The National Bureau for Disease Control and Prevention issued the Technical Guide for Comprehensive Intervention of Public Health for Prevention and Control of Myopia in Children and Adolescents.
Cctv newsAccording to the National Bureau of Disease Control and Prevention, research shows that myopia is the result of many factors, and children and adolescents are generally susceptible. On the basis of considering multiple causes, such as environmental and behavioral factors, genetic factors, eye evolution law and social and cultural factors, this paper puts forward intervention techniques for children and adolescents’ myopia, and adopts three-level prevention strategies to implement comprehensive public health intervention measures to prevent, reduce and slow down the occurrence and development of children and adolescents’ myopia.
First, the prevention of public health intervention technology
(1) Monitoring, evaluation and intervention of myopia risk behaviors.
1. Students’ eye behavior evaluation. For students of different school ages, the eye behavior evaluation form for kindergarten and primary school students in grades 1-3 (parent version) (attached table 1) and the eye behavior evaluation form for primary school students in grades 4-6 (student version) (attached table 2) were used to evaluate the eye behavior of kindergarten to middle school students, and to identify the risk behavior factors that affect myopia of children and adolescents, such as insufficient outdoor activities, excessive use of electronic products, lack of sleep or large social time difference, reading and writing.
2. Application of evaluation results. According to the specific risk factors, teachers and parents should change the bad eye behavior of children and adolescents (the contents listed in Schedule 1 and Schedule 2 can be used as the contents of health education and behavior standards).
3. Promote good eye use behavior with appropriate technology. Actively develop or use the existing appropriate technologies for myopia prevention and control, and apply them to promote the development of children and adolescents’ rational eye use behavior. For example, the height of the desk and chair measuring ruler (desk and chair deployment measuring ruler), correct reading and writing posture wall chart, light monitor, eye relaxation exercises, etc.
(2) The visual environment of schools, families and communities has been improved.
1. The construction of school visual friendly environment. Schools should provide students with good lighting and lighting environment according to the Hygienic Requirements for Prevention and Control of Myopia in School Supplies for Children and Adolescents (GB40070-2021). Each class should be equipped with desks and chairs to allocate measuring ruler, measure the height range of students regularly and adjust the desks and chairs in time. Each classroom should be equipped with adjustable desks and chairs or 2-3 types of desks and chairs according to the height range of students. The desks and chairs of the same type can be placed in columns, and the height of desks and chairs should be adjusted individually once every semester according to the height and sitting height of students. According to the perspective of students’ seats, the lighting situation in the classroom and the changes of students’ eyesight, the school will change students’ seats at least once a month. Multimedia classrooms should choose large-size projectors or computer screens. Under the same screen size, choose products with high screen resolution.
2. Building a family visual friendly environment. The desk should be placed so that its long axis is perpendicular to the window. When studying during the day, natural light enters from the opposite side of the writing hand to avoid direct sunlight. The average illumination value of the desktop is not less than 300lx. Parents should adjust the height of desks and chairs regularly according to the growth and development of children and adolescents. Children and adolescents should be equipped with desk lamps that have passed the national compulsory product certification (CCC certification), and children and adolescents should turn on the ceiling lights in addition to using desk lamps when studying at night. When online learning is needed, electronic products with large screen such as TV and desktop computer should be selected, and electronic products with high screen resolution should be selected under the same screen size. The viewing distance of TV is not less than 4 times the diagonal distance of the screen, the horizontal viewing distance of computer is not less than 50cm, and the viewing distance of mobile phone is not less than 40cm. Children and teenagers don’t put televisions and computers in their bedrooms. They use dark curtains at night and don’t turn on the night light to sleep. Guide children and adolescents to avoid or reduce exposure to high brightness and blue light-rich electronic products at night.
3. Community visual friendly environment construction. Green space can prevent or slow down the occurrence and development of myopia in children and adolescents by increasing outdoor time and reducing screen time. Reasonable green land is set up in the community, with certain activity facilities, which is suitable for carrying out all kinds of parent-child outdoor activities. The night light environment of residential quarters should comply with the current national standards. Except for indicative and functional signs, advertising lighting is not suitable for residential buildings (districts). The glare limit of night lighting lamps in residential and pedestrian areas, the maximum allowable value of illumination on the outer surface of windows of residential buildings, and the maximum allowable value of luminous intensity of night lighting lamps in the direction of rooms should be strengthened in accordance with the Planning Standard for Urban Lighting Construction (CJJ/T 307-2019).
(3) 2 hours of outdoor activities and 1 hour of physical exercise during the day.
1. Ensure 2 hours of outdoor activities every day and 14 hours every week. According to the Grade and Description of Recommended Contents for Prevention and Control of Children and Adolescents’ Myopia by Outdoor Activities (Attached Table 3), school-age children have two hours of outdoor activities during the day, which are carried out inside and outside the school. The insufficient time for daytime outdoor activities on school days should be made up on weekends and reach at least 14 hours of daytime outdoor activities every week. Kindergarten children advocate three hours of outdoor activities during the day and put more conservation content outdoors.
2. Implement one-hour daytime outdoor activities on campus. The school arranges a 30-minute recess activity in the morning and afternoon, emphasizing outdoor activities and not sticking to the form and content of activities. Try to go to physical education class outdoors, and some indoor courses, such as class meetings, can be held outdoors. Set up outdoor activities interest groups and actively carry out various forms and rich contents of outdoor activities. Arrange extracurricular sports homework and provide high-quality exercise resources. Teachers should promptly remind students and class "eye guards" to supervise students to walk out of the classroom for 10 minutes between classes.
3. Grasp the one-hour outdoor activities outside school. It is recommended that children and adolescents have a full or staged walking to school, and junior students should be accompanied by their parents. Parents encourage and actively participate in children’s extracurricular activities, complete extracurricular sports homework, and go outdoors and go to nature with their children on weekends and holidays. Schools, parents and students cooperate, actively explore the development of peer-to-peer school groups, increase the time of outdoor activities during the day, enhance exchanges between students, and reduce parental companionship.
4. Exercise for 1 hour every day. According to the requirements of myopia prevention and control, children and adolescents should be outdoors for 2 hours every day, but according to the requirements of physical and mental health promotion, children and adolescents should be engaged in moderate to high-intensity physical activities for at least 60 minutes every day, mainly aerobic exercise. High-intensity aerobic exercise and muscle and bone strengthening exercise should be carried out at least three days a week. Taking physical education class as the starting point, the school guides students to carry out physical exercise, and brings the daytime outdoor physical exercise time into the range of 2 hours of daily outdoor activities.
(4) Health education for all teachers, students and parents.
1. Strengthen teachers’ health education ability. The school cooperates with public health professional institutions and medical colleges and universities to organize teachers to carry out health education and training on myopia prevention and control, so that teachers can master myopia prevention knowledge. Trained teachers popularize myopia prevention and control knowledge through health education classes, parent-teacher conferences, and myopia prevention and control theme class meetings.
2. Improve students’ eye health literacy. Students should receive at least one health education course or theme class meeting for myopia prevention and control every semester to learn the knowledge and skills of eye protection in like eyes. Teachers guide students to make handwritten reports on myopia prevention knowledge, and carry out knowledge contests, group discussions, role-playing, etc. to improve students’ myopia prevention and control ability. Students will bring the knowledge of myopia prevention and control they have learned and mastered in school back to their families, which will influence their parents and give play to the role of "small hands and big hands" in myopia prevention and control. Advocate the school to train an "eye protector" or preacher in each class, publicize the knowledge about vision protection, and urge students to go out of the classroom during recess.
3. Enhance parents’ awareness of vision protection. Parents should take the initiative to learn like eyes’s knowledge and skills of eye care, educate and urge their children to use their eyes scientifically, improve family lighting, adjust the height of desks and chairs, and correct the thought and behavior of "paying more attention to treatment than prevention", so as to realize the myopia prevention and control situation of "holding hands with big hands".
4. Increase the construction of social supportive environment. Mobilize experts to enter schools and society, popularize scientific knowledge of myopia prevention, and educators and children and adolescents identify scientific vision correction measures. Experts and scholars actively compile and publish popular science materials and books on myopia prevention and control health education, and make new media health education materials. Professional institutions, schools and communities should join forces to promote the dissemination and sharing of health education information and improve the coverage and efficiency of health education by using mobile health platforms or technologies, such as smart phone applications, SMS services and telephone intervention. Severely crack down on the false and illegal marketing and propaganda behavior of children and adolescents’ myopia prevention and control products.
Second, the secondary prevention of public health intervention technology
(1) Vision health screening.
Establish a regular vision screening system, carry out poor vision screening, the screening frequency is not less than 2 times per academic year, standardize the recording of inspection contents, and establish information management of vision health. Pay attention to the standardization of screening and filing process, strengthen quality control, and implement closed-loop management of grading after screening. With the help of artificial intelligence technology, the degree of automation of vision screening is improved, and the work efficiency and popularization are improved.
(2) Early warning management of myopia.
Timely analysis of children’s and adolescents’ visual health, early screening of myopia and other ametropia, dynamic observation of the development and changes of children’s and adolescents’ refractive status in different periods, early detection of myopia tendency or trend, establishment of myopia early warning model, and formulation of applicable and feasible intervention measures to slow down the rapid and severe development of myopia. Combined with vision screening and file establishment, it is suggested that children and adolescents with normal vision but with high risk factors of myopia or insufficient hyperopia reserve should change their high-risk behaviors, and schools, families and communities should cooperate to increase outdoor activities during the day, reduce the behavior of using eyes at close range and improve the visual environment. For those with pre-myopia, we should give high-risk early warning and focus on intervention. It is suggested to go to professional institutions to receive professional examinations such as medical optometry, make a clear diagnosis and take corresponding measures in time to control and slow down the occurrence and development of myopia in children and adolescents.
Three, three prevention of public health intervention technology
(1) scientifically correct myopia.
For children and adolescents who are already nearsighted, parents should be instructed to take their children to professional institutions for examination and correction in time. If it is determined that they need to wear glasses after professional examination, parents should choose glasses with appropriate degrees for their children according to the requirements of doctors or optometrists, wear glasses according to the doctor’s advice, and conduct regular follow-up.
(2) Preventing and controlling the aggravation and complications of myopia.
For children and adolescents with early onset of myopia or rapid development of myopia, specialists should adopt optical correction, drug correction or traditional Chinese medicine to slow down the progress of myopia. Parents should go to regular medical institutions, choose measures suitable for their children under the guidance of doctors or optometrists, and use them according to the doctor’s advice. For children and adolescents with fundus pathological changes and other complications, parents should take their children to professional medical institutions for treatment by specialists in time.
Fourth, the specific implementation measures
(1) Grasp early and small, and implement it in the whole life cycle.
1. The implementation of vision health management pass forward. Early detection of the shortage of hyperopia reserves and timely intervention measures are the key to move forward the prevention and control of myopia for children and adolescents. Move forward in the prevention and control cycle, grasp early and grasp small; Move forward in the prevention and control link, from treatment to early warning; Move forward in the sense of prevention and carry out early intervention for students with healthy vision. Move the myopia defense line forward to pregnancy, infants and preschool stage. Strengthen parents’ and teachers’ awareness of myopia prevention and control, and regard infants, preschool children and lower grades of primary schools as the key links of myopia prevention and control.
2. Promote the prevention and control of myopia in the whole life cycle. From the perspective of the whole life cycle, it focuses on the potentially sensitive periods such as pre-pregnancy, pregnancy, infants, preschool, school age, etc., so as to reduce the impact of biological, environmental and behavioral risk factors in each period on the visual health of children and adolescents. From pre-pregnancy, pregnancy and perinatal period, develop a healthy lifestyle, monitor health status in real time, and reduce the risk of gestational diabetes, hypertension and premature delivery, so as to reduce the risk of myopia in children and adolescents. Implement the "Standard for Eye Care and Vision Examination Services for Children Aged 0-6", establish children’s eye health files, and make one file for each person, which will be transferred in real time with children and adolescents entering school. Popularize the scientific knowledge of children’s eye care to parents, and guide families to actively accept children’s eye care and vision examination services. Carry out health guidance, don’t touch the electronic screen before the age of 3, preschool children should try to avoid touching and using video electronic products, reduce the time of using their eyes at close range, increase the time of outdoor activities, maintain correct reading and writing posture, develop good sleep habits and ensure adequate and regular sleep. At school age, we should advocate at least one hour of outdoor activities in and out of school every day, reduce long-term close eye use and maintain adequate regular sleep. Implementing myopia prevention and control from the whole life cycle can realize the forward movement of myopia prevention and control and improve the vision health in the whole life cycle.
(B) the combination of prevention and control, the whole population and key population strategy.
1. The whole crowd strategy. Children and adolescents are generally susceptible to myopia, so it is necessary to take the whole population strategy to prevent and control myopia, carry out health education on myopia prevention and control, increase outdoor activities during the day, reduce long-term use of eyes at close range, build a visually friendly environment and other public health intervention measures to do a good job of prevention and control at the first level of the whole population.
2. Key population strategy. According to the stages of myopia, corresponding intervention measures should be carried out to reduce the risk of rapid development of myopia. For those with normal vision and sufficient hyperopia reserve, prevent the hyperopia reserve from being consumed prematurely. The main goal of prevention and control of myopia is to slow down the occurrence of myopia. Low myopia should control the progress of myopia, while high myopia should prevent fundus lesions and reduce the risk of blindness.
(three) demonstration and guidance, strengthen the prevention and control and intervention process and effect evaluation.
1. Pilot first, demonstration leading. Construct a six-in-one comprehensive prevention and control strategy of government leadership, responsibility of competent departments, monitoring of professional health institutions, school leadership, family cooperation and students’ subjectivity. Disease control institutions at all levels rely on the monitoring of common diseases and health influencing factors of students and the appropriate technology pilot platform to implement the monitoring of myopia of children and adolescents, guide and coordinate relevant parties to implement effective comprehensive public health intervention measures, and take outdoor activities and sports activities as the main starting point to realize the prevention of multiple diseases.
2. Pay attention to process and effect evaluation. Disease control institutions at all levels should regularly carry out students’ vision monitoring, deeply analyze the monitoring data over the years, and report the main students’ health problems and suggestions found in the monitoring to the local government in time. Based on the practical research method, the transformation and application from theory to practice can promote the implementation and dissemination of intervention actions. Conduct process and effect evaluation, introduce the implementation research framework and theoretical model, such as the process and effect indicators of comprehensive public health intervention for myopia prevention and control and its collection method (Table 4), comprehensively evaluate the accessibility, effectiveness, applicability and sustainability of intervention actions from the individual level and organizational level, and systematically evaluate the implementation effect of comprehensive public health intervention for children and adolescents with myopia.
