauer","year":"2009","journal-title":"Dev. Neurosci."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1038\/s41467-025-68228-9","article-title":"Wearable intelligent throat enables natural speech in stroke patients with dysarthria","volume":"17","author":"Tang","year":"2026","journal-title":"Nat. Commun."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Han, Z., Ye, Z., Wu, W., Hong, C., and Deng, S. (2025). PEGSYS: A Portable and Easy-to-Operate Smart Screening and Grading System for Glaucoma. IEEE Trans. Comput. Soc. Syst., 1\u201319. Early Access.","DOI":"10.1109\/TCSS.2025.3635655"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Agyekum, S., Chan, P.P., Zhang, Y., Huo, Z., Yip, B.H.K., Ip, P., Tham, C.C., Chen, L.J., Zhang, X.J., and Pang, C.P. (2023). Cost-effectiveness analysis of myopia management: A systematic review. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1093836"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"11003","DOI":"10.7189\/jogh.12.11003","article-title":"Healthcare utilization and economic burden of myopia in urban China: A nationwide cost-of-illness study","volume":"12","author":"Ma","year":"2022","journal-title":"J. Glob. Health"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1167\/iovs.66.12.39","article-title":"IMI-Interventions for Controlling Myopia Onset and Progression 2025","volume":"66","author":"Bullimore","year":"2025","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_86","first-page":"Cd014758","article-title":"Interventions for myopia control in children: A living systematic review and network meta-analysis","volume":"2","author":"Lawrenson","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"100124","DOI":"10.1016\/j.apjo.2024.100124","article-title":"Safety of repeated low-level red-light therapy for myopia: A systematic review","volume":"13","author":"Chen","year":"2024","journal-title":"Asia Pac. J. Ophthalmol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1136\/bjo-2025-327366","article-title":"Efficacy comparison of atropine, orthokeratology and repeated low-level red-light therapy for myopia control in children: A systematic review and network meta-analysis","volume":"109","author":"Zheng","year":"2025","journal-title":"Br. J. Ophthalmol."},{"key":"ref_89","doi-asserted-by":"crossref","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":"ref_90","doi-asserted-by":"crossref","first-page":"100493","DOI":"10.1016\/j.optom.2023.100493","article-title":"Myopia progression in children during home confinement in the COVID-19 pandemic: A systematic review and meta-analysis","volume":"17","author":"Laan","year":"2024","journal-title":"J. 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