基于学校的群组随机试验中近视预防与户外光照强度
Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial.
机构信息
Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan, and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
Ophthalmology. 2018 Aug;125(8):1239-1250. doi: 10.1016/j.ophtha.2017.12.011. Epub 2018 Jan 19.
PURPOSE
To investigate the effectiveness of a school-based program promoting outdoor activities in Taiwan for myopia prevention and to identify protective light intensities.
DESIGN
Multi-area, cluster-randomized intervention controlled trial.
PARTICIPANTS
A total 693 grade 1 schoolchildren in 16 schools participated. Two hundred sixty-seven schoolchildren were in the intervention group and 426 were in the control group.
METHODS
Initially, 24 schools were randomized into the intervention and control groups, but 5 and 3 schools in the intervention and control groups, respectively, withdrew before enrollment. A school-based Recess Outside Classroom Trial was implemented in the intervention group, in which schoolchildren were encouraged to go outdoors for up to 11 hours weekly. Data collection included eye examinations, cycloplegic refraction, noncontact axial length measurements, light meter recorders, diary logs, and questionnaires.
MAIN OUTCOME MEASURES
Change in spherical equivalent and axial length after 1 year and the intensity and duration of outdoor light exposures.
RESULTS
The intervention group showed significantly less myopic shift and axial elongation compared with the control group (0.35 diopter [D] vs. 0.47 D; 0.28 vs. 0.33 mm; P = 0.002 and P = 0.003) and a 54% lower risk of rapid myopia progression (odds ratio, 0.46; 95% confidence interval [CI], 0.28-0.77; P = 0.003). The myopic protective effects were significant in both nonmyopic and myopic children compared with controls. Regarding spending outdoor time of at least 11 hours weekly with exposure to 1000 lux or more of light, the intervention group had significantly more participants compared with the control group (49.79% vs. 22.73%; P < 0.001). Schoolchildren with longer outdoor time in school (≥200 minutes) showed significantly less myopic shift (measured by light meters; ≥1000 lux: 0.14 D; 95% CI, 0.02-0.27; P = 0.02; ≥3000 lux: 0.16 D; 95% CI, 0.002-0.32; P = 0.048).
CONCLUSIONS
The school-based outdoor promotion program effectively reduced the myopia change in both nonmyopic and myopic children. Outdoor activities with strong sunlight exposure may not be necessary for myopia prevention. Relatively lower outdoor light intensity activity with longer time outdoors, such as in hallways or under trees, also can be considered.
目的
研究在台湾开展促进户外活动的学校项目对预防近视的效果，并确定保护光强度。
设计
多区域、整群随机干预对照试验。
参与者
共有 693 名一年级学生参与了 16 所学校的研究。267 名学生被分配到干预组，426 名学生被分配到对照组。
方法
最初，24 所学校被随机分为干预组和对照组，但干预组和对照组各有 5 所和 3 所学校在入组前退出。在干预组中实施了一项基于学校的课间户外活动试验，鼓励学生每周户外活动长达 11 小时。数据收集包括眼部检查、睫状肌麻痹验光、非接触式眼轴长度测量、光度计记录器、日记日志和问卷调查。
主要观察指标
1 年后屈光度和眼轴长度的变化以及户外光暴露的强度和时间。
结果
与对照组相比，干预组的近视漂移和眼轴伸长明显减少（0.35 屈光度[D] vs. 0.47 D；0.28 vs. 0.33 mm；P=0.002 和 P=0.003），并且近视进展速度的风险降低了 54%（优势比，0.46；95%置信区间[CI]，0.28-0.77；P=0.003）。与对照组相比，近视和非近视儿童的近视保护作用均有统计学意义。每周至少进行 11 小时户外活动，暴露于 1000 勒克斯或更高的光线下，干预组的参与者比例明显高于对照组（49.79% vs. 22.73%；P<0.001）。在学校的户外活动时间更长（≥200 分钟）的学生的近视漂移明显减少（用光表测量；≥1000 勒克斯：0.14 D；95%CI，0.02-0.27；P=0.02；≥3000 勒克斯：0.16 D；95%CI，0.002-0.32；P=0.048）。
结论
基于学校的户外活动推广项目可有效减少非近视和近视儿童的近视变化。预防近视可能不需要阳光强烈的户外活动。相对较低的户外光强度活动，例如在走廊或树下，也可以考虑。
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