Evaluation of China's "1146" school-based myopia control programme in primary school children: A 12-month study

Structured school-based myopia prevention programmes are increasingly promoted, but real-world evidence supporting multicomponent models remains limited. This study evaluated the 12-month effectiveness of the "1146" programme in China in a routine primary school setting.

This prospective, non-randomised controlled study included 24 classes from a single primary school, assigned to intervention or control groups according to teaching schedule. After follow-up, 100 children from the intervention group and 98 children from the control group were analysed. Intervention classes received the multicomponent "1146" programme, which integrated education, visual behaviour, environmental measures, outdoor activity promotion, monitoring, and adjunctive professional components. Control classes followed standard teaching. Routine refractive correction was provided to myopic children in both groups when indicated. Continuous outcomes were analysed using linear mixed-effects models adjusted for baseline value, age, and sex, with class included as a random effect.

At 12 months, axial length increased less in the intervention group than in controls (0.01 ± 0.11 mm versus [vs] 0.29 ± 0.37 mm; adjusted mean difference -0.288 mm; 95% confidence interval -0.363 to -0.213). Spherical equivalent changed by 0.20 ± 0.61 D vs -0.45 ± 0.77 D, and uncorrected visual acuity changed by 0.37 ± 0.30 vs -0.27 ± 0.25 (all adjusted P<0.001). Improvement of ≥2 lines in uncorrected visual acuity (UCVA) occurred in 53.0% vs 1.0%, indicating meaningful functional gain. No subgroup interaction was significant.

The "1146" programme was associated with less axial elongation and more favourable refractive and UCVA changes over 12 months. The single-school, non-randomised design limited causal inference and generalisability. Larger randomised multicentre studies with longer follow-up are needed.