Trends in myopia prevalence among children and adolescents: a large-scale cross-sectional study in Shihezi, China

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Methods This was a cross-sectional study using data from 2018 to 2023 from the Vision Surveillance Research Program for Students in Shihezi City. Describe the prevalence of myopia with 95% CIs in 31,265 children and adolescents in urban and rural areas, by sex and age. The prevalence rate and chain growth rate of myopia and spherical equivalent refraction in different ages were described the development of myopia. Results A total of 31,265 children and adolescents with a mean age of 11,91 ± 3.67 years were included in the study. The overall prevalence of myopia was 50.93%(15924/31265, 95% CI: 50.38% − 51.49%). The prevalence of myopia was 55.18% (8348/15128, 95% CI: 54.39% − 55.98%) for girls and 46.95% (7576/16137, 95% CI: 46.18% − 47.72%) for boys. Prevalence of overall, mild, moderate, and high myopia is higher in urban than in rural areas. The prevalence of myopia increases with age, with the highest chain growth rate of myopia of 69.18% at the age of 6 years, slowing down at the age of 12 years. Spherical equivalent refraction changes from positive to negative at 6–7 years of age. Conclusions The prevalence of myopia is higher in Shihezi, and myopia develops at an earlier age and the farsighted disappears earlier. The development of myopia begins to increase sharply at the age of 6 years and slows down by the age of 12 years, and the spherical equivalent refraction changes from positive to negative at the age of 6 to 7 years. For policy makers, it is even more important to prevent and control myopia at a younger age. Children and adolescents myopia hyperopia reserve prevalence rate Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Myopia is a common refractive error, when the human eye is in a relaxed state of adjustment, light rays parallel to the visual axis are focused in front of the retina after passing through the refractive system of the eye, which is called myopia. Compared to other countries, myopia is growing fastest in East Asian countries[ 1 ]. Some studies suggest that by 2050, half of the people on the planet will be nearsighted and myopia will become a common eye disease[ 2 ]. In China, myopia is a major public health problem that jeopardizes the visual health of Chinese residents, especially children and adolescents. According to data released by China's National Health Commission, the overall myopia rate among children and adolescents in China in 2020 will be 52.7%, with primary school students at 35.6%, junior high school students at 71.1%, and high school students at 80.5%[ 3 ]. Myopia constantly affects the physical and mental development of children and adolescents, and high levels of myopia may lead to retinal detachment, macular degeneration and other diseases[ 4 , 5 ], myopia is becoming a common condition in the student population. In the neonatal stage, the eye is hyperopic, with an average refractive error of + 2.50 to + 3.00 D, this physiologic hyperopia is called hyperopic reserve[ 6 , 7 ]. Changes in age-corresponding reserve values signal the emergence of vision problems in children. Decrease in hyperopic reserve value is a risk factor for the development of myopia, which may indicate the onset of myopia. Due to the high plasticity of visual development in children aged 0–6 years, the key to preventing myopia should be placed in the age group where the incidence of myopia increases the fastest, and the time of loss of the hyperopic reserve value is also the fastest time of myopia incidence, therefore, it is necessary to study the incidence and development of myopia in children and adolescents. Although many studies on the prevalence of myopia or the factors influencing it have been conducted in inland China, relatively few trend studies have been conducted on the growth rate of the prevalence of myopia and the reserve of hyperopia with such a large sample size. The distribution of myopia among children and adolescents may also be different in Xinjiang, which is less developed and more culturally diverse than inland Chinese cities. The aim of this study is to focus on the occurrence and development of myopia in children and adolescents in Xinjiang, and to provide relevant scientific basis for myopia prevention and control. METHODS Study population This is a cross-sectional study with data from the National Student Common Diseases and Vision Program in Shihezi City. This large-scale study was conducted in October of each year from 2018 to 2023 in 20 primary and secondary kindergarten students in Shihezi, China. Exclusion criteria: Students with previous cataract surgery, laser myopic surgery, low-dose atropine, and use of orthokeratology lenses were excluded. Visual acuity test and refraction screening Students were asked to remove their eyeglasses (including contact lenses) for refraction and uncorrected visual acuity (UCVA) examinations, and all subjects had refraction and visual acuity examinations performed by professional optometrists with standardized training. Uncorrected visual acuity was tested using a standard logarithmic visual acuity E chart. When testing the vision of the right eye, a non-contact black spoon-shaped ocular occluder was used to cover the left eye at a distance of 5 meters. After the right eye was tested for 5 to 10 seconds, the left eye was tested in the same way. Non-cycloplegic refraction were detected using an autorefractor of the TOPCON KR-1 (Tokyo, Japan). Each subject was tested three times per eye, and the results were averaged. If the difference between the three results re any two results was greater than 0.5 diopters (D), each subject was re-examined. Spherical equivalent (SE) was determined using the algebraic sum of the refractive errors of the spherical and cylindrical lenses (spherical + 0.5 cylindrical)[ 8 ]. Myopia is defined as uncorrected visual acuity < 5.0 in either eye and spherical equivalent (SE) <-0.50D, and is categorized as mild myopia (-3.00D ≤ SE <-0.50D), moderate myopia (-6.00D ≤ SE <-3.00D) and high myopia (SE <-6.00D)[ 9 ]. Statistical anaylses Data were analyzed using IBM SPSS V.27.0 and graphed using Graphpad Prism V.9.5.1. Normally distributed continuous variables were described by mean and standard deviation and skewed continuous variables were described by median and interquartile range (IQR). Categorical variables were described by the number of cases and percentages. Normally distributed measures between the two groups were analysed by independent samples t-test, non-normal measures were analysed by Mann-Whitney U-test and count data were analysed by chi-square test, Comparison of left and right eye SE was performed using the Wilcoxon test. The growth rate of myopia in children and adolescents of different ages was used to characterize myopia in children and adolescents in Shihezi City, and the decrease in SE in different ages was used to characterize the changes in hyperopic in children and adolescents in Shihezi City. RESULTS Primary and secondary school students aged 5-16 years in Shihezi City were included in this study. A total of 31,265 subjects with a mean age of 11.91±3.67 years were included in this study. Among them, 16137 (51.61%) were males and 15128 (48.39%) were females. The overall prevalence of myopia was 50.93% (15924/31265, 95% CI: 50.38% - 51.49%). Characteristics of subjects with and without myopia are shown in Table 1, the prevalence of myopia by age group for each year 2018-2023 is shown in Schedule 1. Table1 Characteristics of participants. Characteristics Total No myopia Myopia t/Z/c 2 P Age，mean±SD,years 11.91±3.67 10.23±3.48 13.53±3.08 88.489 0.001 Sex Male(%) 16137(51.61) 8561(55.80) 7576(47.58) 211.848 0.001 Female (%) 15128(48.39) 6780(44.20) 8348(52.42) SE of right eye，M(P 25 ,P 75 ), D -1(-2.69,-0.06) -0.12(-0.50,0.38) -2.62(-4.13,-1.38) -134.041 0.001 SE of left eye，M(P 25 ,P 75 ), D -0.75(-2.38,0) 0.00(-0.44,0.38) -2.25(-3.88,-1.13) -128.948 0.001 UCVA of right eye, mean±SD 4.71±0.38 4.97±0.12 4.46±0.36 -169.722 0.001 UCVA of left eye, mean±SD 4.73±0.37 4.97±0.12 4.50±0.38 -148.876 0.001 Urban/rural areas Urban area, no(%) 21357(68.31) 9795(63.85) 11562(72.61) 276.907 0.001 Rural area, no(%) 9908(31.69) 5546(36.15) 4362(27.39) SE: Spherical equivalent; UCVA: uncorrected visual acuity The prevalence of myopia was 54.14% (11562/21357, 95% CI: 53.47% - 54.81%) in urban areas and 44.03% (4362/9908, 95% CI: 43.04% - 45.01%) in rural areas, which was higher than that in rural areas (c 2 = 276.090, P=0.001). The composition of mild myopia was lower in urban areas 52.09% (6023/11562, 95% CI: 51.18% - 53.01%) than in rural areas 63.64% (2776/4362, 95% CI: 62.19% - 65.07%) (c 2 = 170.815, P=0.001), while the composition of moderate 36.90% (4266/11526, 95% CI: 36.02% - 37.78%) and high myopia 11.01% (1273/11526, 95% CI: 10.45% - 11.59%) were higher than in rural areas 30.44% (1328/4362, 95% CI: 29.08% - 31.83%), 5.91% (258/4362, 95% CI: 5.23% - 6.66%) (c 2 Moderate = 57.854, P=0.001;c 2 High = 94.627, P=0.001). (Table 2, Figure 1). Table 2 Composition of myopia severity between urban and rural areas. Variables Urban area（N=21357） Rural area（N=9908） c 2 P Myopia 11562 4362 276.907 0.001 Mild myopia 6032 2776 170.815 0.001 Moderate myopia 4266 1328 57.854 0.001 High myopia 1273 258 94.627 0.001 The prevalence of myopia was higher among girls 55.18% (8348/15128, 95% CI: 54.39% - 55.98%) than boys 46.95% (7576/16137, 95% CI: 46.18% - 47.72%) (c 2 = 211.848, P=0.001). The composition of moderate myopia was higher in girls 35.94% (3000/8348, 95% CI: 34.91% - 36.98%) than in boys 34.24% (2594/7576, 95% CI: 33.17% - 35.32%) (c 2 = 5.019, P=0.025), while there was no statistically significant difference in the composition of mild and high myopia by sex(P＞0.05) (Table 3, Figure 2). Table 3 Composition of myopia severity between urban and rural areas Variables Male（N=16137） Female（N=15128） c 2 P Myopia 7576（46.95） 8348（55.18） 211.848 0.001 Mild myopia 4247（56.06） 4552（54.53） 3.763 0.052 Moderate myopia 2594（34.24） 3000（35.94） 5.019 0.025 High myopia 735（9.70） 796（9.54） 0.127 0.722 The prevalence of myopia, stratified by age, tended to increase with age. This trend was observed in the composition of moderate and high myopia. The prevalence of myopia among 5-year-olds was 7.43% (100/1346, 95% CI: 6.09% - 8.96%) and among 16-year-olds was 77.12% (3735/4843, 95% CI: 75.91% - 78.30%). By age 16, the composition of moderate myopia reached 44.31% (1655/3735, 95% CI: 42.71% - 45.92%), and high myopia reached 17.59% (657/3735, 95% CI: 16.38% - 18.85%) (Figure 3, Schedule 2). Further analysis of the data showed that the chain growth rate of myopia peaked at 69.18% at the age of 6 years and slowed down at the age of 12 years (Figure 4). And based on the trend of SE, it was found that after the age of 6 years, students' hyperopia gradually disappeared and gradually progressed to myopia, and the overall SE of the right eye was lower than that of the left eye (Table 4, Figure 5). Table 4 SE of left and right eye at different ages. Age SE of right eye，M(P 25 ,P 75 ), D SE of left eye，M(P 25 ,P 75 ), D Z P 5 0.375(-0.125,0.625) 0.375(0,000.625) -2.979 0.003 6 0.125(-0.250,0.500) 0.125(-0.250,0.500) -4.707 0.001 7 -0.125(-0.731,0.375) -0.125(-0.625,0.375) -3.506 0.001 8 -0.250(-1.000,0.185) -0.250(-0.875,0.250) -4.723 0.001 9 -0.500(-1.500,0.060) -0.435(-1.375,0.125) -4.688 0.001 10 -0.750(-2.000,-0.125) -0.625(-1.805,0.000) -7.167 0.001 11 -1.000(-2.500,-0.250) -0.875(-2.250,-0.125) -8.812 0.001 12 -1.250(-2.750,-0.375) -1.000(-2.556,-0.250) -10.367 0.001 13 -1.625(-3.250,-0.625) -1.375(-3.000,-0.375) -11.531 0.001 14 -2.000(-3.625,-0.750) -1.625(-3.375,-0.625) -13.119 0.001 15 -2.443(-4.000,-1.000) -2.0275(-3.750,-0.750) -13.604 0.001 16 -2.750(-4.625,-1.125) -2.375(-4.375,-0.875) -18.551 0.001 Total -1.000(-2.690,-0.060) -0.750(-2.380,0.000) -32.747 0.001 DISCUSSION This study was a large-scale school-based cross-sectional study of children and adolescents in Shihezi to understand the prevalence of myopia, the development of myopia, and changes in SE among children and adolescents in Shihezi city. The overall prevalence of myopia in Shihezi was 50.93%, with a higher prevalence in urban than in rural areas, a higher prevalence in girls than in boys. The prevalence of myopia increases sharply at the age of 6 years, and the trend slows down at the age of 12 years. Consistent with a large body of research, the present study found that the prevalence of myopia increases gradually with age. There is growing evidence that more schooling, rather than age, leads to myopia[ 10 , 11 ]. The trend of myopia with age is due to increased study time and academic stress. The older the age, the longer the school years, and the more time spent in close proximity, the more high myopia becomes. The prevalence of myopia among children and adolescents in Shihezi City is higher than the prevalence of myopia among preschoolers, primary and secondary school students in China in 2019 (50.2%)[ 12 ]. The prevalence of myopia in Shihezi is higher than in Kazakhstan(31.6%)[ 13 ], which has a similar climate and geographic location in the Xinjiang region, but the Kazakhstan study was conducted under conditions of cycloplegic refraction, and the quality of the evidence has some limitations. Compared with the findings of Wang et al, the period of sharp increase in myopia prevalence among children and adolescents in Shihezi appeared at an earlier age and slowed down at an earlier age[ 14 ],which is consistent with the findings of Hu et al[ 15 ]. Age 6 is the period when the prevalence rate of myopia experiences the fastest growth. This may be due to the fact that 6 years of age marks the beginning of mandatory schooling, when children start attending elementary school and are exposed to more intensive educational demands. It has been shown that monitoring hyperopic refractive error in children is beneficial in preventing myopia and high myopia, and that children with lower baseline hyperopic refractive error have a higher incidence of myopia[ 16 ]. In this study, we found that the SE in children and adolescents in Shihezi City became 0 at the age of 6 to 7 years, which is consistent with the sharp increase in the prevalence of myopia at the age of 6 years in our results. Therefore, it is important to implement interventions for the development of myopia in younger children, especially before the third grade of elementary school[ 17 ]. According to the results of this study, the current situation of myopia among children and adolescents in Shihezi City is not optimistic. In China, the high prevalence of myopia among children and adolescents in Xinjiang, a region that is relatively backward in terms of economic and cultural development, may be due to a relatively backward education model, insufficient knowledge of myopia prevention and control among the children's parents, poor eye habits among the children, and insufficient attention to myopia prevention and control as an initiative in society. The strength of this study lies in the large sample size; in addition, we characterized the onset and progression of myopia by calculating the prevalence of myopia and the growth rate of myopia, and we understand changes in SE in children and adolescents. However, there are limitations to this study. First, like most studies, as a screening study, cycloplegic refraction was not used in this study due to the large sample size; therefore, non-cycloplegic refraction may exaggerate the prevalence of myopia in children and inflate the SE. In our study we used UCVA in combination with non-cycloplegic refraction to minimize the screening error in myopia prevalence[ 5 ]. Finally, the study population was all from Xinjiang, which is in northwestern China and has a lower economic level compared with the interior, and the results have limited representation in China. CONCLUSIONS Our study demonstrated that the prevalence of myopia is higher in Shihezi, and myopia develops at an earlier age and the farsighted disappears earlier. The development of myopia begins to increase sharply at the age of 6 years and slows down by the age of 12 years, and the spherical equivalent refraction changes from positive to negative at the age of 6 to 7 years. For policy makers, it is even more important to prevent and control myopia at a younger age. Declarations Acknowledgements We appreciate the Chinese Center for Disease Control and Prevention for giving us the data. Author contributions Xiaopeng Hu : Resources, Conceptualization, Methodology, Formal analysis, Writing - Original Draft Xianyan Yuan : Investigation, Funding acquisition Hua Li : Writing - Original Draft Haoxuan Gong : Investigation Zhicong Fu : Investigation Yuting Xie : Investigation liqun Wang : Data Curation Dongsheng Rui : Supervision, Project administration, Conceptualization Funding Research reported in this publication received financial support from the Chinese Centre for Disease Control and Prevention (CDC); however, there was no CDC involvement of influence with any aspect of the study/initiative/activity supported by grant. Conflicts of interest None declared. Patient consent for publication Not applicable. Informed consent statement Informed consent was obtained from the parents of the respondents in all our studies. Ethics approval statement This study followed the tenets of Declaration of Helsinki and was approved by the Ethical Review Committee of The First Affiliated Hospital of Shihezi University. Participants gave informed consent to participate in the study before taking part(KJ2024-036-02). Data availability statement No data are available. References Yam JC, Tang SM, Kam KW, Chen LJ, Yu M, Law AK, Yip BH, Wang YM, Cheung CYL, Ng DSC, et al. High prevalence of myopia in children and their parents in Hong Kong Chinese Population: the Hong Kong Children Eye Study. Acta Ophthalmol. 2020;98(5):e639–48. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–42. Zhang D, Wu M, Yi X, Shi J, Ouyang Y, Dong N, Gong G, Guo L, Zhou L. 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Br J Ophthalmol. 2024;108(7):1024–9. Additional Declarations No competing interests reported. Supplementary Files Schedule1.docx Schedule2.docx Cite Share Download PDF Status: Published Journal Publication published 28 Apr, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 09 Apr, 2025 Editor assigned by journal 09 Apr, 2025 Reviews received at journal 05 Apr, 2025 Reviewers agreed at journal 26 Mar, 2025 Reviews received at journal 25 Mar, 2025 Reviewers agreed at journal 24 Mar, 2025 Reviewers invited by journal 24 Mar, 2025 Submission checks completed at journal 24 Mar, 2025 First submitted to journal 20 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Rui","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYFACxgYJEGUAIj4wHACLSRCthXEGcVqgCkBamHmI0WI+I7nxxscdtfbm7L2HX9v8uWNvcID54G0eBrs8XFpkbiQ2W848czxxZ8+5NOvctmfMBgfYkq15GJKLcTpKIrFNmrftWILBjRwz49yGw2wGB3jMpIEuTGwgoMXe4P4bM2OLP4d5DA7wfyNGSw3jhhs8xo8Z2A5LAG1hw6+F5yHQL20HEjecyTFj7G07bCB5mM3Yco5BMm4t7OkPb3xsq7M3OH7G+MOPP4ft+Y43P7zxpsIOpxYoOAwi2CDRwQwiDPCrB4I6sNoPBNWNglEwCkbBiAQAWIhZiyE9QuwAAAAASUVORK5CYII=","orcid":"","institution":"Shihezi University","correspondingAuthor":true,"prefix":"","firstName":"Dongsheng","middleName":"","lastName":"Rui","suffix":""}],"badges":[],"createdAt":"2025-01-12 03:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5811655/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5811655/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-22790-5","type":"published","date":"2025-04-28T15:57:41+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79319075,"identity":"883525a4-365a-4d5c-9fdf-257dbf708a8a","added_by":"auto","created_at":"2025-03-27 04:13:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":122818,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of severity of myopia in urban/rural areas.\u003c/p\u003e","description":"","filename":"Data1.png","url":"https://assets-eu.researchsquare.com/files/rs-5811655/v1/3b2f233bb6d7702392ff3be2.png"},{"id":79319073,"identity":"2371c0be-5ec6-4f79-b9cb-299d9b665f6b","added_by":"auto","created_at":"2025-03-27 04:13:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":102220,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of severity of myopia in different sexes.\u003c/p\u003e","description":"","filename":"Data2.png","url":"https://assets-eu.researchsquare.com/files/rs-5811655/v1/991c4bb0b993d659be99b746.png"},{"id":79320107,"identity":"f2245207-966d-4ad0-a721-0bd3d59f52bf","added_by":"auto","created_at":"2025-03-27 04:21:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":302933,"visible":true,"origin":"","legend":"\u003cp\u003eComposition of different severities of myopia by age group.\u003c/p\u003e","description":"","filename":"Data3.png","url":"https://assets-eu.researchsquare.com/files/rs-5811655/v1/d9ae4a58aec6fc730148cb24.png"},{"id":79321171,"identity":"b1be17c4-acf4-45c5-8cee-5ad72445b7e8","added_by":"auto","created_at":"2025-03-27 04:29:54","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":414609,"visible":true,"origin":"","legend":"\u003cp\u003eThe prevalence and chain growth rate of myopia in different ages.\u003c/p\u003e","description":"","filename":"Data4.png","url":"https://assets-eu.researchsquare.com/files/rs-5811655/v1/40bd0298964c2ca6f9c8efb7.png"},{"id":79320111,"identity":"2b4f5ecf-a51e-4a8f-b3bc-171325ddc22e","added_by":"auto","created_at":"2025-03-27 04:21:55","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":345021,"visible":true,"origin":"","legend":"\u003cp\u003eThe spherical equivalent (SE) of right/left eyes in different ages.\u003c/p\u003e","description":"","filename":"Data5.png","url":"https://assets-eu.researchsquare.com/files/rs-5811655/v1/3c1c5d17b2a065e4bb2eb382.png"},{"id":81988165,"identity":"a977883f-70c7-4b28-9f6f-33df4967e63d","added_by":"auto","created_at":"2025-05-05 16:08:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1850238,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5811655/v1/b48e7066-e812-49d1-b3fd-1fb775a7532a.pdf"},{"id":79319082,"identity":"3bd28e48-5a8f-4e19-99ca-08c3fd653507","added_by":"auto","created_at":"2025-03-27 04:13:55","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":18898,"visible":true,"origin":"","legend":"","description":"","filename":"Schedule1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5811655/v1/4d6621ba15d3b2c29d8c891e.docx"},{"id":79319085,"identity":"71be7388-ae36-4aad-a340-60603ed73d6e","added_by":"auto","created_at":"2025-03-27 04:13:55","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":14676,"visible":true,"origin":"","legend":"","description":"","filename":"Schedule2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5811655/v1/9f2655eaab411acece5a4897.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Trends in myopia prevalence among children and adolescents: a large-scale cross-sectional study in Shihezi, China","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMyopia is a common refractive error, when the human eye is in a relaxed state of adjustment, light rays parallel to the visual axis are focused in front of the retina after passing through the refractive system of the eye, which is called myopia. Compared to other countries, myopia is growing fastest in East Asian countries[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Some studies suggest that by 2050, half of the people on the planet will be nearsighted and myopia will become a common eye disease[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In China, myopia is a major public health problem that jeopardizes the visual health of Chinese residents, especially children and adolescents. According to data released by China's National Health Commission, the overall myopia rate among children and adolescents in China in 2020 will be 52.7%, with primary school students at 35.6%, junior high school students at 71.1%, and high school students at 80.5%[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Myopia constantly affects the physical and mental development of children and adolescents, and high levels of myopia may lead to retinal detachment, macular degeneration and other diseases[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], myopia is becoming a common condition in the student population.\u003c/p\u003e \u003cp\u003eIn the neonatal stage, the eye is hyperopic, with an average refractive error of +\u0026thinsp;2.50 to +\u0026thinsp;3.00 D, this physiologic hyperopia is called hyperopic reserve[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Changes in age-corresponding reserve values signal the emergence of vision problems in children. Decrease in hyperopic reserve value is a risk factor for the development of myopia, which may indicate the onset of myopia. Due to the high plasticity of visual development in children aged 0\u0026ndash;6 years, the key to preventing myopia should be placed in the age group where the incidence of myopia increases the fastest, and the time of loss of the hyperopic reserve value is also the fastest time of myopia incidence, therefore, it is necessary to study the incidence and development of myopia in children and adolescents.\u003c/p\u003e \u003cp\u003eAlthough many studies on the prevalence of myopia or the factors influencing it have been conducted in inland China, relatively few trend studies have been conducted on the growth rate of the prevalence of myopia and the reserve of hyperopia with such a large sample size. The distribution of myopia among children and adolescents may also be different in Xinjiang, which is less developed and more culturally diverse than inland Chinese cities.\u003c/p\u003e \u003cp\u003eThe aim of this study is to focus on the occurrence and development of myopia in children and adolescents in Xinjiang, and to provide relevant scientific basis for myopia prevention and control.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis is a cross-sectional study with data from the National Student Common Diseases and Vision Program in Shihezi City. This large-scale study was conducted in October of each year from 2018 to 2023 in 20 primary and secondary kindergarten students in Shihezi, China. Exclusion criteria: Students with previous cataract surgery, laser myopic surgery, low-dose atropine, and use of orthokeratology lenses were excluded.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVisual acuity test and refraction screening\u003c/h3\u003e\n\u003cp\u003eStudents were asked to remove their eyeglasses (including contact lenses) for refraction and uncorrected visual acuity (UCVA) examinations, and all subjects had refraction and visual acuity examinations performed by professional optometrists with standardized training. Uncorrected visual acuity was tested using a standard logarithmic visual acuity E chart. When testing the vision of the right eye, a non-contact black spoon-shaped ocular occluder was used to cover the left eye at a distance of 5 meters. After the right eye was tested for 5 to 10 seconds, the left eye was tested in the same way.\u003c/p\u003e \u003cp\u003eNon-cycloplegic refraction were detected using an autorefractor of the TOPCON KR-1 (Tokyo, Japan). Each subject was tested three times per eye, and the results were averaged. If the difference between the three results re any two results was greater than 0.5 diopters (D), each subject was re-examined. Spherical equivalent (SE) was determined using the algebraic sum of the refractive errors of the spherical and cylindrical lenses (spherical\u0026thinsp;+\u0026thinsp;0.5 cylindrical)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Myopia is defined as uncorrected visual acuity\u0026thinsp;\u0026lt;\u0026thinsp;5.0 in either eye and spherical equivalent (SE) \u0026lt;-0.50D, and is categorized as mild myopia (-3.00D\u0026thinsp;\u0026le;\u0026thinsp;SE \u0026lt;-0.50D), moderate myopia (-6.00D\u0026thinsp;\u0026le;\u0026thinsp;SE \u0026lt;-3.00D) and high myopia (SE \u0026lt;-6.00D)[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStatistical anaylses\u003c/h3\u003e\n\u003cp\u003eData were analyzed using IBM SPSS V.27.0 and graphed using Graphpad Prism V.9.5.1. Normally distributed continuous variables were described by mean and standard deviation and skewed continuous variables were described by median and interquartile range (IQR). Categorical variables were described by the number of cases and percentages. Normally distributed measures between the two groups were analysed by independent samples t-test, non-normal measures were analysed by Mann-Whitney U-test and count data were analysed by chi-square test, Comparison of left and right eye SE was performed using the Wilcoxon test. The growth rate of myopia in children and adolescents of different ages was used to characterize myopia in children and adolescents in Shihezi City, and the decrease in SE in different ages was used to characterize the changes in hyperopic in children and adolescents in Shihezi City.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003ePrimary and secondary school students aged 5-16 years in Shihezi City were included in this study. A total of 31,265 subjects with a mean age of 11.91\u0026plusmn;3.67 years were included in this study. Among them, 16137 (51.61%) were males and 15128 (48.39%) were females. The overall prevalence of myopia was 50.93% (15924/31265, 95% CI: 50.38% - 51.49%). Characteristics of subjects with and without myopia are shown in Table 1, the prevalence of myopia by age group for each year 2018-2023 is shown in Schedule 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable1\u003c/strong\u003e\u0026nbsp; Characteristics of participants.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"111%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eNo myopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMyopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003et/Z/c\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eAge，mean\u0026plusmn;SD,years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e11.91\u0026plusmn;3.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e10.23\u0026plusmn;3.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e13.53\u0026plusmn;3.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e88.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eMale(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e16137(51.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8561(55.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7576(47.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e211.848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eFemale (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e15128(48.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6780(44.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8348(52.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eSE of right eye，M(P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e), D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-1(-2.69,-0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e-0.12(-0.50,0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e-2.62(-4.13,-1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-134.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eSE of left eye，M(P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e), D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.75(-2.38,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.00(-0.44,0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e-2.25(-3.88,-1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-128.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eUCVA of right eye, mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4.71\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4.97\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4.46\u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-169.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eUCVA of left eye, mean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4.73\u0026plusmn;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4.97\u0026plusmn;0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4.50\u0026plusmn;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-148.876\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 81px;\"\u003e\n \u003cp\u003eUrban/rural areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eUrban area, no(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e21357(68.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e9795(63.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e11562(72.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e276.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003eRural area, no(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e9908(31.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5546(36.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4362(27.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003csup\u003eSE:\u003c/sup\u003e\u003csup\u003eSpherical equivalent; \u0026nbsp;\u003c/sup\u003e\u003csup\u003eUCVA:\u003c/sup\u003e\u003csup\u003euncorrected visual acuity\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe prevalence of myopia was 54.14% (11562/21357, 95% CI: 53.47% - 54.81%) in urban areas and 44.03% (4362/9908, 95% CI: 43.04% - 45.01%) in rural areas, which was higher than that in rural areas (c\u003csup\u003e2\u003c/sup\u003e = 276.090, P=0.001). The composition of mild myopia was lower in urban areas 52.09% (6023/11562, 95% CI: 51.18% - 53.01%) than in rural areas 63.64% (2776/4362, 95% CI: 62.19% - 65.07%) (c\u003csup\u003e2\u003c/sup\u003e = 170.815, P=0.001), while the composition of moderate 36.90% (4266/11526, 95% CI: 36.02% - 37.78%) and high myopia 11.01% (1273/11526, 95% CI: 10.45% - 11.59%) were higher than in rural areas 30.44% (1328/4362, 95% CI: 29.08% - 31.83%), 5.91% (258/4362, 95% CI: 5.23% - 6.66%) (c\u003csup\u003e2\u003c/sup\u003e \u003csub\u003eModerate\u003c/sub\u003e= 57.854, P=0.001;c\u003csup\u003e2\u003c/sup\u003e \u003csub\u003eHigh\u003c/sub\u003e= 94.627, P=0.001). (Table 2, Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003eComposition of myopia severity between urban and rural areas.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003eUrban area（N=21357）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003eRural area（N=9908）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eMyopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e11562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e4362\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e276.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eMild myopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e6032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e2776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e170.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eModerate myopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e4266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e1328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e57.854\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eHigh myopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e1273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e94.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe prevalence of myopia was higher among girls 55.18% (8348/15128, 95% CI: 54.39% - 55.98%) than boys 46.95% (7576/16137, 95% CI: 46.18% - 47.72%) (c\u003csup\u003e2\u003c/sup\u003e = 211.848, P=0.001). The composition of moderate myopia was higher in girls 35.94% (3000/8348, 95% CI: 34.91% - 36.98%) than in boys 34.24% (2594/7576, 95% CI: 33.17% - 35.32%) (c\u003csup\u003e2\u003c/sup\u003e = 5.019, P=0.025), while there was no statistically significant difference in the composition of mild and high myopia by sex(P＞0.05) (Table 3, Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003eComposition of myopia severity between urban and rural areas\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003eMale（N=16137）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003eFemale（N=15128）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eMyopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e7576（46.95）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e8348（55.18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e211.848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eMild myopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e4247（56.06）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e4552（54.53）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e3.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eModerate myopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e2594（34.24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e3000（35.94）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e5.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eHigh myopia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e735（9.70）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e796（9.54）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe prevalence of myopia, stratified by age, tended to increase with age. This trend was observed in the composition of moderate and high myopia. The prevalence of myopia among 5-year-olds was 7.43% (100/1346, 95% CI: 6.09% - 8.96%) and among 16-year-olds was 77.12% (3735/4843, 95% CI: 75.91% - 78.30%). By age 16, the composition of moderate myopia reached 44.31% (1655/3735, 95% CI: 42.71% - 45.92%), and high myopia reached 17.59% (657/3735, 95% CI: 16.38% - 18.85%) (Figure 3, Schedule 2). Further analysis of the data showed that the chain growth rate of myopia peaked at 69.18% at the age of 6 years and slowed down at the age of 12 years (Figure 4).\u003c/p\u003e\n\u003cp\u003eAnd based on the trend of SE, it was found that after the age of 6 years, students\u0026apos; hyperopia gradually disappeared and gradually progressed to myopia, and the overall SE of the right eye was lower than that of the left eye (Table 4, Figure 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e\u0026nbsp; SE of left and right eye at different ages.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003eSE of right eye，M(P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e), D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003eSE of left eye，M(P\u003csub\u003e25\u003c/sub\u003e,P\u003csub\u003e75\u003c/sub\u003e), D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e0.375(-0.125,0.625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e0.375(0,000.625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-2.979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e0.125(-0.250,0.500)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e0.125(-0.250,0.500)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-4.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-0.125(-0.731,0.375)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-0.125(-0.625,0.375)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-3.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-0.250(-1.000,0.185)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-0.250(-0.875,0.250)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-4.723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-0.500(-1.500,0.060)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-0.435(-1.375,0.125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-4.688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-0.750(-2.000,-0.125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-0.625(-1.805,0.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-7.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-1.000(-2.500,-0.250)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-0.875(-2.250,-0.125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-8.812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-1.250(-2.750,-0.375)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-1.000(-2.556,-0.250)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-10.367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-1.625(-3.250,-0.625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-1.375(-3.000,-0.375)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-11.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-2.000(-3.625,-0.750)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-1.625(-3.375,-0.625)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-13.119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-2.443(-4.000,-1.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-2.0275(-3.750,-0.750)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-13.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-2.750(-4.625,-1.125)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-2.375(-4.375,-0.875)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-18.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 184px;\"\u003e\n \u003cp\u003e-1.000(-2.690,-0.060)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e-0.750(-2.380,0.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-32.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study was a large-scale school-based cross-sectional study of children and adolescents in Shihezi to understand the prevalence of myopia, the development of myopia, and changes in SE among children and adolescents in Shihezi city. The overall prevalence of myopia in Shihezi was 50.93%, with a higher prevalence in urban than in rural areas, a higher prevalence in girls than in boys. The prevalence of myopia increases sharply at the age of 6 years, and the trend slows down at the age of 12 years.\u003c/p\u003e \u003cp\u003eConsistent with a large body of research, the present study found that the prevalence of myopia increases gradually with age. There is growing evidence that more schooling, rather than age, leads to myopia[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The trend of myopia with age is due to increased study time and academic stress. The older the age, the longer the school years, and the more time spent in close proximity, the more high myopia becomes.\u003c/p\u003e \u003cp\u003eThe prevalence of myopia among children and adolescents in Shihezi City is higher than the prevalence of myopia among preschoolers, primary and secondary school students in China in 2019 (50.2%)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The prevalence of myopia in Shihezi is higher than in Kazakhstan(31.6%)[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which has a similar climate and geographic location in the Xinjiang region, but the Kazakhstan study was conducted under conditions of cycloplegic refraction, and the quality of the evidence has some limitations. Compared with the findings of Wang et al, the period of sharp increase in myopia prevalence among children and adolescents in Shihezi appeared at an earlier age and slowed down at an earlier age[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e],which is consistent with the findings of Hu et al[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Age 6 is the period when the prevalence rate of myopia experiences the fastest growth. This may be due to the fact that 6 years of age marks the beginning of mandatory schooling, when children start attending elementary school and are exposed to more intensive educational demands.\u003c/p\u003e \u003cp\u003eIt has been shown that monitoring hyperopic refractive error in children is beneficial in preventing myopia and high myopia, and that children with lower baseline hyperopic refractive error have a higher incidence of myopia[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In this study, we found that the SE in children and adolescents in Shihezi City became 0 at the age of 6 to 7 years, which is consistent with the sharp increase in the prevalence of myopia at the age of 6 years in our results. Therefore, it is important to implement interventions for the development of myopia in younger children, especially before the third grade of elementary school[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the results of this study, the current situation of myopia among children and adolescents in Shihezi City is not optimistic. In China, the high prevalence of myopia among children and adolescents in Xinjiang, a region that is relatively backward in terms of economic and cultural development, may be due to a relatively backward education model, insufficient knowledge of myopia prevention and control among the children's parents, poor eye habits among the children, and insufficient attention to myopia prevention and control as an initiative in society.\u003c/p\u003e \u003cp\u003eThe strength of this study lies in the large sample size; in addition, we characterized the onset and progression of myopia by calculating the prevalence of myopia and the growth rate of myopia, and we understand changes in SE in children and adolescents. However, there are limitations to this study. First, like most studies, as a screening study, cycloplegic refraction was not used in this study due to the large sample size; therefore, non-cycloplegic refraction may exaggerate the prevalence of myopia in children and inflate the SE. In our study we used UCVA in combination with non-cycloplegic refraction to minimize the screening error in myopia prevalence[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Finally, the study population was all from Xinjiang, which is in northwestern China and has a lower economic level compared with the interior, and the results have limited representation in China.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOur study demonstrated that the prevalence of myopia is higher in Shihezi, and myopia develops at an earlier age and the farsighted disappears earlier. The development of myopia begins to increase sharply at the age of 6 years and slows down by the age of 12 years, and the spherical equivalent refraction changes from positive to negative at the age of 6 to 7 years. For policy makers, it is even more important to prevent and control myopia at a younger age.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e We appreciate the Chinese Center for Disease Control and Prevention for giving us the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eXiaopeng Hu\u003c/strong\u003e:\u0026nbsp;Resources, Conceptualization, Methodology, Formal analysis, Writing - Original Draft\u0026nbsp;\u003cstrong\u003eXianyan Yuan\u003c/strong\u003e:\u0026nbsp;Investigation,\u0026nbsp;Funding acquisition\u0026nbsp;\u003cstrong\u003eHua Li\u003c/strong\u003e:\u0026nbsp;Writing - Original Draft \u003cstrong\u003eHaoxuan Gong\u003c/strong\u003e:\u0026nbsp;Investigation \u003cstrong\u003eZhicong Fu\u003c/strong\u003e:\u0026nbsp;Investigation \u003cstrong\u003eYuting Xie\u003c/strong\u003e:\u0026nbsp;Investigation \u003cstrong\u003eliqun Wang\u003c/strong\u003e:\u0026nbsp;Data Curation \u003cstrong\u003eDongsheng Rui\u003c/strong\u003e:\u0026nbsp;Supervision, Project administration, Conceptualization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eResearch reported in this publication received financial support from the Chinese Centre for Disease Control and Prevention (CDC); however, there was no CDC involvement of influence with any aspect of the study/initiative/activity supported by grant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u0026nbsp;\u003c/strong\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent statement\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from the parents of the respondents in all our studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study followed the tenets of Declaration of Helsinki and was approved by the Ethical Review Committee of The First Affiliated Hospital of Shihezi University. Participants gave informed consent to participate in the study before taking part(KJ2024-036-02).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e No data are available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYam JC, Tang SM, Kam KW, Chen LJ, Yu M, Law AK, Yip BH, Wang YM, Cheung CYL, Ng DSC, et al. High prevalence of myopia in children and their parents in Hong Kong Chinese Population: the Hong Kong Children Eye Study. Acta Ophthalmol. 2020;98(5):e639\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. 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Prevalence of myopia among children and adolescents aged 6\u0026ndash;16 during COVID-19 pandemic: a large-scale cross-sectional study in Tianjin, China. Br J Ophthalmol. 2024;108(6):879\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMukazhanova A, Aldasheva N, Iskakbayeva J, Bakhytbek R, Ualiyeva A, Baigonova K, Ongarbaeva D, Vinnikov D. Prevalence of refractive errors and risk factors for myopia among schoolchildren of Almaty, Kazakhstan: A cross-sectional study. PLoS ONE. 2022;17(6):e0269474.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Li Y, Zhao Z, Wei N, Qi X, Ding G, Li X, Li J, Song L, Zhang Y, et al. School-based epidemiology study of myopia in Tianjin, China. Int Ophthalmol. 2020;40(9):2213\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol. 2020;138(11):1129\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S-M, Wei S, Atchison DA, Kang M-T, Liu L, Li H, Li S, Yang Z, Wang Y, Zhang F, et al. Annual Incidences and Progressions of Myopia and High Myopia in Chinese Schoolchildren Based on a 5-Year Cohort Study. Invest Ophthalmol Vis Sci. 2022;63(1):8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang J, Qi Z, Feng Y, Chen J, Du L, Yang J, Xie H, Zhu J, Zou H, He X, et al. Normative value of hyperopia reserve and myopic shift in Chinese children and adolescents aged 3\u0026ndash;16 years. Br J Ophthalmol. 2024;108(7):1024\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Children and adolescents, myopia, hyperopia reserve, prevalence rate","lastPublishedDoi":"10.21203/rs.3.rs-5811655/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5811655/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003ePurpose\u003c/b\u003e The aim of this study was to understand the trends of myopia prevalence among children and adolescents in Shihezi, China.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e This was a cross-sectional study using data from 2018 to 2023 from the Vision Surveillance Research Program for Students in Shihezi City. Describe the prevalence of myopia with 95% CIs in 31,265 children and adolescents in urban and rural areas, by sex and age. The prevalence rate and chain growth rate of myopia and spherical equivalent refraction in different ages were described the development of myopia.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e A total of 31,265 children and adolescents with a mean age of 11,91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67 years were included in the study. The overall prevalence of myopia was 50.93%(15924/31265, 95% CI: 50.38% \u0026minus;\u0026thinsp;51.49%). The prevalence of myopia was 55.18% (8348/15128, 95% CI: 54.39% \u0026minus;\u0026thinsp;55.98%) for girls and 46.95% (7576/16137, 95% CI: 46.18% \u0026minus;\u0026thinsp;47.72%) for boys. Prevalence of overall, mild, moderate, and high myopia is higher in urban than in rural areas. The prevalence of myopia increases with age, with the highest chain growth rate of myopia of 69.18% at the age of 6 years, slowing down at the age of 12 years. Spherical equivalent refraction changes from positive to negative at 6\u0026ndash;7 years of age.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e The prevalence of myopia is higher in Shihezi, and myopia develops at an earlier age and the farsighted disappears earlier. The development of myopia begins to increase sharply at the age of 6 years and slows down by the age of 12 years, and the spherical equivalent refraction changes from positive to negative at the age of 6 to 7 years. For policy makers, it is even more important to prevent and control myopia at a younger age.\u003c/p\u003e","manuscriptTitle":"Trends in myopia prevalence among children and adolescents: a large-scale cross-sectional study in Shihezi, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-27 04:13:49","doi":"10.21203/rs.3.rs-5811655/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-09T10:18:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-09T10:17:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-05T19:16:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56646056514110840675285259036516065174","date":"2025-03-26T15:13:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-25T15:50:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245248207673435043880178555734749216503","date":"2025-03-24T15:52:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-24T14:13:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-24T06:52:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-03-20T08:18:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39539549-79b4-4919-aadc-d144ffbe33a5","owner":[],"postedDate":"March 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T16:05:58+00:00","versionOfRecord":{"articleIdentity":"rs-5811655","link":"https://doi.org/10.1186/s12889-025-22790-5","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-04-28 15:57:41","publishedOnDateReadable":"April 28th, 2025"},"versionCreatedAt":"2025-03-27 04:13:49","video":"","vorDoi":"10.1186/s12889-025-22790-5","vorDoiUrl":"https://doi.org/10.1186/s12889-025-22790-5","workflowStages":[]},"version":"v1","identity":"rs-5811655","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5811655","identity":"rs-5811655","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}