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Int J Med Sci 2015; 12(8):633-638. doi:10.7150/ijms.12133

Research Paper

Risk Factors of Myopic Shift among Primary School Children in Beijing, China: A Prospective Study

Li-Juan Wu1,2, You-Xin Wang1,2, Qi-Sheng You3, Jia-Li Duan4, Yan-Xia Luo1,2, Li-Juan Liu3, Xia Li1,2, Qi Gao1,2, Hui-Ping Zhu1,2, Yan He1,2, Liang Xu3, Man-Shu Song1,2, Jost B Jonas3,5, Xiu-Hua Guo1,2✉, Wei Wang1,2,6✉

1. School of Public Health, Capital Medical University, Beijing 100069, China
2. Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
3. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing100005, China
4. Beijing Center for Disease Prevention and Control, Beijing 100013, China
5. Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, 68167 Mannheim, Germany
6. School of Medical Science, Edith Cowan University, Perth 6027, Australia


Objective: To evaluate factors associated with myopic shift among primary school children.

Methods: In a one-year prospective school-based study, 5052 children from ten schools were enrolled using a multi-stage random cluster approach. The baseline examination included non-cycloplegic auto-refractometry and questionnaire interview. Measurements were repeated at the follow-up.

Results: Among 5052 students at baseline investigated, 4292 students (85.0%) returned for the follow-up examination. The mean refractive error (-1.13±1.57 diopters) had changed -0.52±0.73 diopters from the baseline to the follow-up examination. 2170 (51.0%) had a rate of significant myopic shift (significant myopic shift is defined as the change of spherical equivalent of the refraction ≤ -0.50D between the follow-up and baseline measures). We confirmed that common associated factors (older age, parental myopia, lower refractive status at baseline, shorter reading distance and lower frequency of outdoor activities during class recesses) were associated with greater shift towards myopia. After controlling for age, sex, region of habitation, parental myopia and refractive status at baseline, greater shift towards myopia was independently associated with distance from near-work (OR=1.48 , 95% CI=1.26-1.74, P<0.001) and longer time outdoors for leisure (OR=0.87, 95% CI=0.78-0.97, P<0.013).

Conclusion: Greater shift towards myopia was independently associated with modifiable factors (distance from near-work and longer time outdoors for leisure) might suggest that encouraging children to go outside for outdoor activities during class recess and after school may be a promising and feasible intervention against myopia development.

Keywords: Myopic shifts, Risk factors, Primary school children, Myopia, Beijing China.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See for full terms and conditions.
How to cite this article:
Wu LJ, Wang YX, You QS, Duan JL, Luo YX, Liu LJ, Li X, Gao Q, Zhu HP, He Y, Xu L, Song MS, Jonas JB, Guo XH, Wang W. Risk Factors of Myopic Shift among Primary School Children in Beijing, China: A Prospective Study. Int J Med Sci 2015; 12(8):633-638. doi:10.7150/ijms.12133. Available from