key: cord-0814142-tyu1ule5 authors: Wang, Hong; Li, Liansheng; Wang, Wencan; Wang, Hao; Zhuang, Youyuan; Lu, Xiaoyan; Zhang, Guosi; Wang, Siyu; Lin, Peng; Chen, Chong; Bai, Yu; Chen, Qi; Chen, Hao; Qu, Jia; Xu, Liangde title: Simulations to Assess the Performance of Multifactor Risk Scores for Predicting Myopia Prevalence in Children and Adolescents in China date: 2022-04-11 journal: Front Genet DOI: 10.3389/fgene.2022.861164 sha: a00a2755b6ffdf9d76da4d1dd6f3185ef19dd00f doc_id: 814142 cord_uid: tyu1ule5 Background: Myopia is the most common visual impairment among Chinese children and adolescents. The purpose of this study is to explore key interventions for myopia prevalence, especially for early-onset myopia and high myopia. Methods: Univariate and multivariate analyses were conducted to evaluate potential associations between risk factor exposure and myopia. LASSO was performed to prioritize the risk features, and the selected leading factors were used to establish the assembled simulation model. Finally, two forecasting models were constructed to predict the risk of myopia and high myopia. Results: Children and adolescents with persistently incorrect posture had a high risk of myopia (OR 7.205, 95% CI 5.999–8.652), which was 2.8 times higher than that in students who always maintained correct posture. In the cohort with high myopia, sleep time of less than 7 h per day (OR 9.789, 95% CI 6.865–13.958), incorrect sitting posture (OR 8.975, 95% CI 5.339–15.086), and siblings with spherical equivalent <−6.00 D (OR 8.439, 95% CI 5.420–13.142) were the top three risk factors. The AUCs of integrated simulation models for myopia and high myopia were 0.8716 and 0.8191, respectively. Conclusion: The findings illustrate that keeping incorrect posture is the leading risk factor for myopia onset, while the onset age of myopia is the primary factor affecting high myopia progression. The age between 8 and 12 years is the crucial stage for clinical intervention, especially for children with parental myopia. The global prevalence of myopia has been rising at an astonishing speed, with nearly 30% of the world population currently having myopia (Dolgin, 2015; Morgan et al., 2018; Sankaridurg et al., 2021) . It is anticipated that this number may further rise and even reach one-half of the global population in 2050 (Holden et al., 2016; Sankaridurg et al., 2021) . At the same time, almost 10% of the world population is expected to experience high myopia, which will cause much more severe visual impairment and become an unbearably heavy burden for both individuals and society (Williams et al., 2015b; Sankaridurg et al., 2021) . According to the latest statistics, the ratio of Chinese children and adolescents suffering from myopia has already reached 52.7%, which makes things even more frightening (Ma et al., 2016; Mountjoy et al., 2018) . In particular, owing to the global outbreak of COVID-19 in 2019, children and adolescents were forced to learn at home through screen teaching and were deprived of outdoor activities, which tremendously increased their risk of myopia (Xu et al., 2021a; Xu et al., 2021b) . With the advent of the epidemic era, intermittent home quarantine will become the norm. It has become an urgent need to thoroughly investigate the epidemiological characteristics of myopia, comprehensively explore the risk factors of myopia, and formulate feasible and effective prevention strategies. Numerous epidemiologic studies have been conducted to explore risk factors associated with myopia (Morgan et al., 2021; Sankaridurg et al., 2021) . It has frequently been reported that outdoor time (Wu et al., 2013) , reading time (Liang et al., 2021) , diet habits (Burke et al., 2021) , parental myopia, and education level were closely related to myopia (Jan et al., 2019; Jiang et al., 2020; Morgan et al., 2021) . A retrospective myopia study between 1983 and 2017 indicated that the main risk factors for increasing prevalence of schoolchildren myopia were older age and more time spent on near-work (Tsai et al., 2021) . It has also been verified by multiple studies that education level and outdoor time were two major risk factors for students' myopia at present (Morgan et al., 2018; Mountjoy et al., 2018) . Cordain et al. suggested that diet habits could be a possible reason for the increased prevalence of myopia (Morgan et al., 2021) . Studies of different ethnic groups have shown that parental myopia, either father's or mother's, increased the risk of myopia in their children (Ghorbani Mojarrad et al., 2018; Morgan et al., 2021) . However, several reports have only focused on a few risk factors and lacked a sufficiently large sample size. Moreover, high myopia was often neglected. Therefore, it is necessary to recruit sufficient participants and develop novel and effective predicting models for myopia and high myopia by taking into account the influence of comprehensive risk factors. In this study, we collected and evaluated multiple risk factors for myopia and high myopia in a large-scale cohort with more than 20,000 children and adolescents. Then, two risk forecasting models were established to predict the prevalence of myopia and identify key interventions for improving the universal visual health. The study protocol was approved by a large-scale survey, CAMS, in Wenzhou, China, as described previously (Xu et al., 2021b) . Two years (six times) of follow-up were completed from 2019 to 2021. Participants in our study consisted of 24,318 children and adolescents who were sampled from CAMS using a simple randomized sampling method. The participants with dysgnosia or from a special education school, with abnormal basic information (ID card recording errors, manually entered data, and conflicting questionnaire information), hyperopia (strabismus or others), using orthokeratology or having undergone eye surgery, and missing questionnaires were removed. The study protocol and recruitment method were approved by the Ethics Committee of the Eye Hospital Affiliated to Wenzhou Medical University (2021-015-K-21). All procedures were conducted in accordance with the ethical standards of the institution/National Research Council and the 1964 Helsinki Declaration. All students underwent a comprehensive eye examination, and the detailed procedure was described by CAMS. Distance visual acuity (DVA) was assessed using a Chinese standard logarithm visual acuity E chart (GB 11533-2011) in an illuminated room (WSVC-100, Wenzhou, China). Non-cycloplegic autorefraction was conducted using Goaleye RM-9000 (Shenzhen Aist Industrial Co., Ltd., China). We calculated the spherical equivalent (SE) via the sphere plus one half of the cylinder. Emmetropia was defined as +0.25 D