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      The Prevalence of Myopia and Factors Associated with It Among Secondary School Children in Rural Vietnam

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          Abstract

          Purpose

          To assess the prevalence of myopia and associated factors among secondary school children in a rural area of Vietnam.

          Methods

          A school-based cross-sectional study of children in grades six to nine was conducted in four secondary schools in Hoang Mai town, Nghe An Province, Vietnam, during December 2018 and January 2019. The status of myopia was defined as a spherical equivalent objective refractive error of −0.50 D or worse in either eye. A case–control study was conducted to explore factors associated with myopia, where children with myopia were considered to be cases, and children without myopia were considered to be controls. Factors associated with myopia were analyzed using univariate and multivariate logistic regression.

          Results

          The prevalence of myopia among secondary school children was 14.2% (95% CI: 12.7–15.7%) and tended to increase with grade, from 10.5% in grade six to 17.7% in grade nine. Myopia prevalence in girls was significantly higher than in boys. Factors associated with myopia were a mother with a college/university education (OR = 2.5, 95% CI = 1.2–5.3), parents who wore spectacles (OR = 2.0, 95% CI = 1.1–3.8), distance from near work (OR = 5.2, 95% CI = 3.5–7.9), and taking breaks after 30 minutes of continued reading (OR = 1.6, 95% CI = 1.1–2.5). However, there were inverse associations with myopia for children belonging to the wealthiest households (OR = 0.2, 95% CI = 0.1–0.5) and time spent performing outdoor activities (OR = 0.6, 95% CI = 0.4–0.9).

          Conclusion

          Our study showed that the prevalence of myopia is considerable among secondary children in rural areas of Vietnam. The prevalence of myopia tended to increase among children in higher grade levels. Thus, appropriate interventions should be developed and conducted to deal with the issue of school-age myopia.

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          Most cited references38

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          The epidemics of myopia: Aetiology and prevention.

          There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.
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            Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial.

            Myopia has reached epidemic levels in parts of East and Southeast Asia. However, there is no effective intervention to prevent the development of myopia.
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              Genome-wide meta-analyses of multiancestry cohorts identify multiple new susceptibility loci for refractive error and myopia.

              Refractive error is the most common eye disorder worldwide and is a prominent cause of blindness. Myopia affects over 30% of Western populations and up to 80% of Asians. The CREAM consortium conducted genome-wide meta-analyses, including 37,382 individuals from 27 studies of European ancestry and 8,376 from 5 Asian cohorts. We identified 16 new loci for refractive error in individuals of European ancestry, of which 8 were shared with Asians. Combined analysis identified 8 additional associated loci. The new loci include candidate genes with functions in neurotransmission (GRIA4), ion transport (KCNQ5), retinoic acid metabolism (RDH5), extracellular matrix remodeling (LAMA2 and BMP2) and eye development (SIX6 and PRSS56). We also confirmed previously reported associations with GJD2 and RASGRF1. Risk score analysis using associated SNPs showed a tenfold increased risk of myopia for individuals carrying the highest genetic load. Our results, based on a large meta-analysis across independent multiancestry studies, considerably advance understanding of the mechanisms involved in refractive error and myopia.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clin Ophthalmol
                OPTH
                clinop
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove
                1177-5467
                1177-5483
                22 April 2020
                2020
                : 14
                : 1079-1090
                Affiliations
                [1 ]Quynh Lap National Leprosy Dermatology Hospital , Hoang Mai Town, Nghe An, Vietnam
                [2 ]Nghe An Department of Health , Vinh City, Nghe An, Vietnam
                [3 ]Vietnam National Eye Hospital , Hanoi, Vietnam
                [4 ]Nghe An Eye Hospital , Vinh City, Nghe An, Vietnam
                [5 ]School of Medicine and Pharmacy, The University of Da Nang , Da Nang City, Vietnam
                [6 ]Hanoi Medical University , Hanoi, Vietnam
                [7 ]National Institute of Hygiene and Epidemiology , Hanoi, Vietnam
                [8 ]OnCare Medical Technology Company Limited , Hanoi, Vietnam
                Author notes
                Correspondence: Ho Duc Hung Quynh Lap National Leprosy Dermatology Hospital, Quynh Thien Ward , Hoang Mai, Nghe An, VietnamTel +84 912287851 Email hoduchung0905@gmail.com
                Author information
                http://orcid.org/0000-0002-0537-6256
                http://orcid.org/0000-0003-2721-8424
                http://orcid.org/0000-0001-8214-2931
                http://orcid.org/0000-0002-4333-8912
                Article
                251218
                10.2147/OPTH.S251218
                7183771
                32368006
                991a068f-13ee-4ff3-a8b9-1e71103ff9c7
                © 2020 Hung et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 25 February 2020
                : 03 April 2020
                Page count
                Figures: 2, Tables: 6, References: 47, Pages: 12
                Funding
                No funding or sponsorship was received for this study or publication of this article. The article processing charges were funded by the authors.
                Categories
                Original Research

                Ophthalmology & Optometry
                myopia,vision impairment,prevalence,secondary school children,rural,vietnam
                Ophthalmology & Optometry
                myopia, vision impairment, prevalence, secondary school children, rural, vietnam

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