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

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.

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.

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).

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.