儿童青少年近视防控需要更高质量的研究证据

何鲜桂; 潘臣炜

doi:10.16835/j.cnki.1000-9817.2021.02.001

儿童青少年近视防控需要更高质量的研究证据

doi: 10.16835/j.cnki.1000-9817.2021.02.001

何鲜桂^{1, 2},
潘臣炜³

1.
上海市眼病防治中心/上海市眼科医院/上海市视觉健康中心(上海市儿童青少年近视防治技术中心), 200040
2.
上海交通大学附属第一人民医院/上海市眼底病重点实验室/国家眼部疾病临床医学研究中心
3.
苏州大学医学部公共卫生学院

基金项目:

上海市公共卫生优秀学科带头人培养计划项目 GWV-10.2-XD09

详细信息

作者简介:
何鲜桂(1982-)，女，广西人，博士，副主任医师，主要研究方向为儿童青少年近视防控

中图分类号: R 179 R 778.11
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- 被引次数: 0
出版历程
- 收稿日期: 2021-01-15
- 修回日期: 2021-01-20
- 网络出版日期: 2021-04-06
- 刊出日期: 2021-02-25

Prevention and control of children and adolescents myopia needs more high-quality research evidence

HE Xiangui^{1, 2},
PAN Chenwei³

1.
Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute (200040), Shanghai, China

摘要

摘要: 近年来，随着国家高度重视和相应政策出台，儿童青少年近视防控再次成为学校卫生、眼科等领域工作重点。目前近视率多年持续攀升、已处于高位，近视率的下降难以一蹶而就，须基于循证证据长期推进防控工作，通过持续“量变”迎来“质变”。然而，当前近视防控多个环节尚缺乏高质量的研究证据。本文就近视防控效果评价指标选择、增加户外活动时间干预、规范化开展筛查和闭环管理、近视影响因素和有效防控手段探索等关键方面，分析已有证据和存在局限，提出努力方向和建议，为科学制定、实施近视防控方案和评估近视防控效果提供参考。
- 近视 /
- 综合预防 /
- 组织和管理 /
- 儿童 /
- 青少年
Abstract: In recent years, the state has paid greater attention to the prevention and control of myopia in children and adolescents, as well as to the issuance of corresponding policies, which means that this issue has once again become the focus of work in the fields of school health and ophthalmology. It should be noted that the prevalence of myopia has continued to rise for many years and it has reached a very high level. Therefore, reducing its prevalence requires long-term evidence-based prevention and treatment strategies, and a shift from "quantitative change" to "qualitative change". However, there is still a lack of high-quality research evidence regarding many aspects of myopia prevention and control. This paper summarizes the existing evidence and identifies limitations, proposes a direction for future efforts, and puts forward some suggestions regarding key aspects, such as the selection of evaluation indicators for myopia prevention and control, interventions that aim to increase the time spent on outdoor activities, standardized screening and closed-loop management, and the exploration of effective prevention and control measurements, so as to provide a referential framework that can be used to scientifically develop and implement myopia prevention and control strategies, as well to evaluate their efficacy.
- Myopia /
- Universal precautions /
- Organization and administration /
- Child /
- Adolescent

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参考文献(28)

[1]	中华人民共和国教育部. 综合防控儿童青少年近视实施方案[EB/OL]. [2020-12-20]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201808/t20180830_346672.html. Ministry of Education of the People's Republic of China. Implementation plan for comprehensive prevention and control of myopia in children and adolescents[EB/OL]. [2020-12-20]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201808/t20180830_346672.html.
[2]	中华人民共和国教育部. 教育部牵头完善全国综合防控儿童青少年近视工作联席会议机制[EB/OL]. [2020-12-20]. http://www.moe.gov.cn/jyb_xwfb/gzdt_gzdt/s5987/202004/t20200401_437290.html. Ministry of Education of the People's Republic of China. Ministry of Education takes the lead to improve the mechanism of National Joint Conference on comprehensive prevention and control of myopia among children and adolescents[EB/OL]. [2020-12-20]. http://www.moe.gov.cn/jyb_xwfb/gzdt_gzdt/s5987/202004/t20200401_437290.html.
[3]	中华人民共和国卫生健康委员会疾病预防控制局. 国家卫生健康委办公厅教育部办公厅财政部办公厅关于开展2018年儿童青少年近视调查工作的通知[EB/OL]. [2020-12-20]. http://www.nhc.gov.cn/jkj/s5898bm/201810/08e2b45092d346a8a8c960d3e3d98b62.shtml. Health Commission of the People's Republic of China. Bureau of disease control and prevention. Notice of the general office of the State Health Commission, the general office of the Ministry of education and the general office of the Ministry of Finance on the investigation of myopia among children and adolescents in 2018[EB/OL]. [2020-12-20]. http://www.nhc.gov.cn/jkj/s5898bm/201810/08e2b45092d346a8a8c960d3e3d98b62.shtml.
[4]	中华人民共和国教育部. 教育部办公厅关于公布全国综合防控儿童青少年近视专家宣讲团组成人员名单的通知[EB/OL]. [2020-12-20]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201907/t20190702_388677.html. Ministry of Education of the People's Republic of China. Notice of the general office of the Ministry of education on publishing the list of members of the national publicity group of experts on comprehensive prevention and control of myopia among children and adolescents[EB/OL]. [2020-12-20]. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201907/t20190702_388677.html.
[5]	中华人民共和国卫生健康委员会法规司. 关于发布推荐性卫生行业标准《中小学生屈光不正筛查规范》的通告[EB/OL]. [2020-12-20]. http://www.nhc.gov.cn/fzs/s7852d/202001/699b6ef20621496ab31375a861d1ebed.shtml. Health Commission of the People's Republic of China. Department of laws and regulations. Notice on Issuing recommended health industry standard "Specification for screening ametropia of primary and secondary school students"[EB/OL]. [2020-12-20]. http://www.nhc.gov.cn/fzs/s7852d/202001/699b6ef20621496ab31375a861d1ebed.shtml.
[6]	中华人民共和国卫生健康委员会疾病预防控制局. 儿童青少年新冠肺炎疫情期间近视预防指引[EB/OL]. [2020-12-20]. http://www.nhc.gov.cn/jkj/s5899tg/202004/ff168e31a90441bd8f2e4867ecf273d3.shtml. Health Commission of the People's Republic of China. Bureau of disease control and prevention. Guidelines for novel coronavirus pneumonia prevention during childhood and adolescence[EB/OL]. [2020-12-20]. http://www.nhc.gov.cn/jkj/s5899tg/202004/ff168e31a90441bd8f2e4867ecf273d3.shtml.
[7]	中华人民共和国卫生健康委员会疾病预防控制局. 国家卫生健康委在全国开展儿童青少年近视防控适宜技术试点[EB/OL]. [2020-12-20]. http://www.nhc.gov.cn/jkj/s5899tg/202009/2b7615d65ebb488f84fe4e7835492c82.shtml. Health Commission of the People's Republic of China. Bureau of disease control and prevention. The National Health Commission launched a pilot project of appropriate technology for prevention and control of myopia among children and adolescents in China[EB/OL]. [2020-12-20]. http://www.nhc.gov.cn/jkj/s5899tg/202009/2b7615d65ebb488f84fe4e7835492c82.shtml.
[8]	中华人民共和国教育部. 教育部国家卫生健康委国家体育总局联合印发全国综合防控儿童青少年近视工作评议考核办法[EB/OL]. [2021-01-20]. http://www.moe.gov.cn/jyb_xwfb/gzdt_gzdt/s5987/202008/t20200807_477173.html. Ministry of Education of the People's Republic of China. Ministry of Education, National Health Commission and General Administration of Sports jointly issued the national assessment method for comprehensive prevention and control of myopia among children and adolescents[EB/OL]. [2021-01-20]. http://www.moe.gov.cn/jyb_xwfb/gzdt_gzdt/s5987/202008/t20200807_477173.html.
[9]	中华人民共和国卫生健康委员会. 国家卫生健康委员会2019年4月29日例行新闻发布会[EB/OL]. [2021-01-20]. http://www.nhc.gov.cn/xwzb/webcontroller.do?titleSeq=11158&gecstype=1. Health Commission of the People's Republic of China. National Health Commission's regular press conference on April 29, 2019[EB/OL]. [2021-01-20]. http://www.nhc.gov.cn/xwzb/webcontroller.do?titleSeq=11158&gecstype=1.
[10]	WU P C, TSAI C L, WU H L, et al. Outdoor activity during class recess reduces myopia onset and progression in school children[J]. Ophthalmology, 2013, 120(5): 1080. doi: 10.1016/j.ophtha.2012.11.009
[11]	HE M, XIANG F, ZENG Y, et al. Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial[J]. JAMA, 2015, 314(11): 1142-1148. doi: 10.1001/jama.2015.10803
[12]	JIN J X, HUA W J, JIANG X, et al. Effect of outdoor activity on myopia onset and progression in school-aged children in northeast China: the sujiatun eye care study[J]. BMC ophthalmol, 2015, 15: 73. DOI: 10.1186/s12886-015-0052-9.
[13]	XIONG S, SANKARIDURG P, NADUVILATH T, et al. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review[J]. Acta Ophthalmol, 2017, 95(6): 551-566. doi: 10.1111/aos.13403
[14]	SMITH E L, HUNG L F, HUANG J. Protective effects of high ambient lighting on the development of form-deprivation myopia in rhesus monkeys[J]. Invest Ophthalmol Vis, 2012, 53(1): 421-428. doi: 10.1167/iovs.11-8652
[15]	徐荣彬, 高迪, 王政和, 等. 2016年中国学生户外活动时间现状分析[J]. 中国儿童保健杂志, 2018, 26(3): 254-257. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201803008.htm XU R B, GAO D, WANG Z H, et al. Analysis of the current status of outdoor activity time of Chinese students in 2016[J]. Chinese J Child Health Care, 2018, 26(3): 254-257. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201803008.htm
[16]	GILL V, JOGH M. Children's outdoor play: exploring parental concerns about children's safety and the changing nature of childhood[J]. Geoforum, 1997, 28(2): 219-235. doi: 10.1016/S0016-7185(97)00010-9
[17]	陶芳标, 潘臣炜, 伍晓艳, 等. 户外活动防控儿童青少年近视专家推荐[J]. 中国学校卫生, 2019, 40(5): 641-643. http://2269799.s21d-2.faiusrd.com/61/ABUIABA9GAAgwOqH5wUooJ3zhwc.pdf TAO F B, PAN C W, WU X Y, et al. Expert recommendation for outdoors activities as myopia prevention and control in children and adolescents[J]. Chin J Sch Health, 2019, 40(5): 641-643. http://2269799.s21d-2.faiusrd.com/61/ABUIABA9GAAgwOqH5wUooJ3zhwc.pdf
[18]	YE B, LIU K, CAO S, et al. Discrimination of indoor versus outdoor environmental state with machine learning algorithms in myopia observational studies[J]. J Transl Med, 2019, 17(1): 314. doi: 10.1186/s12967-019-2057-2
[19]	温龙波, 蓝卫忠, 李晓柠, 等. 客观监测近视眼相关环境因素的新设备"云夹"的准确性和稳定性研究[J]. 中华眼视光学与视觉科学志, 2017, 19(4): 198-203. http://d.wanfangdata.com.cn/periodical/ysgx201704002 WEN L B, LAN W Z, LI X N, et al. Accuracy and stability of Clouclip TM, a novel device to record myopic environmental risks[J]. Chin J Optom Ophthalmol Vis Sci, 2017, 19(4): 198-203. http://d.wanfangdata.com.cn/periodical/ysgx201704002
[20]	中华人民共和国国家卫生健康委员会. 中小学生屈光不正筛查规范WS/T 663—2020[S]. 北京, 2020. National Health Commission of the People's Republic of China. Screening criterion of ametropia in primary and middle school students WS/T 663-2020[S]. Beijing, 2020.
[21]	儿童眼及视力保健技术规范[J]. 中国乡村医药, 2013, 20(12): 85-87. Technical specification for children's eye and vision care[J]. J Chin Rural Med, 2013, 20(12): 85-87.
[22]	中华医学会眼科学分会斜视与小儿眼科学组. 弱视诊断专家共识(2011年)[J]. 中华眼科杂志, 2011, 47(8): 768. doi: 10.3760/cma.j.issn.0412-4081.2011.08.027 Strabismus and Pediatric Ophthalmology Group, Ophthalmology Bra-nch, Chinese Medical Association. Expert consensus on amblyopia diagnosis (2011)[J]. Chin J Ophthalmol, 2011, 47(8): 768. doi: 10.3760/cma.j.issn.0412-4081.2011.08.027
[23]	上海市卫生健康委员会. 上海市社区健康管理工作规范-儿童青少年视觉健康管理[EB/OL]. [2020-12-20]. http://wsjkw.sh.gov.cn/jbfk2/20190814/0012-64929.html. Shanghai Health Committee. Shanghai community health management standard-visual health management for children and adolescents[EB/OL]. [2020-12-20]. http://wsjkw.sh.gov.cn/jbfk2/20190814/0012-64929.html.
[24]	褚仁远, 瞿小妹. 建立儿童屈光发育档案是预防近视的基础步骤[J]. 中华眼科杂志, 2009, 45(7): 577-579. doi: 10.3760/cma.j.issn.0412-4081.2009.07.001 CU R Y, QU X M. Setting the individual file of ocular refractive development of children is the primary procedure in the prevention of myopia[J]. Chin J Ophthalmol, 2009, 45(7): 577-579. doi: 10.3760/cma.j.issn.0412-4081.2009.07.001
[25]	MCCRANN S, FLITCROFT I, LALOR K, et al. Parental attitudes to myopia: a key agent of change for myopia control?[J]. Ophthal Physiol Opt, 2018, 38(3): 298-308. doi: 10.1111/opo.12455
[26]	CAO K, WAN Y, YUSUFU M, et al. Significance of outdoor time for myopia prevention: a systematic review and meta-analysis based on randomized controlled trials[J]. Ophthal Res, 2019, 63(2): 1-9. http://www.zhangqiaokeyan.com/academic-journal-cn_international-journal-ophthalmology_thesis/0201276097192.html
[27]	HUANG H M, CHANG S T, WU P C. The association between near work activities and myopia in children: a systematic review and meta-analysis[J]. PLoS One, 2015, 10(10): e0140419. doi: 10.1371/journal.pone.0140419
[28]	SMALDONE G, CAMPAGNA O, PACELLA F, et al. Computer use and onset of myopia in children: a systematic review[J]. Senses Sci, 2015, 2(1): 1-7. http://www.ingentaconnect.com/content/doaj/22842489/2015/00000002/00000001/art00001