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Interventions recommended for myopia prevention and control among children and adolescents in China: a systematic review
  1. Zhuoting Zhu1,
  2. Yanxian Chen1,
  3. Zachary Tan2,
  4. Ruilin Xiong1,
  5. Myra Beth McGuinness2,3,
  6. Andreas Müller4
  1. 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  2. 2 Centre for Eye Research Australia, East Melbourne, Victoria, Australia
  3. 3 Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Andreas Müller, Department of Noncommunicable Diseases, World Health Organization, 1211 Geneve, Switzerland; muellera{at}


In 2018, a consortium of government bodies in China led by the Ministry of Education released the Comprehensive Plan to Prevent Nearsightedness among Children and Teenagers (CPPNCT), aiming to reduce the incidence of myopia and control myopic progression in China. Recommendations span from home-based to school-based interventions, including time outdoors, physical activity, light exposure, near-work activity, screen time, Chinese eye exercises, diet and sleep. To date, the levels of evidence for this suite of interventions have not been thoroughly investigated. This review has summarised the evidence of the interventions recommended by the CPPNCT in myopia prevention and control. Thus, the following statements are supposed by the evidence: (1) Increasing time outdoors and reducing near-work time are effective in lowering incident myopia in school-aged children. (2) All interventions have a limited effect on myopia progression. Ongoing research may lead to a better understanding of the underlying mechanisms of myopia development, the interaction of different interventions and recommendations, confounding variables and their true effect on myopia prevention, and the identification of those most likely to respond to specific interventions. This field may also benefit from longer-term studies of the various interventions or strategies covered within this review article, to better understand the persistence of treatment effects over time and explore more novel approaches to myopia control.

  • epidemiology

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  • Contributors Study concept and design: ZZ, AM. Acquisition, analysis or interpretation: ZZ, YC, AM. Drafting of the manuscript: ZZ, YC. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: ZZ, YC. Administrative, technical or material support: AM. Study supervision: AM.

  • Funding The present work was supported by the Fundamental Research Funds of the State Key Laboratory of Ophthalmology.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.