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Risk factors for myopia among children and adolescents: an umbrella review of published meta-analyses and systematic reviews
  1. Zhi-Qi Ying1,
  2. Dan-Lin Li1,
  3. Xin-Yu Zheng1,
  4. Xiao-Feng Zhang2,
  5. Chen-Wei Pan1
  1. 1 School of Public Health, Medical College of Soochow University, Suzhou, China
  2. 2 Department of Ophthalmology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
  1. Correspondence to Dr Chen-Wei Pan, School of Public Health, Medical College of Soochow University, Suzhou 215123, China; pcwonly{at}


Aims To identify potential risk factors for myopia in children and adolescents and assess the credibility of each evidence, providing reference for the development of myopia prevention strategies.

Methods We searched PubMed, Web of Science and Embase databases from inception to April 2022 to find systematic reviews or meta-analyses investigating the relationship between potential risk factors and myopia, and conducted an umbrella review. We recalculated the pooled effect sizes and 95% CIs of each potential risk factor through random-effects model, and reported its 95% prediction interval and between-study heterogeneity. Small-study effect and excess of significance bias were assessed to reveal potential publication bias.

Results Twelve publications were included in this umbrella review, including eight meta-analyses and four qualitative systematic reviews. Twenty-two factors were identified, of which 16 were analysed quantitatively. Ten factors showed statistically significant association with myopia. Myopia in one or two parents and per additional hour of time spend outdoors per week were rated as highly suggestive evidence. Near work and gender were evaluated as suggestive evidence. The other five factors are weak evidence.

Conclusions We found several risk factors for myopia with different levels of evidence, of which parental myopia presented the strongest association with myopia in children and adolescents. Our findings contribute to a better understanding of the association between potential risk factors and myopia among children and adolescents and are important for informing parenting, education, clinical practice guidelines and public health policy.


  • Epidemiology
  • Public health

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Z-QY and D-LL contributed equally.

  • Contributors Z-QY and X-YZ conducted the search, selection, data extraction and quality assessment of relevant literature. Z-QY and D-LL contributed to the statistical analysis. Z-QY and D-LL wrote the manuscript. C-WP and X-FZ designed the study and revised the manuscript. C-WP is the guarantor.

  • Funding This study was supported by the National Natural Science Foundation of China (82122059).

  • 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.