Department of Medical Statistics and Epidemiology, Sun Yat-Sen University School of Public Health, Guangzhou, China.
Department of Refractive and Low Vision, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
JAMA Ophthalmol. 2021 Nov 1;139(11):1165-1172. doi: 10.1001/jamaophthalmol.2021.3695.
Myopia is a common cause of vision loss, and its prevalence is increasing globally.
To evaluate the effects of school-based family health education via WeChat in raising parents' awareness of myopia prevention and behavior and in controlling the development of myopia in children.
DESIGN, SETTING, AND PARTICIPANTS: A single-masked cluster randomized clinical trial of children was conducted from October 1, 2018, to December 31, 2020, among grade 1 students from 12 primary schools in Guangzhou, China. The 12 primary schools were randomly selected in 2 districts and randomized to the intervention and control groups. All grade 1 students were invited to participate, and 688 students were included in the intervention group and 752 in the control group.
Weekly health education via the social media platform WeChat was provided to the parents in the intervention group.
Data include results of eye examinations of children and questionnaires completed by parents. The primary outcome was the 2-year cumulative incidence rate of myopia. Myopia was defined as a spherical equivalent (SE) refractive error (sphere of +0.5 cylinder) of at least -0.50 diopters (D). The secondary outcomes were the 2-year changes in the axis length and SE refraction, parental awareness, children's screen time, outdoor activities, and learning tools during COVID-19.
Among the 1525 children included at baseline (835 boys [54.8%]; mean [SD] age, 6.3 [0.5] years), 1244 competed the final assessment; the 2-year cumulative incidence rate of myopia was 106 of 544 (19.5%) in the intervention group and 171 of 700 (24.4%) in the control group (difference, 4.9% [95% CI, 0.3%-9.5%]; P = .04). The mean myopic shift in SE refraction in the intervention group (-0.82 D) was lower than that in the control group (-0.96 D; difference, -0.14 [95% CI, -0.22 to -0.06] D; P < .001). No difference in change in axial length was detected (difference, 0.02 [95% CI, -0.06 to 0.09] mm; P = .70).
School-based weekly family health education via WeChat resulted in a small decrease in the 2-year cumulative incidence rate of myopia with a difference in SE of less than 0.25 D not accompanied by any axial length differences. Whether these findings extrapolate elsewhere in the world or are clinically relevant in the short or long term remain to be determined.
Chinese Clinical Trial Registry Identifier: ChiCTR1900022236.
近视是视力丧失的一个常见原因，其患病率在全球范围内呈上升趋势。
评估通过微信进行基于学校的家庭健康教育对提高家长预防近视意识和行为以及控制儿童近视发展的效果。
设计、设置和参与者：这是一项于 2018 年 10 月 1 日至 2020 年 12 月 31 日在中国广州的 12 所小学进行的针对儿童的单盲、整群随机临床试验。这 12 所小学在 2 个区被随机选择，并随机分为干预组和对照组。所有一年级学生均被邀请参加，其中 688 名学生被纳入干预组，752 名学生被纳入对照组。
每周通过社交媒体平台微信向家长提供健康教育。
数据包括儿童眼部检查结果和家长完成的问卷。主要结局是 2 年近视累积发病率。近视定义为等效球镜（SE）屈光不正（球镜为+0.5 柱镜）至少为-0.50 屈光度（D）。次要结局为 2 年期间眼轴长度和 SE 折射的变化、父母意识、儿童屏幕时间、户外活动和在 COVID-19 期间的学习工具。
在基线时（835 名男孩[54.8%]；平均[SD]年龄，6.3[0.5]岁）的 1525 名儿童中，有 1244 名完成了最终评估；干预组的 2 年近视累积发病率为 544 名中的 106 名（19.5%），对照组为 700 名中的 171 名（24.4%）（差异，4.9%[95%CI，0.3%-9.5%]；P=0.04）。干预组 SE 屈光度的平均近视变化（-0.82 D）低于对照组（-0.96 D；差异，-0.14[95%CI，-0.22 至-0.06] D；P<0.001）。未检测到眼轴长度变化的差异（差异，0.02[95%CI，-0.06 至 0.09] mm；P=0.70）。
基于学校的每周通过微信进行家庭健康教育导致近视的 2 年累积发病率略有下降，SE 差异小于 0.25 D，但不伴有眼轴长度差异。这些发现是否在世界其他地方推广，或者在短期或长期内是否具有临床相关性，仍有待确定。
中国临床试验注册中心标识符：ChiCTR1900022236。
