[Professional Answer] How to prevent and control myopia in children and adolescents?

- Oct 25, 2019-

The myopia of children and adolescents in China is high and low, which seriously affects the physical and mental health of children and adolescents. It has become the focus of attention of the whole society. Recently, the National Health and Health Commission issued the "Technical Guide for the Prevention and Control of Myopia for Children and Adolescents". In order to do a good job in the prevention and control of myopia for children and adolescents, the "Online Interview" section of the official website of the National Health and Health Commission, invite relevant experts to interpret the "Guide" and answer questions for netizens.

Ma Jun, Director and Professor of School Health Center of China CDC; Tao Fangbiao, Dean and Professor of School of Health Management, Anhui Medical University; Wang Ningli, Leader of National Anti-Blind Technical Guidance Group, Chairman of Public Eye Branch of Chinese Preventive Medicine Association, Beijing Tongren Director, Chief Physician, Professor of Hospital Eye Center.


What is the purpose and significance of the formulation?

Ma Jun: The purpose of the Guideline is to further promote the implementation of the Integrated Prevention and Control Program for Children and Adolescents with Myopia. The purpose is to guide scientific and standardized prevention and control of children and adolescents' myopia, and to improve the ability of children and adolescents to prevent and control myopia.

In terms of meaning, I think there are three main aspects:


The causes and influencing factors of the development of myopia are complicated. The main reasons for the development of myopia, such as healthy eye behavior, daytime outdoor activities, and key factors of myopia prevention and control, such as accurate screening, health records, scientific diagnosis and correction, etc., to develop targeted and appropriate key Technology is of great significance for effective prevention and control of myopia and implementation of the Implementation Plan.


The National Health and Health Commission's CDC implements the spirit of the National Health and Wellness Conference and combines the major health issues of children and adolescents in China. From 2016, it is responsible for organizing and implementing an annual “National Common Diseases and Health Influencing Factors Monitoring” to understand children and adolescents. Health problems and their influencing factors. In 2018, the children and adolescents' myopia survey was carried out on this platform. In 2019, the National Health and Welfare Commission's CDC actively sought to transfer local funds to local payments, and basic public health services were funded. In 2019, the funding increased by more than 20 times compared with 2018. . In 2019, “National Common Diseases and Health Influencing Factors Monitoring” not only covers 100% of the country's total coverage, but also conducts interventions for cities that have carried out monitoring of common diseases and health influencing factors in 2018, targeting students' myopia, obesity and spine. Focus on common diseases and health-related factors such as abnormal bending and further targeted interventions to protect and promote the health of children and adolescents. .


Nowadays, there are many merchants on the market that offer various kinds of claims to help children reduce myopia and even cure myopia advertisements, such as "myopia cure", "rehabilitation", or "myopia nemesis". Up to now, there is no cure for myopia in medicine. Don't believe that it can cure myopia and commercial marketing. Unscientific disposal may lead to further decline in vision and even serious consequences such as eye infection or trauma. Therefore, the prevention and control of myopia must be scientific and standardized, and the "Guide" requires that standardized diagnosis and scientific correction must be carried out. .


What is the basis for the “adding daytime outdoor activities” as a recommended technology? What role can outdoor activities play in preventing or relieving myopia?

Tao Fangbiao: The topic of genetic and environmental etiology of myopia has been discussed for a long time, and more and more research evidence shows that the environment plays a decisive role in children's and adolescent myopia. The recommendation of “increasing daytime outdoor activities” is based on a large number of empirical studies and evidence-based research.


A prospective cohort study found that the main and independent factors affecting the occurrence of myopia after 5 years and 10 years of primary and secondary school students are less outdoor activities for myopia students.


A number of randomized controlled intervention trials have demonstrated that outdoor activities play a protective role in the occurrence and progression of myopia. .


Increasing outdoor activities has been confirmed in animal experiments. High light intensity increases dopamine secretion in the animal's retina and slows axial growth. Pharmacological blocking of the dopamine effect can reverse the protective effect of high light on myopia. .


New research evidence shows that outdoor activities have good myopia prevention and control even in corridors and shades. .

Evidence of the protective effects of outdoor activities on the progression of myopia has not yet been unanimously concluded. However, there are currently four randomized controlled intervention studies with high levels of evidence. At least two experiments have found that increasing outdoor activities has a protective effect on myopia progression, but its protective effect is less than that of new-onset myopia. A recent study found that the use of wearable devices to measure the light conditions of children's outdoor activities found that the longer the daily exposure to bright light outdoors, the slower the progression of myopia. In addition, there are differences in myopia progression in different seasons, rapid progression of myopia in winter, and slow progression of myopia in summer. This seasonal trend also indirectly proves that outdoor activities may have a protective effect on the occurrence and development of myopia. It should also be emphasized that daytime outdoor activities have less protective effects on the progression of myopia in myopic students than in the prevention of myopia. It is not that students with myopia do not have outdoor activities. On the contrary, students with nearsightedness should extend their outdoor activities. Activities can achieve better delays in the progression of myopia.


Is all myopia corrected by surgery?

Wang Ningli: First of all, there is no cure for myopia so far. Myopia surgery only corrects the refractive state. Surgery is actually a flexion correction. The glasses are worn on the cornea of the eye. Although the refractive state is corrected, the pathological damage of the fundus still exists. If the learning burden is still heavy, myopia will continue to develop. Of course, there are several options for myopia surgery. First of all, if your occupation is really inconvenient to wear glasses, you can choose surgery correction. When surgery correction, we think that the effect below 800 degrees is very good, of course, technology. There are more than 1,000 degrees of development in this type of surgery, which can achieve a good correction. However, for people with thin corneas and pathological changes in the eyes, we recommend not doing such corrective surgery. Secondly, some patients have had two Baidu myopias just after one year of surgery. This is because the patient thinks that myopia is cured after the operation, so he still watches the computer and reads the book in an intemperate manner, and finally causes new myopia. Our surgery is correction, not treatment, especially for patients with high myopia, after surgery, you must go to the hospital to check your fundus changes regularly.