The relationship between green space and myopia in children and adolescents: a systematic review and meta-analysis

To investigate the effect of green space exposure on the risk of myopia in children and adolescents.

Studies on the relationship between green space and myopia in children and adolescents published before October 1, 2024, were retrieved from five electronic databases: web of Science Core Collection, PubMed, EBSCOhost, ScienceDirect and Cochrane Library. A systematic review was conducted to summarize the relevant articles, followed by a meta-analysis.

A total of 11 studies were included in the systematic review, encompassing 2,224,332 participants aged 6-22 years. Of these, 6 studies were incorporated into the meta-analysis. Most studies indicated that increased green space is associated with a reduced risk of myopia. The Normalized Difference Vegetation Index (NDVI) showed a negative correlation with the prevalence of myopia in children and adolescents (cross-sectional studies: OR = 0.95, 95% CI: 0.94-0.96, I ²= 37.2%, P = 0.158; cohort studies: OR = 0.91, 95% CI: 0.91-0.91, I ²= 88.9%, P < 0.001). NDVI within school boundaries and a 500-meter buffer zone had a more significant effect on myopia prevention (within school boundaries: OR = 0.87, 95% CI: 0.77-0.99, P = 0.206; 500-meter buffer zone around schools: OR = 0.96, 95% CI: 0.94-0.97, P = 0.098; 1,000-meter buffer zone around schools: OR = 0.94, 95% CI: 0.92-0.97, P = 0.315) (within school boundaries: OR = 0.96, 95% CI: 0.94-0.98, P = 0.066; 500-meter buffer zone around schools: OR = 0.90, 95% CI: 0.90-0.91, P = 0.053).

Increased exposure to green spaces has a beneficial effect on reducing the risk of myopia in children and adolescents. For every 0.1 increase in the NDVI, the prevalence of myopia decreases. Furthermore, the prevention and control of myopia are more effective within school boundaries and in the surrounding 500-meter buffer zone. Therefore, it is recommended that schools and relevant government authorities focus on enhancing vegetation coverage within school grounds and around areas where students frequently engage in activities, thereby providing stronger environmental support for myopia prevention in children and adolescents. However, potential publication bias cannot be excluded given the limited number of included studies; therefore, the pooled estimates should be interpreted with caution.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251153654, PROSPERO: CRD420251153654.