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Behavioral Intervention with Eye-Use Monitoring to Delay Myopia Onset and Progression in Children: A Cluster
Yuanyuan Hu1, Mingkun Yu2, Xiaotong Han3
1Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Shandong Academy of Eye Disease Prevention and Therapy, Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Shandong Provincial Clinical Medical Research Center of Optometry and Children Visual Impairment Prevention and Control, Shandong Engineering Technology Research Center of Visual Intelligence, Shandong Institute of Children Health and Myopia Prevention and Control, Shandong, China; Ophthalmology and Optometry Medical School, Shandong University of Traditional Chinese Medicine, Shandong, China.
Insights
Eye-Use Monitoring technology with behavioral feedback effectively delayed myopia onset and progression in children. Sustained intervention is likely needed for long-term benefits in pediatric eye care.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Behavioral Science
Background:
- Myopia, a common vision impairment in children, poses a significant public health concern.
- Early detection and intervention are crucial for managing myopia progression.
- Behavioral interventions show promise in controlling myopia development.
Purpose of the Study:
- To evaluate the effectiveness of a behavioral intervention utilizing Eye-Use Monitoring technology in delaying myopia onset and progression among children.
- To compare the efficacy of reminder-only alerts versus combined reminders and feedback.
Main Methods:
- A prospective, cluster-randomized, examiner-masked clinical trial involving 413 children (grades 2-4) in China.
- Participants were randomized by class into three groups: reminder and feedback, reminder-only, and control.
- The intervention involved Eye-Use Monitoring technology for 49 weeks, followed by a 49-week observation period.
Main Results:
- The reminder and feedback group showed the least change in cycloplegic spherical equivalent (SE) and axial length (AL) at 49 weeks (P < 0.001).
- Myopia incidence was significantly lower in the reminder and feedback group (13.3%) compared to the other groups (P < 0.05).
- These beneficial effects diminished by the 98-week follow-up, suggesting a need for sustained intervention.
Conclusions:
- Combining Eye-Use Monitoring reminders with behavioral feedback effectively delays myopia onset and progression in children.
- The study highlights the potential of technology-assisted behavioral interventions in pediatric myopia management.
- Long-term efficacy requires sustained application of the intervention to maintain benefits.
Purpose:
To assess the efficacy of a behavioral intervention using Eye-Use Monitoring technology to delay the onset and progression of myopia in children.
Design:
A prospective, cluster-randomized, parallel-groups, examiner-masked, clinical trial (Chinese Clinical Trial Registry, ChiCTR2100052101).
Participants:
A total of 413 children from grades 2 to 4 in Shandong, China, from October 2021 to December 2023 were randomized by class into 3 groups: reminder and feedback (6 classes, 156 children), reminder-only (5 classes, 147 children), and control (3 classes, 110 children). Children with prior myopia control interventions, significant eye conditions, or a history of eye diseases were excluded.
Methods:
The reminder-only group received simultaneous vibration alerts for prolonged near work, close proximity, head tilt, or inadequate lighting. The reminder and feedback group received these alerts plus behavioral feedback, including praise, rewards, and weekly reports. The control group received no intervention. The intervention lasted 49 weeks, followed by a 49-week observation period without intervention.
Main Outcome Measures:
The primary outcome was the mean change in cycloplegic spherical equivalent (SE) at 49 weeks. Secondary outcomes included changes in axial length (AL), myopia incidence, rates of rapid myopic shift, participant compliance, and eye-use behaviors.
Results:
At 49 weeks, changes in SE and AL were least in the reminder and feedback group (SE: 0.52 ± 0.35 diopters [D] vs. 0.59 ± 0.43 D vs. 0.73 ± 0.48 D, AL: 0.30 ± 0.14 mm vs. 0.33 ± 0.16 mm vs. 0.40 ± 0.20 mm, in reminder and feedback group, reminder only group, and control group, respectively, both P < 0.001). Myopia incidence was lowest in the reminder and feedback group (13.3% vs. 21.6% vs. 27.8%, in reminder and feedback group, reminder only group, and control group, respectively, P < 0.05). However, differences diminished by the 98-week follow-up.
Conclusions:
This study demonstrated that the combination of Eye-Use Monitoring reminders and feedback on eye-use behaviors can effectively delay the onset and progression of myopia in children. However, sustained intervention may be necessary to maintain long-term benefits.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found after the references.
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