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Zhou, H.; Bai, X. School Spatial Environment and Visual Health of Minors. Encyclopedia. Available online: (accessed on 21 June 2024).
Zhou H, Bai X. School Spatial Environment and Visual Health of Minors. Encyclopedia. Available at: Accessed June 21, 2024.
Zhou, Huihui, Xiaoxia Bai. "School Spatial Environment and Visual Health of Minors" Encyclopedia, (accessed June 21, 2024).
Zhou, H., & Bai, X. (2023, March 27). School Spatial Environment and Visual Health of Minors. In Encyclopedia.
Zhou, Huihui and Xiaoxia Bai. "School Spatial Environment and Visual Health of Minors." Encyclopedia. Web. 27 March, 2023.
School Spatial Environment and Visual Health of Minors

Rising childhood myopia rate has detrimental health consequences that pose a considerable challenge to health systems. The school spatial environment, which is where students are for the longest period of time, has a high health value for myopia systematic intervention. Intensive near work activity (as a risk factor) and longer time spent outdoors (as a protective factor), are involved in visual health factors. Two main research themes are obtained and relate to: (1) The environment of visual work behavior (especially the near work learning environment) and adaptable multimedia learning environment; and (2) the environment of outdoor exposure behavior.

health promotion learning environment myopia outdoor exposure

1. Introduction

Vision, the most dominant sense, plays a crucial role in obtaining information. Visual health, mental health and levels of well-being are closely interconnected [1], and the human body needs healthy vision in order to function optimally [2]. Rising childhood myopia problems with high incidence that occur in young ages pose a considerable challenge to health systems globally, and this is especially true in Asia [3]. Estimates of growth in the urbanization and human development index suggest that, by 2030, there may be 3.36 billion people with myopia across the globe. The number of people with high myopia, which is frequently accompanied by serious complications, is estimated to increase to 516.7 million in the same year [4]. The COVID-19 pandemic also greatly changed lifestyles, longtime online working and learning in ways that will aggravate the severity of the myopia problem. Take China as an example. As a result of increased large-scale online teaching, decreased physical activities and outdoor exposure during the 2020 pandemic, minors’ visual health levels decreased significantly, and the myopia rate increased by 11 percent [5]. This phenomenon is almost a natural experiment that verifies that near work mode, content and environment directly impact visual health.
As an irreversible process, myopia develops most rapidly in minors since the minors’ eyeball structure is not yet mature and school learning requires heavy near work. The known related factors of minors’ visual health include genetics, environment, diet, sleep, personal habits, educational pressure and so on [6]. Of these factors, environment is related to strong intrusive characteristics, which mainly involve the family and school environment. In contrast to the diversity of family environments, school is a place where minors spend the longest amount of time for near work, and this environment has great value for group interventions that seek to promote visual health. In addition, spatial environment intervention design provides minors with a healthy environment, but this is also the countries’ fundamental responsibility. School spatial environment refers to indoor spaces and outdoor spaces, such as classroom, sports fields, greenery and other spaces, and encompasses both architectural composition and spatial layout. It mainly studies the spatial and environmental characteristics that are related to student behavior [7].

2. Description of the Visual Health Loop

Ever since myopia research began, several decades of research have addressed genetic inheritance; however, the related population genes have not changed significantly. Meanwhile, the number of people with myopia has increased greatly as a result of changes in the physical living environment and lifestyle in recent years, and this indicates that environment may play a decisive role [8][9] (p. 8). Myopia is not only affected by genetic factors, but also by the biological hormone regulation of the internal physiological mechanism [10][11] (p. 13).
Furthermore, there is a close relationship between human behavior under the influence of the external environment and biological reaction. For instance, outdoor exposure could boost the secretion of dopamine in minor retinas, and this could regulate eye development and promote visual health [12]. Concurrently, the short-wavelength blue light of sunlight, namely the spectral component of 446–477 nm, is much more abundant in daylight than artificial lighting, and its substance is related to the secretion of melatonin, which can promote circadian rhythm, assist the development of the eyeball, and improve sleep [13]. Behaviors that are subject to different environmental influences will further affect the internal hormone regulation, and this clearly indicates that myopia is a disease caused by the interaction between genetic and environmental factors. Closer inspection shows it is more related to the surrounding environment of minors, after force majeure such as heredity are excluded. Similarly, key influencing factors, such as the minors getting out and enjoying outdoor activities, and the possession of a comfortable near work environment are closely connected to spatial environment characters. Hormones act as the inner core influencing mechanism, and the environment could be artificially designed externally and could influence visual behavior further. In being subject to the influence of the social environment and educational mode, near work behavior and outdoor exposure behavior are the main types of visual health behavior that are related to the spatial environment.

2.1. Medical Related Research

  • genetic inheritance
(1) Parents myopia
Myopia prevalence is significantly higher among children whose parents both have myopia. The greater the severity of parental myopia, the higher the risk of myopia [14][15][16][17][18][19] (p. 6,8,9). Minors’ eye AL (ocular axial length) values may also have been affected by parental genetics [10]. Parental myopia is also thought to be a symbol of genetic and shared family environmental exposure, and parents with myopia are more likely to create an environment that creates visual fatigue, including more intensive education or less time out-doors [11][20] (p. 8); however, gene-environment interactions are not well understood.
(2) Susceptibility gene
The minor’s gender affects the probability of myopia, which means it is more probable that girls will develop myopia during adolescence [14][15][21] (p. 6). Medical gene studies have found that at least 10 genes are associated with early-onset changes in refractive error [22]. Additionally, some gene mutations can lead to myopia or other refractive error phenotypes [23].
The risk of myopia developing varies in accordance with age—it progresses most rapidly between the ages of six and seven and slows down after the ages of 11 and 12 [8][14][24][25] (p. 6,8,9).
(3) Atropine
With regard to drug treatment related to Optometry, it has been found that antimuscarinic drugs, such as the most widely studied atropine, slow the progression of myopia; however, some minors do not respond to it, and there has been no large-scale popularization or application [26].
  • peripheral refractive error
(1) peripheral refraction
The central refractive error is determined by the foveal region on the visual axis, although peripheral retinal and other regions also play an important role in eye growth [27]. The degree of peripheral hyperopia varies among different heritage groups [28][29], and minors with myopia have greater peripheral relative hyperopia [30]. Both emmetropic and hyperopic children had peripheral relative myopia at all eccentric points [31]. Peripheral hyperopia co-occurs with prolonged myopia and determines the myopia patients’ eyeball shape. In contrast, a longitudinal study found that baseline peripheral refraction did not predict nor influence the development of myopia [32].
(2) physiological hormone regulation
Recent medical studies found that outdoor exposure could promote the secretion of dopamine in minors’ retina and could regulate eye development and promote visual health [33]. Meanwhile, the short-wavelength blue light of sunlight, namely the spectral components of 446–477 nm, is much more abundant in daylight than artificial lighting. Additionally, this substance is related to the secretion of melatonin, which can promote the circadian rhythm and eye development, and improve sleep quality [13].

2.2. Environment Related Studies

  • educational environment
The difference in education level largely determines the difference in the probability and degree of myopia and intelligence test scores [34]. Education level was also positively correlated with AL length, which is an important judging factor for myopia [35][36]. Meanwhile, early intensive education is associated with higher prevalence of myopia than the other factors [37].Education level is usually measured by years of formal education or academic achievement, and is also highly correlated with near work time. Education level may therefore be a substitute factor for proximity work and number among the influencing factors of myopia [20][38][39] (p. 8,9). The relationship between education and myopia may also reflect the common inheritance of intelligence and refraction, which enrich the method of myopia researches.
When the traditional educational mode turns to multimedia teaching, the old instructional design criteria are no longer suitable. School type [40] (p. 8), desk lighting [9] (p. 8), sitting location in classroom, screening time [8][40][41][42] (p. 6,8) and multimedia teaching under daylight conditions [43] (p. 5), will also influence minors’ visual health through near work. Classroom unit spatial design should also be changed to adapt to the current education model, in order to provide more visual health environment.
  • spatial environment
The development of myopia is also related to geographical location, and urban dwellers have a higher risk of visual impairment and blindness than those in rural areas, including in China [44] (p. 9), [45], Ghana [46] and Australia [47], this may be caused by differences in lifestyle, urbanization, school type and demographic characteristics [8][20][40][48][49][50] (p. 6,8,9). Meantime, different geographical areas have various climacteric characteristics that are related to differences of daylight environment, this can be seen in Istanbul [51], Chongqing, Lasa [52], London, Chicago, Dubai and Bangkok and so on. London, Chicago, Dubai and Bangkok have different fenestration parameters in order to ensure the effective use of daylighting, due to local daylight performance [53]. Outdoor activities in China’s rural area have a weak protective effect on visual health, and this may be because minors in rural areas have a lower genetic susceptibility to myopia; in addition, environmental factors may be an important reason for visual impairment [54]. Additionally, the indoor environment, like plants, can also influence the relief of visual fatigue [55] (p. 7).
  • outdoor environment
Outdoor daylight exposure could protect visual health to a certain extent and delay the development of myopia, and this is because outdoor time is an important protective factor [14][15][56][57][58][59][60][61][62] (p. 5,6,9–11). Minors who spent less time outdoors and more time near work had a higher rate of myopia, and those who spent less time on near work had a lower rate [55][63][64][65][66][67][68][69] (p.7,8,16), which indicated increased outdoor time as a solution for myopia, and provided architecture design direction. Similarly, animal experiments have also found that a less bright environment can increase the probability of myopia [70].
However, the biological mechanism of the association between outdoor exposure and myopia remains unclear. It has been hypothesized that higher outdoor brightness increases field depth and reduces image blur, and that light stimulation induces dopamine production in the retina and adjusts eye growth [69]. It has also been hypothesized that the spectral component of daylight is an important visual health factor [71]. Studies have also identified the non-visual effects of light and Healthy Circadian Lighting, namely that light has an important impact on the human body’s circadian system. Non- visual photoreceptor cells (ipRGC) transmit light signals to the brain’s suprachiasmatic nucleus (SCN) and body clock and regulate the secretion of melatonin and cortisol (which are closely related to circadian rhythm) [72]. Both these explain how outdoor time could protect visual health.

2.3. Behavior Related Studies

  • negative behaviors related to visual health
Near work is usually defined as long or close reading by minors. Children who read continuously within 30 cm for more than 30 min tend to develop myopia [73]. Meanwhile, children who read more than two hours per day and more than two books per week are more likely to be nearsighted [61][64][66][73][74][75][76][77] (p. 5,7–11). It has also been found that the light environment of near work will influence visual health [78] (p. 5). Meanwhile, outdoor activities can protect visual health [79].
Some studies have also found there is no association between close visual work and vision-related health risks [80][81]. Most myopia and near work are cross-sectional and cannot examine the temporal relationship. Those who have myopia may wear glasses and find it more difficult to participate in sports tasks, which results in lower levels of physical activity [82]. Parents also filled in most of the information about minors’ near work and outdoor time, which led to recall bias. In the future, more accurate and standard methods should be used to quantify the near work modifiable variables in near work, such as reading posture, rest during reading and appropriate lighting. These should be studied in order to promote health [83], and this could change e and adjust behavior in accordance with spatial environment design. The increased burden of school learning plays an important role in the high prevalence of myopia and visual impairment. This may be due to intensive near work, which increases the risk of myopia [8][84]. Bad eye habits and electronic devices are also risk factors [85][86]. Family eating habits and BMI risk factors [17] (p. 9), including changing from a Japanese to a Western diet, may increase the risk of myopia [41][87][88] (p. 5). Additionally, these factors could be improved in other ways, like social management policy and media guidance. This can help to produce positive behaviors related to visual health positive behaviors related to visual health.
  • positive behaviors related to visual health
Resting behaviors (including night’s sleep and short rest) have been associated with the probability of minors’ myopia [77][89] (p. 7), that could protect visual health. The level of myopia is significantly associated with night sleep, and not with the duration of total noon and evening sleep [79][90][91] (p. 8,11). With regard to the biological mechanism, the circadian rhythm of human sleep mainly depends on the joint regulation of melatonin and dopamine, when melatonin combines with the corresponding eye receptors to jointly regulate the eye’s development [18] (p. 14). Short rests, meanwhile, have been found to reduce fatigue [82]. Some animal experiments have also demonstrated that the circadian rhythm disorder will increase the risk of myopia [92]. Change of minors’ daily waking and sleeping time is a simple measure that can be introduced to restrain myopia [93].
Eye exercises organized by schools have a certain protective effect on myopia [47][94] (p. 9). In addition appropriate myopia correction can also protect visual health, further reduce visual damage and slow myopia progression [95]. Parents’ awareness of refractive error also determines the proportion of minors‘ myopia correction, and this further affects visual health [96][97] (p. 11).

3. Visual Health Guidelines for School Architecture

In referring to the loop diagram’s logical chain, it is both plausible and likely that the school spatial environment will impact on minors’ visual behavior. However, few review studies have discussed associations with minors’ visual health. In the causal loop diagrams of visual health, school layout is shown to be closely related to the indoor light environment through effects on near work behavior; in addition, spatial environment greatly influences minors’ outdoor times via hormone regulation and physiological processes in daylight. The natural elements could also relieve visual fatigue, and this applies both indoors and outdoors. These studies use direct and indirect routes to combine visual health promotion and school design.
Usually, visual health is always connected to near work behavior that is related to indoor light environment in school. Additionally, school layout, windows’ scale, buildings’ orientation and so on are the main influences. For the most part, visual health promotion has not only considered physical school environment variables but has provided general support to providing minors with adequate outdoor activities. For example, diverse playgrounds, convenient outdoor access, various types of activity equipment and varied travel experience all show how this can be achieved. While the specific relationship between school spatial environment and visual health has not been precisely defined, it has been demonstrated that the school environment promotes visual health opportunities. Minors’ outdoors activities at school have decreased dramatically over preceding decades, and this is why the importance of outdoors time as a way of improving visual health has been increasingly reiterated. Unfortunately, many schools and surrounding environments have not been conducive to outdoor activities. In addition, minors who lived in cities were more prone to myopia than rural counterparts, and in this regard it was significant that urban schoolchildren enjoyed substantially less school outdoor time.
The complex causal pathways between school spatial environmental factors and minors’ visual behaviors are still unclear. However, in acknowledging the ongoing need to improve visual health behaviors across numerous minor populations, schools have introduced and promoted design guidelines. They are summarized on the basis of the literature review and relevance analysis.


  1. Rainey, L.; Elsman, E.B.M.; van Nispen, R.M.A.; van Leeuwen, L.M.; van Rens, G.H.M.B. Comprehending the impact of low vision on the lives of children and adolescents: A qualitative approach. Qual. Life Res. 2016, 25, 2633–2643.
  2. Sergott, R.C. Depression and Anxiety in Visually Impaired Older People. Yearb. Ophthalmol. 2007, 2007, 209–210.
  3. Spillmann, L. Stopping the rise of myopia in Asia. Graefe’s Arch. Clin. Exp. Ophthalmol. 2019, 258, 943–959.
  4. Holden, B.A.; Fricke, T.R.; Wilson, D.A.; Jong, M.; Naidoo, K.S.; Sankaridurg, P.; Resnikoff, S. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology 2016, 123, 1036–1042.
  5. Ministry of Education. Available online: (accessed on 27 April 2020).
  6. Grzybowski, A.; Kanclerz, P.; Tsubota, K.; Lanca, C.; Saw, S.-M. A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmol. 2020, 20, 27.
  7. Li, Z. Architectural Space Environment and Behavior; Huazhong University of Science and Technology Press: Wuhan, China, 2009; pp. 27–35.
  8. Ma, Y.; Lin, S.; Zhu, J.; Xu, X.; Lu, L.; Zhao, R.; Zou, H. Different patterns of myopia prevalence and progression between internal migrant and local resident school children in Shanghai, China: A 2-year cohort study. BMC Ophthalmol. 2018, 18, 53.
  9. Kim, H.; Seo, J.S.; Yoo, W.-S.; Kim, G.-N.; Kim, R.B.; Chae, J.E.; Kim, S.J. Factors associated with myopia in Korean children: Korea National Health and nutrition examination survey 2016–2017 (KNHANES VII). BMC Ophthalmol. 2020, 20, 31.
  10. Saw, S.-M.; Carkeet, A.; Chia, K.-S.; Stone, R.A.; Tan, D.T. Component dependent risk factors for ocular parameters in Singapore Chinese children. Ophthalmology 2002, 109, 2065–2071.
  11. Mutti, D.O.; Mitchell, G.L.; Moeschberger, M.L.; Jones, L.A.; Zadnik, K. Parental myopia, near work, school achievement, and children’s refractive error. Invest. Ophthalmol. Vis. Sci. 2002, 43, 3633–3640.
  12. French, A.N.; Ashby, R.S.; Morgan, I.G.; Rose, K.A. Time outdoors and the prevention of myopia. Exp. Eye Res. 2013, 114, 58–68.
  13. Brainard, G.C.; Hanifin, J.P.; Greeson, J.M.; Byrne, B.; Glickman, G.; Gerner, E.; Rollag, M.D. Action Spectrum for Melatonin Regulation in Humans: Evidence for a Novel Circadian Photoreceptor. J. Neurosci. 2001, 21, 6405–6412.
  14. Zhao, H.; Yu, J.; Xu, H. Prevalence and Associated Factors of Myopia among Third-Grade Primary School Students in the Gongshu District of Hangzhou. Chin. J. Optom. Ophthalmol. Vis. Sci. 2019, 21, 321–326.
  15. Wu, L.J.; You, Q.S.; Duan, J.L.; Luo, Y.X.; Liu, L.J.; Li, X.; Gao, Q.; Zhu, H.P.; He, Y.; Xu, L.; et al. Prevalence and associated factors of myopia in high-school students in Beijing. PLoS ONE 2015, 10, e0120764.
  16. Leng, L.; Zhang, J.; Xie, S.; Ding, W.; Ji, R.; Tian, Y.; Long, K.; Yu, H.; Guo, Z. Effect of Sunshine Duration on Myopia in Primary School Students from Northern and Southern China. Int. J. Gen. Med. 2021, 14, 4913–4922.
  17. Jin, J.-X.; Hua, W.-J.; Jiang, X.; Wu, X.-Y.; Yang, J.-W.; Gao, G.-P.; Tao, F.-B. Effect of outdoor activity on myopia onset and progression in school-aged children in northeast china: The sujiatun eye care study. BMC Ophthalmol. 2015, 15, 73.
  18. Ip, J.M.; Huynh, S.C.; Robaei, D.; Rose, K.A.; Morgan, I.G.; Smith, W.; Mitchell, P. Ethnic Differences in the Impact of Parental Myopia: Findings from a Population-Based Study of 12-Year-Old Australian Children. Investig. Opthalmol. Vis. Sci. 2007, 48, 2520.
  19. Zadnik, K. The Effect of Parental History of Myopia on Children’s Eye Size. JAMA J. Am. Med. Assoc. 1994, 271, 1323.
  20. Lundberg, K.; Suhr Thykjaer, A.; Søgaard Hansen, R.; Vestergaard, A.H.; Jacobsen, N.; Goldschmidt, E.; Grauslund, J. Physical activity and myopia in Danish children—The CHAMPS Eye Study. Acta Ophthalmol. 2017, 96, 134–141.
  21. Li, Y.; Liu, J.; Qi, P. The increasing prevalence of myopia in junior high school students in the Haidian District of Beijing, China: A 10-year population-based survey. BMC Ophthalmol. 2017, 17, 88.
  22. Fan, Q.; Guo, X.; Tideman JW, L.; Williams, K.M.; Yazar, S.; Evans, D.M. Childhood gene-environment interactions and age-dependent effects of genetic variants associated with refractive error and myopia: The CREAM Consortium. Sci. Rep. 2016, 6, 25853.
  23. Hysi, P.G.; Choquet, H.; Khawaja, A.P.; Wojciechowski, R.; Tedja, M.S. Meta-analysis of 542,934 subjects of European ancestry identifies new genes and mechanisms predisposing to refractive error and myopia. Nat. Genet. 2020, 52, 401–407.
  24. Du, Y.; Bai, N.; Xu, H.; Lu, P.; Jiang, Z. An Epidemiological Survey on Myopia and Related Factors among Rural and Urban Adolescents in Xingyi City of Guizhou Province. Chin. J. Optom. Ophthalmol. Vis. Sci. 2021, 23, 205–210.
  25. Hyman, L. Relationship of Age, Sex, and Ethnicity With Myopia Progression and Axial Elongation in the Correction of Myopia Evaluation Trial. Arch. Ophthalmol. 2005, 123, 977.
  26. Wu, P.-C.; Chuang, M.-N.; Choi, J.; Chen, H.; Wu, G.; Ohno-Matsui, K.; Cheung, C.M.G. Update in myopia and treatment strategy of atropine use in myopia control. Eye 2018, 33, 3–13.
  27. Smith, E.L.; Ramamirtham, R.; Qiao-Grider, Y.; Hung, L.-F.; Huang, J.; Kee, C.; Paysse, E. Effects of Foveal Ablation on Emmetropization and Form-Deprivation Myopia. Investig. Opthalmol. Vis. Sci. 2007, 48, 3914.
  28. Mutti, D.O.; Hayes, J.R.; Mitchell, G.L.; Jones, L.A.; Moeschberger, M.L.; Cotter, S.A.; Zadnik, K. Refractive Error, Axial Length, and Relative Peripheral Refractive Error before and after the Onset of Myopia. Investig. Opthalmol. Vis. Sci. 2007, 48, 2510.
  29. Chen, X.; Sankaridurg, P.; Donovan, L.; Lin, Z.; Li, L.; Martinez, A.; Ge, J. Characteristics of peripheral refractive errors of myopic and non-myopic Chinese eyes. Vis. Res. 2010, 50, 31–35.
  30. Mutti, D.O.; Sholtz, R.I.; Friedman, N.E.; Zadnik, K. Peripheral refraction and ocular shape in children. Investig. Ophthalmol. Vis. Sci. 2000, 41, 1022–1030.
  31. Sng, C.C.A.; Lin, X.-Y.; Gazzard, G.; Chang, B.; Dirani, M.; Chia, A.; Saw, S.-M. Peripheral Refraction and Refractive Error in Singapore Chinese Children. Investig. Opthalmol. Vis. Sci. 2011, 52, 1181.
  32. Sng, C.C.A.; Lin, X.-Y.; Gazzard, G.; Chang, B.; Dirani, M.; Lim, L.; Saw, S.-M. Change in Peripheral Refraction over Time in Singapore Chinese Children. Investig. Opthalmol. Vis. Sci. 2011, 52, 7880.
  33. Brodstein, R.S.; Brodstein, D.E.; Olson, R.J.; Hunt, S.C.; Williams, R.R. The Treatment of Myopia with Atropine and Bifocals. Ophthalmology 1984, 91, 1373–1378.
  34. Teasdale, T.W.; Goldschmidt, E. Myopia and its relationship to education, intelligence and height: Preliminary results from an on-going study of Danish draftees. Acta Ophthalmol. 2009, 66, 41–43.
  35. Wong, T.Y.; Foster, P.J.; Ng, T.P.; Tielsch, J.M.; Johnson, G.J.; Seah, S.K. Variations in ocular biometry in an adult Chinese population in Singapore: The Tanjong Pagar Survey. Investig. Ophthalmol. Vis. Sci. 2001, 42, 73–80.
  36. Lim, L.S.; Saw, S.-M.; Jeganathan, V.S.E.; Tay, W.T.; Aung, T.; Tong, L.; Wong, T.Y. Distribution and Determinants of Ocular Biometric Parameters in an Asian Population: The Singapore Malay Eye Study. Investig. Opthalmol. Vis. Sci. 2010, 51, 103.
  37. Rose, K.A. Myopia, Lifestyle, and Schooling in Students of Chinese Ethnicity in Singapore and Sydney. Arch. Ophthalmol. 2008, 126, 527.
  38. Han, S.; Jang, J.; Yang, H.K.; Hwang, J.-M.; Park, S. Prevalence and risk factors of myopia in adult Korean population: Korea national health and nutrition examination survey 2013–2014 (KNHANES VI). PLoS ONE 2019, 14, e0211204.
  39. Morgan, I.; Rose, K. How genetic is school myopia? Prog. Retin. Eye Res. 2005, 24, 1–38.
  40. Rim, T.H.; Kim, S.-H.; Lim, K.H.; Kim, H.Y.; Baek, S.-H. Body Stature as an Age-Dependent Risk Factor for Myopia in a South Korean Population*. Semin. Ophthalmol. 2016, 32, 326–336.
  41. Berticat, C.; Mamouni, S.; Ciais, A.; Villain, M.; Raymond, M.; Daien, V. Probability of myopia in children with high refined carbohydrates consumption in France. BMC Ophthalmol. 2020, 20, 337.
  42. Assem, A.S.; Tegegne, M.M.; Fekadu, S.A. Prevalence and associated factors of myopia among school children in Bahir Dar city, Northwest Ethiopia, 2019. PLoS ONE 2021, 16, e0248936.
  43. Hinterlong, J.E.; Holton, V.L.; Chiang, C.C.; Tsai, C.Y.; Liou, Y.M. Association of multimedia teaching with myopia: A national study of school children. J. Adv. Nurs. 2019, 75, 3643–3653.
  44. Jonas, J.B.; Xu, L.; Wang, Y.X.; Bi, H.S.; Wu, J.F.; Jiang, W.J.; Panda-Jonas, S. Education-Related Parameters in High Myopia: Adults versus School Children. PLoS ONE 2016, 11, e0154554.
  45. Xu, L.; Wang, Y.; Li, Y.; Wang, Y.; Cui, T.; Li, J.; Jonas, J.B. Causes of Blindness and Visual Impairment in Urban and Rural Areas in Beijing. Ophthalmology 2006, 113, 1134.e1–1134.e11.
  46. Wiafe, B. Ghana Blindness and Vision Impairment Study. International Agency for the Prevention of Blindness. 2015. Available online: (accessed on 15 April 2021).
  47. Ip, J.M.; Rose, K.A.; Morgan, I.G.; Burlutsky, G.; Mitchell, P. Myopia and the Urban Environment: Findings in a Sample of 12-Year-Old Australian School Children. Investig. Opthalmol. Vis. Sci. 2008, 49, 3858.
  48. Zhou, Y.; Huang, X.B.; Cao, X.; Wang, M.; Jin, N.X.; Gong, Y.X.; Xiong, Y.J.; Cai, Q.; Zhu, Y.; Song, Y.; et al. Prevalence of myopia and influencing factors among high school students in Nantong, China: A cross-sectional study. Ophthalmic Res. 2022.
  49. Guo, L.; Yang, J.; Mai, J.; Du, X.; Guo, Y.; Li, P.; Zhang, W.-H. Prevalence and associated factors of myopia among primary and middle school-aged students: A school-based study in Guangzhou. Eye 2016, 30, 796–804.
  50. Atowa, U.C.; Wajuihian, S.O.; Munsamy, A.J. Associations between near work, outdoor activity, parental myopia and myopia among school children in Aba, Nigeria. Int. J. Ophthalmol. 2020, 13, 309–316.
  51. Ko, D.-H.; Elnimeiri, M.; Clark, R.J. Assessment and prediction of daylight performance in high-rise office buildings. Struct. Design Tall Spec. Build. 2008, 17, 953–976.
  52. Guan, Y. Study on Healthy Daytime Lighting in Classrooms in Chongqing; Chongqing University: Chongqing, China, 2017.
  53. Durna, B.; Şahin, A.D. Mapping of daylight illumination levels using global solar radiation data in and around Istanbul, Turkey. Weather 2020, 75, 19–25.
  54. Pan, C.-W.; Wu, R.-K.; Li, J.; Zhong, H. Low prevalence of myopia among school children in rural China. BMC Ophthalmol. 2018, 18, 140.
  55. Wu, X.; Gao, G.; Jin, J.; Hua, W.; Tao, L.; Xu, S.; Tao, F. Housing type and myopia: The mediating role of parental myopia. BMC Ophthalmol. 2016, 16, 151.
  56. Holton, V.; Hinterlong, J.E.; Tsai, C.-Y.; Tsai, J.-C.; Wu, J.S.; Liou, Y.M. A Nationwide Study of Myopia in Taiwanese School Children: Family, Activity, and School-Related Factors. J. Sch. Nurs. 2019, 37, 117–127.
  57. Guo, Y.; Liu, L.J.; Tang, P.; Lv, Y.Y.; Feng, Y.; Xu, L.; Jonas, J.B. Outdoor activity and myopia progression in 4-year follow-up of Chinese primary school children: The Beijing Children Eye Study. PLoS ONE 2017, 12, e0175921.
  58. Read, S.A.; Collins, M.J.; Vincent, S.J. Light Exposure and Physical Activity in Myopic and Emmetropic Children. Optom. Vis. Sci. 2014, 91, 330–341.
  59. Guo, Y.; Liu, L.J.; Xu, L.; Tang, P.; Lv, Y.Y.; Feng, Y.; Jonas, J.B. Myopic Shift and Outdoor Activity among Primary School Children: One-Year Follow-Up Study in Beijing. PLoS ONE 2013, 8, e75260.
  60. Dhakal, R.; Verkicharla, P. Increasing Time in Outdoor Environment Could Counteract the Rising Prevalence of Myopia in Indian School-Going Children. Curr. Sci. 2020, 119, 1616–1619.
  61. Ramamurthy, D.; Chua, S.Y.L.; Saw, S.M. A review of environmental risk factors for myopia during early life, childhood and adolescence. Clin. Exp. Optom. 2015, 98, 497–506.
  62. Rose, K.A.; Morgan, I.G.; Ip, J.; Kifley, A.; Huynh, S.; Smith, W.; Mitchell, P. Outdoor Activity Reduces the Prevalence of Myopia in Children. Ophthalmology 2008, 115, 1279–1285.
  63. Xie, H.L.; Xie, Z.K.; Zhou, F.; Hu, L. Myopia prevalence and influencing factor analysis of primary and middle school students in our country. Zhonghua Yi Xue Za Zhi 2013, 93, 999–1002. (In Chinese)
  64. Liu, X.N.; Naduvilath, T.J.; Wang, J.; Xiong, S.; He, X.; Xu, X.; Sankaridurg, P.R. Sleeping late is a risk factor for myopia development amongst school-aged children in China. Sci. Rep. 2020, 10, 17194.
  65. Lin, Z.; Gao, T.Y.; Vasudevan, B.; Ciuffreda, K.J.; Liang, Y.B.; Jhanji, V.; Wang, N.L. Near work, outdoor activity, and myopia in children in rural China: The Handan offspring myopia study. BMC Ophthalmol. 2017, 17, 203.
  66. Li, S.-M.; Li, S.-Y.; Kang, M.-T.; Zhou, Y.; Liu, L.-R.; Li, H. Near Work Related Parameters and Myopia in Chinese Children: The Anyang Childhood Eye Study. PLoS ONE 2015, 10, e0134514.
  67. Jones, L.A.; Sinnott, L.T.; Mutti, D.O.; Mitchell, G.L.; Moeschberger, M.L.; Zadnik, K. Parental History of Myopia, Sports and Outdoor Activities, and Future Myopia. Investig. Opthalmol. Vis. Sci. 2007, 48, 3524.
  68. Morgan, I.G. Myopia Prevention and Outdoor Light Intensity in a School-based Cluster Randomized Trial. Ophthalmology 2018, 125, 1251–1252.
  69. Ashby, R.S.; Schaeffel, F. The Effect of Bright Light on Lens Compensation in Chicks. Investig. Opthalmol. Vis. Sci. 2010, 51, 5247.
  70. Cohen, Y.; Belkin, M.; Yehezkel, O.; Solomon, A.S.; Polat, U. Dependency between light intensity and refractive development under light-dark cycles. Exp. Eye Res. 2011, 92, 40–46.
  71. Mehdizadeh, M.; Nowroozzadeh, M.H. Outdoor activity and myopia. Ophthalmology 2009, 116, 1229–1230.
  72. Xiao, H.; Cai, H.; Li, X. Non-visual effects of indoor light environment on humans: A review. Physiol. Behav. 2020, 228, 113195.
  73. Ip, J.M.; Saw, S.-M.; Rose, K.A.; Morgan, I.G.; Kifley, A.; Wang, J.J.; Mitchell, P. Role of Near Work in Myopia: Findings in a Sample of Australian School Children. Investig. Opthalmol. Vis. Sci. 2008, 49, 2903.
  74. Zhong, M.; Xu, S.; Sun, C. Prevalence, associates and stage-specific preventive behaviors of myopia among junior high school students in Guangdong province: Health action process approach- and theory of planned behavior-based analysis. Chin. J. Public Health 2022, 38, 33–38.
  75. Saxena, R.; Vashist, P.; Tandon, R.; Pandey, R.M.; Bhardawaj, A.; Menon, V.; Mani, K. Prevalence of Myopia and Its Risk Factors in Urban School Children in Delhi: The North India Myopia Study (NIM Study). PLoS ONE 2015, 10, e0117349.
  76. Cheng, H.-C.; Chang, K.; Shen, E.; Luo, K.-S.; Ying, Y.-H. Risk Factors and Behaviours of Schoolchildren with Myopia in Taiwan. Int. J. Environ. Res. Public Health 2020, 17, 1967.
  77. Ayaki, M.; Torii, H.; Tsubota, K.; Negishi, K. Decreased sleep quality in high myopia children. Sci. Rep. 2016, 6, 33902.
  78. Hua, W.-J.; Jin, J.-X.; Wu, X.-Y.; Yang, J.-W.; Jiang, X.; Gao, G.-P.; Tao, F.-B. Elevated light levels in schools have a protective effect on myopia. Ophthalmic Physiol. Opt. 2015, 35, 252–262.
  79. Zhou, Z.; Morgan, I.G.; Chen, Q.; Jin, L.; He, M.; Congdon, N. Disordered sleep and myopia risk among Chinese children. PLoS ONE 2015, 10, e0121796.
  80. Saw, S.M.; Chan, B.; Seenyen, L.; Yap, M.; Tan, D.; Chew, S.J. Myopia in Singapore kindergarten children. Optometry 2001, 72, 286–291.
  81. Jones-Jordan, L.A.; Mitchell, G.L.; Cotter, S.A.; Kleinstein, R.N.; Manny, R.E.; Mutti, D.O.; Zadnik, K. Visual Activity before and after the Onset of Juvenile Myopia. Investig. Opthalmol. Vis. Sci. 2011, 52, 1841.
  82. Deere, K.; Williams, C.; Leary, S.; Mattocks, C.; Ness, A.; Blair, S.N.; Riddoch, C. Myopia and later physical activity in adolescence: A prospective study. Br. J. Sport. Med. 2009, 43, 542–544.
  83. Wong, T.Y.; Hyman, L. Population-Based Studies in Ophthalmology. Am. J. Ophthalmol. 2008, 146, 656–663.
  84. Wang, J.; Ying, G.; Fu, X.; Zhang, R.; Meng, J.; Gu, F.; Li, J. Prevalence of myopia and vision impairment in school students in Eastern China. BMC Ophthalmol. 2020, 20, 2.
  85. Tarutta, E.P.; Proskurina, O.V.; Tarasova, N.A.; Markosyan, G.A. Analysis of risk factors that cause myopia in pre-school children and primary school students. Health Risk Anal. 2019, 2019, 26–33.
  86. Xie, Z.; Long, Y.; Wang, J.; Li, Q.; Zhang, Q. Prevalence of myopia and associated risk factors among primary students in Chongqing: Multilevel modeling. BMC Ophthalmol. 2020, 20, 146.
  87. Guo, Y.; Duan, J.L.; Liu, L.J.; Sun, Y.; Tang, P.; Lv, Y.Y.; Jonas, J.B. High myopia in Greater Beijing School Children in 2016. PLoS ONE 2017, 12, e0187396.
  88. Terasaki, H.; Yamashita, T.; Yoshihara, N.; Kii, Y.; Sakamoto, T. Association of lifestyle and body structure to ocular axial length in Japanese elementary school children. BMC Ophthalmol. 2017, 17, 123.
  89. Yang, M.; Luensmann, D.; Fonn, D.; Woods, J.; Jones, D.; Gordon, K.; Jones, L. Myopia prevalence in Canadian school children: A pilot study. Eye 2018, 32, 1042–1047.
  90. Lim, D.H.; Han, J.; Chung, T.-Y.; Kang, S.; Yim, H.W. The high prevalence of myopia in Korean children with influence of parental refractive errors: The 2008–2012 Korean National Health and Nutrition Examination Survey. PLoS ONE 2018, 13, e0207690.
  91. Saw, S.M.; Chua, W.H.; Wu, H.M.; Yap, E.; Chia, K.S.; Stone, R.A. Myopia: Gene-environment interaction. Ann. Acad. Med. Singap. 2000, 29, 290–297.
  92. Jee, D.; Morgan, I.G.; Kim, E. Inverse relationship between sleep duration and myopia. Acta Ophthalmol. 2015, 94, e204–e210.
  93. Qu, Y.; Yu, J.; Xia, W.; Cai, H. Correlation of Myopia with Physical Exercise and Sleep Habits among Suburban Adolescents. J. Ophthalmol. 2020, 2020, 1–10.
  94. Lin, Z.; Vasudevan, B.; Fang, S.J.; Jhanji, V.; Mao, G.Y.; Han, W.; Liang, Y.B. Eye exercises of acupoints: Their impact on myopia and visual symptoms in Chinese rural children. BMC Complement. Altern. Med. 2016, 16, 349.
  95. Gessesse, S.A.; Teshome, A.W. Prevalence of myopia among secondary school students in Welkite town: South-Western Ethiopia. BMC Ophthalmol. 2020, 20, 176.
  96. Walline, J.J. Myopia Control: A Review. Eye Contact Lens. 2016, 42, 3–8.
  97. Choy, B.N.K.; You, Q.; Zhu, M.M.; Lai, J.S.M.; Ng, A.L.K.; Wong, I.Y.H. Prevalence and associations of myopia in Hong Kong primary school students. Jpn. J. Ophthalmol. 2020, 64, 437–449.
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