Shi-Ming Li1, An-Ran Ran1,2, Meng-Tian Kang1, Xiaoyuan Yang3, Ming-Yang Ren4,5, Shi-Fei Wei1, Jia-He Gan1, Lei Li6, Xi He1, He Li6, Luo-Ru Liu6, Yipeng Wang6, Si-Yan Zhan7, David A Atchison8, Ian Morgan9, Ningli Wang1. 1. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China. 2. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China. 3. Department of Ophthalmology, Henan Provincial People's Hospital, Zhengzhou, China. 4. School of Mathematical Sciences, Chinese Academy of Sciences, Beijing, China. 5. Key Laboratory of Big Data Mining and Knowledge Management, Chinese Academy of Sciences, Beijing, China. 6. Anyang Eye Hospital, Anyang, China. 7. Department of Epidemiology and Health Statistics, School of Public Health, Peking University, Beijing, China. 8. Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia. 9. Research School of Biology, Australian National University, Canberra, Australia.
Abstract
Importance: Myopia in school-aged children is a public health issue worldwide; consequently, effective interventions to prevent onset and progression are required. Objective: To investigate whether SMS text messages to parents increase light exposure and time outdoors in school-aged children and provide effective myopia control. Design, Setting, and Participants: This randomized clinical trial was conducted in China from May 2017 to May 2018, with participants observed for 3 years. Of 528 965 primary school-aged children from Anyang, 3113 were randomly selected. Of these, 268 grade 2 schoolchildren were selected and randomly assigned to SMS and control groups. Data were analyzed from June to December 2021. Interventions: Parents of children in the SMS group were sent text messages twice daily for 1 year to take their children outdoors. All children wore portable light meters to record light exposure on 3 randomly selected days (2 weekdays and 1 weekend day) before and after the intervention. Main Outcomes and Measures: The co-primary outcomes were change in axial length (axial elongation) and change in spherical equivalent refraction (myopic shift) from baseline as measured at the end of the intervention and 3 years later. A secondary outcome was myopia prevalence. Results: Of 268 grade 2 schoolchildren, 121 (45.1%) were girls, and the mean (SD) age was 8.4 (0.3) years. Compared with the control group, the SMS intervention group demonstrated greater light exposure and higher time outdoors during weekends, and the intervention had significant effect on axial elongation (coefficient, 0.09; 95% CI, 0.02-0.17; P = .01). Axial elongation was lower in the SMS group than in the control group during the intervention (0.27 mm [95% CI, 0.24-0.30] vs 0.31 mm [95% CI, 0.29-0.34]; P = .03) and at year 2 (0.39 mm [95% CI, 0.35-0.42] vs 0.46 mm [95% CI, 0.42-0.50]; P = .009) and year 3 (0.30 mm [95% CI, 0.27-0.33] vs 0.35 mm [95% CI, 0.33-0.37]; P = .005) after the intervention. Myopic shift was lower in the SMS group than in the control group at year 2 (-0.69 diopters [D] [95% CI, -0.78 to -0.60] vs -0.82 D [95% CI, -0.91 to -0.73]; P = .04) and year 3 (-0.47 D [95% CI, -0.54 to -0.39] vs -0.60 D [95% CI, -0.67 to -0.53]; P = .01) after the intervention, as was myopia prevalence (year 2: 38.3% [51 of 133] vs 51.1% [68 of 133]; year 3: 46.6% [62 of 133] vs 65.4% [87 of 133]). Conclusions and Relevance: In this randomized clinical trial, SMS text messages to parents resulted in lower axial elongation and myopia progression in schoolchildren over 3 years, possibly through increased outdoor time and light exposure, showing promise for reducing myopia prevalence. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOC-17010525.
Importance: Myopia in school-aged children is a public health issue worldwide; consequently, effective interventions to prevent onset and progression are required. Objective: To investigate whether SMS text messages to parents increase light exposure and time outdoors in school-aged children and provide effective myopia control. Design, Setting, and Participants: This randomized clinical trial was conducted in China from May 2017 to May 2018, with participants observed for 3 years. Of 528 965 primary school-aged children from Anyang, 3113 were randomly selected. Of these, 268 grade 2 schoolchildren were selected and randomly assigned to SMS and control groups. Data were analyzed from June to December 2021. Interventions: Parents of children in the SMS group were sent text messages twice daily for 1 year to take their children outdoors. All children wore portable light meters to record light exposure on 3 randomly selected days (2 weekdays and 1 weekend day) before and after the intervention. Main Outcomes and Measures: The co-primary outcomes were change in axial length (axial elongation) and change in spherical equivalent refraction (myopic shift) from baseline as measured at the end of the intervention and 3 years later. A secondary outcome was myopia prevalence. Results: Of 268 grade 2 schoolchildren, 121 (45.1%) were girls, and the mean (SD) age was 8.4 (0.3) years. Compared with the control group, the SMS intervention group demonstrated greater light exposure and higher time outdoors during weekends, and the intervention had significant effect on axial elongation (coefficient, 0.09; 95% CI, 0.02-0.17; P = .01). Axial elongation was lower in the SMS group than in the control group during the intervention (0.27 mm [95% CI, 0.24-0.30] vs 0.31 mm [95% CI, 0.29-0.34]; P = .03) and at year 2 (0.39 mm [95% CI, 0.35-0.42] vs 0.46 mm [95% CI, 0.42-0.50]; P = .009) and year 3 (0.30 mm [95% CI, 0.27-0.33] vs 0.35 mm [95% CI, 0.33-0.37]; P = .005) after the intervention. Myopic shift was lower in the SMS group than in the control group at year 2 (-0.69 diopters [D] [95% CI, -0.78 to -0.60] vs -0.82 D [95% CI, -0.91 to -0.73]; P = .04) and year 3 (-0.47 D [95% CI, -0.54 to -0.39] vs -0.60 D [95% CI, -0.67 to -0.53]; P = .01) after the intervention, as was myopia prevalence (year 2: 38.3% [51 of 133] vs 51.1% [68 of 133]; year 3: 46.6% [62 of 133] vs 65.4% [87 of 133]). Conclusions and Relevance: In this randomized clinical trial, SMS text messages to parents resulted in lower axial elongation and myopia progression in schoolchildren over 3 years, possibly through increased outdoor time and light exposure, showing promise for reducing myopia prevalence. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOC-17010525.
Authors: Seang-Mei Saw; Anoop Shankar; Say-Beng Tan; Hugh Taylor; Donald T H Tan; Richard A Stone; Tien-Yin Wong Journal: Invest Ophthalmol Vis Sci Date: 2006-05 Impact factor: 4.799
Authors: Caixia Lin; Shi-Ming Li; Kyoko Ohno-Matsui; Bing Song Wang; Yu Xin Fang; Kai Cao; Li Qin Gao; Jie Hao; Ye Zhang; Jian Wu; Ning Li Wang Journal: Ophthalmic Physiol Opt Date: 2018-05 Impact factor: 3.117