Students' association of poor eye-use behavior with myopia: focus on study phase

学生不良用眼行为与近视的关联：关注学习阶段

Authors：Tingting Li, Feng Yang, Xiaoling Liu, Caiyun Cao, Peng Ding, Shaojun Xu, Shuman Tao, Xiaoyan Wu, Fangbiao Tao

Source：Bmc Ophthalmology

DOI: 10.1186/s12886-025-04072-1 

Abstract

Background: To investigate the prevalence of poor eye-use behavior and myopia in Chinese students, and examine the associations of poor eye-use behavior with myopia, as well as its study phase differences.

Methods: From March to July 2023, a total of 67 910 students were selected from 56 schools in 14 cities of China by stratified cluster sampling. The Eye-use Behavior Evaluation Scale for Students (EBESS) was adopted to investigate the eye-use behavior of students. Students underwent an uncorrected visual acuity examination and a non-cycloplegic autorefraction examination. The chi-square test was used to compare the prevalence of myopia between different groups. The binary logistic regression model was conducted to analyze the association of poor eye-use behavior with myopia.

Results: The prevalence of poor eye-use behavior and myopia of students were 27.6% and 53.0%, respectively. The poorer the eye-use behavior of students, the higher the prevalence of myopia (P < 0.001). After adjusting for age, gender, sibling, parental myopia, parental education level, self-reported learning burden, mode of travel to school, physical education lesson, city, usage distance of mobile phone / iPad / game console, reading and writing distance, weekdays outdoor time, and weekends outdoor time, binary logistic regression model analysis results showed that the poor eye-use behavior was positively correlated with myopia (OR = 1.10, 95% CI: 1.03 ~ 1.19). According to the study phase and further stratified analysis, in primary school (OR = 1.35, 95% CI: 1.20 ~ 1.50) and senior high school students (OR = 1.28, 95% CI: 1.08 ~ 1.51), poor eye-use behavior was positively correlated with myopia. However, in kindergarten and junior high school students, there was no statistically significant difference (P > 0.05).

Conclusion: Poor eye-use behavior was a potential risk factor for myopia in students, and this effect was significantly different between study phases. This suggests that future research should establish interventions to protect students from the effects of poor eye-use behavior.

Keywords: Eye-use behavior; Myopia; Study phase.

摘要

背景：调查中国学生不良用眼行为和近视的患病率，探究不良用眼行为与近视的关联及学习阶段的差异。

方法：2023年3月至7月，采用分层整群抽样从中国14个城市的56所学校中选取了67 910名学生。采用学生用眼行为评价表（Eye-use Behavior Evaluation Scale for Students，EBESS）调查学生的用眼行为。学生接受了未矫正视力检查和非睫状肌麻痹屈光检查。采用卡方检验比较不同组间近视患病率。采用二元Logistic回归模型分析不良用眼行为与近视的关联。

结果：学生不良用眼行为和近视的患病率分别为27.6%和53.0%。学生的用眼行为越差，近视的患病率越高（P＜0.001）。在调整了年龄、性别、兄弟姐妹、父母近视、父母文化水平、自我报告的学习负担、上学主要交通方式、体育课、所在城市、手机/iPad/游戏机使用时的距离、读写距离、工作日户外时间和周末户外时间后，二元Logistic回归模型分析结果显示，不良用眼行为与近视呈正相关（OR＝1.10，95% CI：1.03～1.19）。根据学习阶段，进一步分层分析，在小学生（OR＝1.35，95% CI：1.20～1.50）和高中生（OR＝1.28，95% CI：1.08～1.51）中，不良用眼行为与近视呈正相关。然而，在幼儿园和初中生中，差异无统计学意义（P＞0.05）。

结论：不良用眼行为是学生近视的潜在风险因素，这种影响在学习阶段之间存在显著差异。表明未来的研究应该建立干预措施，以保护学生免受不良用眼行为的影响。

关键词：用眼行为；近视；研究阶段