Abstract
Background: Text messaging is effective in management of public health problems such as obesity, HIV, and childhood cataract, but no evidence is available for its effect on controlling myopia in children. Increasing time spent outdoors during school hours has been shown to retard myopia development in children but increasing time outdoors easily and effectively remains an important issue. The aims of this study were to investigate whether a mobile phone text message/short message service (SMS) for parents could increase light exposure and time outdoors in school-aged children, and what its long-term effect on controlling myopia. Methods: Of 3113 primary school students from the Anyang Childhood Eye Study, 268 grade 2 schoolchildren (mean age 8.4 years, 45% girls), recruited from October 2013 to May 2014, were randomly assigned (1:1) to a SMS group (n=135) where the parents received twice-daily text message reminders to take children outdoors, or a control group (n=133) for which the parents did not receive text messages. All children were instructed to wear portable light meters (HOBO, Pendant temp/light Part # UA-002-64) to record light exposure. A lower limit of 1000 lux in light intensity was defined for calculate time outdoors. Ocular examinations were performed annually by investigators masked to group allocation during the one-year intervention, and with three years of follow-up. The primary outcomes were changes in axial length and cycloplegic autorefraction. Findings: 261 children (97·4%) completed the Intervention period. At 1 year, the SMS group showed significantly greater light exposure than the control group at weekends (46 lux/day vs. 28 lux/day, P=0·02). Time outdoors was higher in the intervention group than in the control group at weekends (0·34 hours/day vs. 0·18 hours/day, P=0·03). Axial elongation was significantly smaller in the intervention group than in the control group during the trial (0·27 mm/y vs. 0·31 mm/y, P=0·03). Axial elongation and myopic shift remained smaller in the intervention group at the end of the 2nd year (0·39 mm vs. 0·46 mm, P<0·01; -0·69 D/y vs. -0·82 D/y, P=0·04) and 3rd year (0·30 mm vs. 0·35 mm, P<0·01; -0·47 D/y vs. -0·60 D/y, P=0·01). The main limitations of this study were the use of light meter not yet well validated for Chinese children and the cut-off of light intensity to define time outdoors Interpretation: The use of SMS increased children’s light exposure and time outdoors at weekends and resulted in slower axial elongation and myopia progression over a longer period. SMS in combination with wearable devices is promising for controlling myopia in populations of children. Trial Registration: The study has been registered in Chinese Clinical Trial Registry (ChiCTR-IOC-17010525). Funding Statement: Beijing talents foundation (2016000021469ZK28), the Capital health research and development of special (2020-4-2056), the Ministry of Science and Technology, the Major International (Regional) Joint Research Project of the National Natural Science Foundation of China (81120108007) and the National Natural Science Foundation of China (81300797). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The trial was approved by the Institutional Review Board of Beijing Tongren Hospital, Capital Medical University and followed the tenets of the Declaration of Helsinki. Written consent was obtained from at least one of the parents after the experimental procedures had been fully described to them.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call