Effect of outdoor time on the incidence of myopia among primary school students in 9 provinces of China

Abstract

Objective: We aimed to assess the effects of outdoor time in preventing incident myopia among primary school students and evaluate its differences among different grades to provide evidence for policy formulation related to myopia prevention. Methods: This study is a cohort study. We investigated 6 046 grade 1 to 5 students in 9 provinces, Jiangsu, Shanghai, Fujian, Shanxi, Henan, Hunan, Gansu, Chongqing, and Guangxi. In 2019, we measured their myopia on site. In 2020, we did a follow-up visit on those students to detect the myopia incidence rate. Information regarding outdoor time and myopia-related behaviors were obtained from a questionnaire within one week of visual acuity measurement in 2020. The chi-square test and Cochran-Armitage trend test compared the differences between groups. The Cox proportional hazards risk model was used to test the relationship between outdoor time and myopia. Results: In 2020, the overall myopia incidence rate of grade 1 to 5 students in the baseline was 27.5%; while 23.0% in grades 1 and 2 students and 31.7% in grades 3 to 5 students, respectively. After controlling for covariates, for students in grade 1 to 2, those with ≥1 hour of outdoor time per day were at 0.76 (95%CI: 0.62-0.93, P=0.008) times risk of being myopia than that of students with <1 hour of outdoor time per day; while for students in grades 3 to 5, an average of ≥3 hours of outdoor time per day was required to have a significant protective effect on myopia. The students with ≥3 hours of outdoor time per day were less likely to be myopia (OR=0.75, 95%CI: 0.61-0.93, P=0.007) than those students with <3 hours of outdoor time per day. Conclusions: For grade 1 and 2 students, 1 hour of outdoor time per day could reduce the incidence of myopia, whereas for grade 3 to 5 students, 3 hours of outdoor time per day could effectively reduce the incidence of myopia. Therefore, the recommendations for outdoor time as myopia prevention should be different for different grades. The higher the grade is, the more outdoor time should be spent to reduce myopia incidence. Moreover, other factors that affect myopia's incidence should be also paid attention to, and a comprehensive approach should be adopted to prevent and control the incidence of myopia.