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      The increasing prevalence of myopia and high myopia among high school students in Fenghua city, eastern China: a 15-year population-based survey

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          Myopia is the leading cause of preventable blindness in children and young adults . Multiple epidemiological studies have confirmed a high prevalence of myopia in Asian countries. However, fewer longitudinal studies have been performed to evaluate the secular changes in the prevalence of myopia, especially high myopia in China. In the present study, we investigated trends in the prevalence of myopia among high school students in Fenghua city, eastern China, from 2001 to 2015.


          This was a population-based, retrospective study. Data were collected among 43,858 third-year high school students. Noncycloplegic autorefraction was used to determine refractive error, which was defined as low myopia, moderate myopia, high myopia and very high myopia according to the spherical equivalent from the worse eye of each participant. The prevalence of myopia was calculated and the annual percentage change (APC) was used to quantify the time trends. All analyses were conducted using the SPSS, Stata and Graphpad Prism software.


          From 2001 to 2015, the prevalence of overall myopia increased from 79.5% to 87.7% (APC =0.59%), with a significant increase of moderate myopia (38.8% to 45.7%, APC = 0.78%), high myopia (7.9% to 16.6%, APC = 5.48%) and very high myopia (0.08% to 0.92%, APC = 14.59%), while the prevalence of low myopia decreased from 32.7% to 24.4% (APC = − 1.73%). High myopia and very high myopia contributed the major part of the increasing trend of myopia prevalence (contribution rate 27.00% and 69.07%, respectively).


          During the 15-year period, there was a remarkable increase in the prevalence of high and very high myopia among high school students, which might become a serious public health problem in China for the next few decades.

          Electronic supplementary material

          The online version of this article (10.1186/s12886-018-0829-8) contains supplementary material, which is available to authorized users.

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          Most cited references 27

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          Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004.

           Susan Vitale (2009)
          To compare US population prevalence estimates for myopia in 1971-1972 and 1999-2004. The 1971-1972 National Health and Nutrition Examination Survey provided the earliest nationally representative estimates for US myopia prevalence; myopia was diagnosed by an algorithm using either lensometry, pinhole visual acuity, and presenting visual acuity (for presenting visual acuity > or =20/40) or retinoscopy (for presenting visual acuity -2.0 diopters [D]: 17.5% vs 13.4%, respectively [P -7.9 D: 22.4% vs 11.4%, respectively [P < .001]; < or =-7.9 D: 1.6% vs 0.2%, respectively [P < .001]). When using similar methods for each period, the prevalence of myopia in the United States appears to be substantially higher in 1999-2004 than 30 years earlier. Identifying modifiable risk factors for myopia could lead to the development of cost-effective interventional strategies.
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            Prevalence of refractive error in the United States, 1999-2004.

            To describe the prevalence of refractive error in the United States. The 1999-2004 National Health and Nutrition Examination Survey (NHANES) used an autorefractor to obtain refractive error data on a nationally representative sample of the US noninstitutionalized, civilian population 12 years and older. Using data from the eye with a greater absolute spherical equivalent (SphEq) value, we defined clinically important refractive error as follows: hyperopia, SphEq value of 3.0 diopters (D) or greater; myopia, SphEq value of -1.0 D or less; and astigmatism, cylinder of 1.0 D or greater in either eye. Of 14,213 participants 20 years or older who completed the NHANES, refractive error data were obtained for 12,010 (84.5%). The age-standardized prevalences of hyperopia, myopia, and astigmatism were 3.6% (95% confidence interval [CI], 3.2%-4.0%), 33.1% (95% CI, 31.5%-34.7%), and 36.2% (95% CI, 34.9%-37.5%), respectively. Myopia was more prevalent in women (39.9%) than in men (32.6%) (P < .001) among 20- to 39-year-old participants. Persons 60 years or older were less likely to have myopia and more likely to have hyperopia and/or astigmatism than younger persons. Myopia was more common in non-Hispanic whites (35.2%) than in non-Hispanic blacks (28.6%) or Mexican Americans (25.1%) (P < .001 for both). Estimates based on the 1999-2004 NHANES vision examination data indicate that clinically important refractive error affects half of the US population 20 years or older.
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              Prevalence of myopia and its association with body stature and educational level in 19-year-old male conscripts in seoul, South Korea.

              To examine prevalence of refractive errors and its associated factors, such as body stature and educational level, among 19-year-old males in Seoul, Korea. A population-based cross-sectional study was performed in male subjects (n = 23,616; age = 19 years) who were normally resident in Seoul for male compulsory conscripts during the study period (2010). Refractive examination was performed with cycloplegia. Height, weight, and educational level were examined. Myopia was defined as a spherical equivalent less than -0.5 diopters (D) and high myopia less than -6.0 D. The association of myopia with body stature and educational level was analyzed using logistic regression analysis. The prevalence of myopia in 19-year-old males in Seoul was 96.5%. The prevalence of high myopia was 21.61%. Body stature was not significantly associated with myopia. Four- to 6-year university students (odds ratio [OR] 1.69; P < 0.001) and 2 to 3-year college students (OR 1.68; P < 0.001) showed significantly higher risk for myopia than those with lower academic achievement (< high school graduation). The 19-year-old male population in Seoul, Korea, demonstrated a very high myopic prevalence. Myopic refractive error was associated with academic achievement, not with body stature.

                Author and article information

                BMC Ophthalmol
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central (London )
                3 July 2018
                3 July 2018
                : 18
                [1 ]ISNI 0000 0004 1759 700X, GRID grid.13402.34, Eye Center, the 2nd Affiliated Hospital, , Medical College of Zhejiang University, ; Hangzhou, China
                [2 ]ISNI 0000 0004 1759 700X, GRID grid.13402.34, Zhejiang Provincial Key Lab of Ophthalmology, ; Hangzhou, China
                [3 ]Department of Ophthalmology, Fenghua People’s Hospital, Fenghua, Zhejiang China
                [4 ]GRID grid.459700.f, Department of Ophthalmology, Lishui People’s Hospital, ; Lishui, Zhejiang China
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: No.81700829
                Award Recipient :
                Funded by: Fundamental Research Funds for the Central Universities
                Research Article
                Custom metadata
                © The Author(s) 2018

                Ophthalmology & Optometry

                epidemiology, myopia, high myopia, prevalence, high school student


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