myopia! myopia!
In recent years, the myopia of adolescents in my country has shown a trend of high incidence, younger age and severity.
According to data from the National Health Commission, in 2018, the overall myopia rate of children and adolescents in my country was 53.6%.
In 2020, the youth vision survey data released by the Ministry of Education shows that during the new crown pneumonia epidemic, due to the increase in the time spent watching electronic screens and the decrease in outdoor sports time, compared with 2019, the myopia rate of primary and secondary school students in my country has increased by 11.7%, among which the myopia of primary school students The rate increased by 15.2%.
Around the world, myopia is also the most common eye disease among adolescents. According to the World Vision Report released by WHO, there are 2.6 billion people with myopia in the world, of which 312 million are adolescents and children under 19 years old. The incidence of myopia in East Asia is higher. high.
The problems of premature myopia and high myopia among adolescents in my country have seriously affected the quality of our population and restricted the realization of the long-term goal of a strong education country and a healthy China.
To this end, the National Educational Macro Policy Research Institute of East China Normal University formed a research team to select high schools in provincial capitals, prefecture-level cities, and county-level cities in Jilin, Inner Mongolia, Beijing, Zhejiang, Shanghai, Henan, Hunan and other places in 2020. Questionnaire surveys were conducted in junior high schools and elementary schools, and more than 18,000 valid questionnaires were collected to conduct special research on this issue.
The survey shows that the prevalence of myopia among primary and middle school students is nearly 60%
Through data analysis, the research team came to the following conclusions:
First, in general, the prevalence of myopia in primary and middle school students is higher, and the proportion of high myopia is lower.
Survey data shows that 58% of primary and middle school students in the overall sample are nearsighted, and 3% of students do not know whether they are nearsighted.
In terms of myopia, most students (58%) are below 300 degrees, 38% are between 300-600 degrees, and 4% are over 600 degrees (high myopia).
Second, in terms of grades, the proportion of myopia continues to increase as the grade increases.
The survey data shows that the proportion of myopia in elementary school, junior high school and high school students is 31.3%, 64.9%, and 79.3% respectively.
From elementary school to high school, the proportion of high myopia increased from 1.2% to 7.6%.
Third, in terms of the location of schools, the myopia rate of students in small and medium-sized cities is higher than that in big cities.
The survey data shows that the myopia rate of students in prefecture-level city schools (69%) is higher than that of students in municipalities/capital cities (56%).
This may be due to the more advanced medical technology and richer resources in municipalities and provincial capitals, and students who suffer from myopia can get better treatment.
Fourth, from the perspective of school types, the myopia rate of students in private schools is higher than that in public schools.
Research data shows that the proportion of myopia in private schools (74.0%) is 18.3 percentage points higher than that in public schools (55.7%).
There are four main causes of myopia in primary and middle school students
According to the analysis of the research team, there are four main causes of myopia in primary and middle school students:
First, the occurrence and prevention of myopia are long-term and cumulative, not easy to attract attention and there are misunderstandings.
Myopia is a chronic eye disease, and the development of vision is a long-term process of change.
It is precisely because the harm of myopia is not easy to detect immediately and can be controlled by wearing glasses, so that the society is not sufficiently aware of the harm of myopia and does not pay enough attention to the prevention and treatment of myopia.
Although myopia is a chronic disease, it is harmful.
Myopia is usually accompanied by other symptoms such as astigmatism and glaucoma. High myopia has multiple complications such as fundus macula and retinal detachment, which increase the probability of students suffering from cataracts in adulthood. In severe cases, they can lead to blindness.
In addition to causing inconvenience to daily life, myopia will also cause continuous correction costs and increase the financial burden of poor families.
Parents have misunderstandings about myopia prevention.
In the concept of some parents, myopia is a normal physiological phenomenon, which can be prevented by wearing glasses.
However, frame glasses only play a corrective role, and do not have the effect of curing myopia. Wearing glasses unreasonably can worsen myopia.
Some parents believe that “laser surgery can be done once and for all”, but laser surgery can only correct vision and achieve the purpose of removing glasses. It cannot cure fundus diseases or reduce the risk of blindness.
In addition, myopia correction surgery belongs to medical cosmetic plastic surgery and is not covered by the medical insurance reimbursement, which to some extent deepens the misunderstanding that "myopia is not a disease".
Second, the high degree of academic pressure makes students unscientific.
At present, academic performance is still the main indicator of student evaluation and advancement.
Under the influence of the "baton" of the college entrance examination, students have faced fierce education competition since elementary school.
Under academic pressure, students have a heavy burden both inside and outside of class, which has a serious impact on vision.
One is that the homework time after class is too long, making the eyes focus on close objects such as books and electronic devices for a long time.
The "Implementation Plan for the Comprehensive Prevention and Control of Myopia in Children and Adolescents" requires the completion of written homework in grades three to six in elementary schools not to exceed 60 minutes, and in junior high schools not to exceed 90 minutes. The research data of the research team shows that more than 60% of primary school students and nearly 70% of junior high school students Operation time exceeded requirements.
Second, academic time squeezes exercise time and sleep time, and the eyes cannot be fully adjusted and relaxed.
Students stay indoors for a long time to study, and they have fewer opportunities to be exposed to natural light.
The research data of the research group shows that 78% of primary and middle school students exercise less than one hour a day, and their exposure to natural light is reduced.
In particular, the shortage of school space in the city’s old city limits students’ outdoor activities.
For example, in the middle and elementary schools of Shanghai's central urban area, there are generally small activity spaces per student.
73.6% of primary and middle school students do not sleep up to the standard every day, and the eye muscles cannot be relaxed for a long time, resulting in asthenopia and increasing the risk of myopia.
Third, the prevention and control of myopia on campus lack the guidance of professional medical personnel.
In order to ensure the eye health needs of students, a sufficient number of professional ophthalmologists are required to provide professional guidance.
Although as early as 2014, there were 1.13 ophthalmologists per 50,000 people in my country (the data was 1.5 in 2018), which exceeded the WHO requirement of 1 ophthalmologist per 50,000 people in well-off countries.
However, in the face of increasing demand for outpatient and emergency services, professional medical staff cannot spend more time on campus myopia prevention and control.
The "China Health Statistics Yearbook" shows that from 2012 to 2018, the burden of ophthalmologists has continued to increase, and the average number of outpatient visits per physician has increased from 2,714 to 2,787.
Ophthalmologists who focus on myopia prevention and control account for less than 10% of the total number of ophthalmologists.
Medical resources are scarce and expert resources are limited. Professional medical staff do not have much energy to enter campuses to carry out prevention work, and campus myopia prevention and control lack professional guidance.
The lack of professional medical staff gives bad businesses an opportunity.
At present, the motivation of social resources to participate in the prevention and treatment of myopia on campus is complicated, which can easily mislead students and parents and over-treat.
For example, studies have shown that there is no direct relationship between anti-blue light and visual fatigue and myopia prevention and control, but some medical companies exaggerate the harm of blue light on electronic screens to eyesight for profit purposes in order to sell "anti-blue light films."
Fourth, medical research on myopia in children and adolescents has not yet reached a conclusion.
There are still insufficient epidemiological studies on adolescent myopia.
First, the mechanism of genetic factors and environmental factors (lighting, sleep, diet, etc.) on myopia in children and adolescents has not been fully elucidated.
Second, there is a disconnect between research results and myopia prevention and treatment methods, and research conclusions cannot be directly translated into effective prevention and treatment measures.
Five measures to deal with myopia of primary and middle school students
The research team recommends:
First, develop an eye health education curriculum system.
On the basis of following the laws of students' physical and mental development, integrate pedagogy, psychology, physical education, nutrition, medicine and other multidisciplinary resources to develop an eye health education curriculum system that matches each school stage.
Especially grasp the critical period of myopia prevention and control, and carry out targeted eye health education.
Junior high school, junior high school and high school entrance examination stage are the three peak growth periods of the myopia rate of young people in my country.
During these peak growth periods, students have longer study time, more reading, and less exercise time. They need to use systematic courses for targeted eye health education.
Second, promote medical school cooperation and provide professional guidance for campus myopia prevention and control.
Promote hospitals, community health service centers and schools to build healthy campuses.
Among them, the hospital is responsible for the popularization of myopia science and publicity and education, the community health service center is responsible for providing nearby eye care services, and the school conducts various myopia prevention and control tasks under the guidance of professional medical personnel.
The research team recommends that, first of all, strengthen the training of teachers, parents and other non-professionals, so that they can master the knowledge of myopia prevention and treatment, and help students to screen for myopia symptoms in time and carry out effective intervention.
At the same time, the cooperation between medical majors and teacher-training majors is encouraged, and courses such as vision health management are set up in the teacher-training majors to increase the knowledge about the prevention and control of myopia for normal students.
Second, promote the joint training of regional ophthalmology medical talents.
Promote the development of national strategies in the Yangtze River Delta, Pearl River Delta, Beijing-Tianjin-Hebei and other regions, give full play to the resource advantages of medical experts in Beijing, Shanghai and other places, and strengthen the continuing education and training of primary-level ophthalmic medical personnel in small and medium-sized cities.
Use training mechanisms and network support to strengthen the technical guidance of experts on the prevention and control of myopia at the grassroots level.
Third, give full play to the unique advantages of traditional Chinese medicine to form a Chinese model for the prevention and control of youth myopia.
Traditional Chinese medicine plays an irreplaceable role in the prevention and control of myopia.
Studies have shown that TCM treatments such as acupuncture, ear acupoints, and Chinese medicine fumigation can help improve naked vision and are safe and effective for young people with low-grade myopia.
We should actively promote the pairing between schools and regional TCM hospitals, and popularize the health management concept of TCM "preventing disease" and the knowledge of health preservation and fitness of the same medicine and food on campus, so that parents and students can correctly understand the advantages and characteristics of TCM in preventing and controlling myopia.
The school cooperates with clinical prescriptions, dietary prescriptions, health prescriptions, meridian massage prescriptions issued by traditional Chinese medicine doctors, combined with diversified outdoor activities, to comprehensively adjust the vision of young people, and provide Chinese solutions for the prevention and treatment of myopia in the world.
Fourth, with the help of scientific research institutes, more accurate research on myopia can be carried out.
First of all, deepen the research on juvenile myopia related topics.
Educational research institutes can set up joint research groups with medical and health institutions and universities to strengthen research on the mechanism of myopia in adolescents, explore the interaction mechanism of myopia's genetic factors and environmental factors, and provide early intervention for the vulnerable population.
Use more clinical data to support more effective myopia prevention and treatment programs.
Second, give play to the role of intelligent equipment in myopia research.
Through smart bracelets, light recorders and other equipment, it can more accurately monitor distance, sleep time, and light conditions, monitor, record, and analyze students' vision and various environmental factors.
Fifth, strengthen schools and families as the main position to build a vision-friendly campus environment and home environment.
As a chronic disease, myopia must be prevented and controlled at the grass-roots level and long-term. Schools and families are the main positions.
The research team suggested that, first of all, guide the school to build a vision-friendly campus environment.
Establish a vision health management team composed of principals, principals in charge, class teachers, school hospital physicians, community ophthalmologists, parents, etc., to refine responsibilities; implement "sunshine sports", optimize physical education curriculum settings, and ensure that students have enough outdoor activities in school Time; to establish a vision-friendly classroom environment, such as improving indoor lighting conditions, equipped with height-adjustable desks and chairs, etc.; establish a regular screening system for students’ vision to dynamically monitor the development and changes of adolescents’ vision in different periods.
In addition, the study time of girls is higher than that of boys, the weekly physical exercise time is lower than that of boys, and the prevalence of myopia is higher than that of boys. The "Spring Bud Program" can be combined with the comprehensive prevention and control guidance for girls.
Second, urge parents to fulfill their myopia guardianship responsibilities.
Take the lead in reducing the time spent watching electronic screens; focus on family sports, and urge young people to participate in regular after-school exercises, especially table tennis, badminton and other small ball sports that help vision development, so as to form healthy behaviors and lifestyles; improve dietary structure , Ingest more milk, fruits, green leafy vegetables; increase sleep time, help young people relax eye muscles and relieve visual fatigue.
Finally, the government provides the necessary support.
Educational departments at all levels strengthen cooperation with health, network information and other departments to carry out extensive publicity activities for the prevention and control of myopia in children and adolescents, guide students and parents to scientifically understand the prevention and correction of myopia, and avoid being invaded by false advertisements; develop mobile apps and WeChat applets Such platforms provide convenient services for students who have accepted refractive development files, so that parents can query their children’s vision data in time.
(Wu Jing and Li Tingzhou are associate researchers of the National Education Macro Policy Research Institute of East China Normal University; Ge Liang is a postgraduate student of the School of Management of Fudan University)