Paper title:近工作活动与儿童近视之间的关联 - 系统的综述和荟萃分析
Authors:Hsiu-Mei Huang (1), Dolly Shuo-Teh Chang (2) Pei-Chang Wu
- Kaohsiung Chang Gung Memorial Hospital和Chang Gung大学医学院Kaohsiung，Kaohsiung，R.O.
- 威尔默眼科研究所,约翰•霍普金斯大学落下帷幕timore, Maryland, U.S.A
Date:Oct 2015
参考：PLoS ONE 10(10): e0140419 [链接到开放访问纸]
Summary
The visual demand of concentrating on close-up tasks such as reading and studying are thought to be a driving force for increased myopia in children.
To better understand this relationship the authors consolidated data from several studies to quantify the effect of near work activities on myopia in children and discover any association there may be between them. They chose studies which concentrated on near activities as a co-variate of the incidence, prevalence or progression of myopia.
这项系统的综述表明，近乎工作的活动与近视有关，并且增加了近工作的“双向小时”可能会增加近视的患病率。
It was found that more time spent on near work activities was associated with higher odds of myopia (OR = 1.14 or an 14% increased chance) and that the odds of myopia increased by 2% for every one dioptre-hour more of near work per week.
The authors suggest that the impact of near work could be cumulative over time and that other factors such as lighting conditions and break times from near work could influence results.
临床相关性
- It is important for eye care practitioners to ask their young patients specific questions about what their near work activities are and how long they spend on each one daily.
- It is important that the patient and parent is encouraged to be truthful and not downplay the time spent on near work - we shouldn’t suggest that near work is bad, more that it is important to fully understand behavior to help us advise appropriate management strategies.
- Some children may be having extra after-school tuition which extends their daily near work time.
- 这项荟萃分析研究表明，近视的几率增加，每小时的近距离工作时间为2％。
- We can encourage more ‘balance’ in children’s lifestyles by considering how much time they spend on schoolwork, reading and studying compared to how much time is spent playing sports and being outdoors.
- Recommendations can be made to limit the hours spent on close tasks and screen time where feasible without impacting schooling, and encourage regular breaks. This will be relevant to all of our young patients, but especially those children who:
- might already be at an increased risk of myopia from having myopic parents
- are susceptible to myopia due to their ethnicity
- are in an age range for potential onset of myopia
Limitations and future research
- 由于结合荟萃分析研究的性质，研究设计和数据收集的差异可能是结果不一致的原因：
- 几项研究对近视的定义有所不同，以及近工作的构成。
- Patient/parent answers to the questions regarding time spent doing near work may not have been accurate or truthful.
- The results from this study reinforce the association between near work activities (such as reading, studying, playing video games, etc) which has been found elsewhere, but it doesn’t show us conclusively how much near work is too much.
- Further research may give us a definite time limit as to how long children should spend concentrating at a given distance each day to either avoid myopic progression, or even avoid onset in the first place.
- When the time that myopes spent reading per week was compared to the time non-myopes spent, it was shown that on average, those who were myopic spent more time reading. However:
- There was no significant difference found associating myopia with other near past-times such as playing video games, watching TV or studying.
- We can’t be sure if the reading had made them myopic, or if they happened to be myopic and like reading more than the other activities.
- The authors of this study suggested that the impact of near work could be cumulative over time and that other factors such as lighting conditions and break times from near work could influence results.
- More longitudinal research is needed to better quantify the risk factor of near work on myopia development over time.
- The authors compared outcomes from this meta-analysis which revealed 2%increasedodds for myopia progression for each hour spent indoors to the results of a meta-analysis conducted by Sherwin et al in 2012¹ that showed 2%减少每小时在户外度过的近视进展的赔率：
- 儿童之间的关系在室内度过的时间与在户外度过的时间需要进一步研究预防近视。
完整的故事
目的
This study aimed to quantify the effect of near work activities on myopia in children. The authors examined the association between time spent on near work activities and the prevalence, incidence and progression of myopia by consolidating cross-sectional and cohort studies.
The estimations were of the association of near work activities with the prevalence, incidence and progression of myopia, using a consolidation of cross-sectional and cohort studies.
学习规划
作者对从Medline，Embase和Cochrane库数据库中选择的27项研究进行了定性综述，其出版日期在1989年至2014年之间。根据包括18岁以下参与者的数据，选择了研究，将其报告为近乎工作的工作covariate with myopic incidence or progression and where participants hadn’t been included in duplicate studies.
这些研究包括15项横断面研究和12项纵向队列研究和25,025名年龄在6至18岁之间的儿童。
使用随机效应模型（或包括少于5个研究的固定效应模型）来汇总数据和优势比（ORS）。由于荟萃分析的研究间变化，还计算出I²统计量以确定变异的比例。在研究中评估了不对称性的漏斗图，这可能是由于出版偏见引起的。
Measurement procedure
荟萃分析中包括的研究向孩子及其父母询问了孩子在近工作上花费的时间。研究之间的定义各不相同，但被认为是在短期工作距离（例如家庭作业或写作，计算机使用或玩视频游戏和看电视等）进行的活动。近视的定义在整个研究中也有所不同。
When attempting to quantify the impact of near work activity on myopia development, some of the authors of the featured studies had calculated a weighted variable by adding 3 times reading, 2 times computer use and 2 times video games use in the hours per day as ‘diopter-hours’.
There were 27 studies (with 25,025 participants) that met the inclusion criteria for the qualitative synthesis: 15 cross-sectional studies and 12 cohort studies. The majority of them (14) were from Asia, with 6 from North America, 3 each from Australia and Europe and 1 from the Middle East.
The studies were split into groups according to the estimate they referred to and a forest plot was applied to show the collective odds ratio:
- 15个横断面研究用于估计近部研究中近距离工作活动与近视率之间的关联。
- 6 cohort studies were used to estimate the association between near work activities and the incidence of myopia in cohort studies.
- 6 longitudinal studies were used to estimate the association between near work activities and myopia progression in prospective studies.
在进一步排除了一些没有优势比或参与者也出现的研究之后，总共有14项研究（10,382名参与者）符合定量荟萃分析的纳入标准：11项横断面研究和3项队列研究。
There were two further sub-group analysed:
- One collated the data from 6 studies which reported an association with near work and myopic prevalence
- The other sub-group comprised 5 studies which had reported an association between myopic prevalence and near work in terms of per dioptre-hour per week. The collective increased odds suggested that myopia increased by 2% for every one dioptre-hour of close work.
结果
的总结时间ne的差异ar work activities between myopes and non-myopes showed that myopic children spent an average of 0.66 hours more per week reading compared to a non-myopic child. Other activities such as watching television or playing computer games did not have the same association with myopia.
近乎工作活动与近视的患病率之间的关联
横截面研究显示了一个合并的odds ratio of 1.14%with 9 of the 11 studies indicating that more near work could increase the prevalence of myopia in children aged between 6 and 18yrs old. There was some heterogeneity with these results which may have been from near work having different definitions across the studies. The funnel plot was asymmetrical which can be indicative of a small study error or publication bias.
近工作活动与近视发生率之间的关联
From the six cohort studies, two showed that more near work activities increased the risk of developing myopia, however, four of the studies did not find a significant association.
Three of the cohort studies appeared to show that the chance of developing myopia did not increase with extra dioptre-hours spent on near work activities. These 3 studies had also shown similar outcome measures in assessing myopia development.
Estimation of association between near work activities and myopia progression
从包括在内的六项前瞻性研究中，两项研究表明，近距离工作是近视发展的危险因素，但有四个没有发现显着的关系。
The two sub-group analyses revealed that for the studies which had reported an association between near work and myopic prevalence, the pooled odds ratio was 1.85. This suggests that those children who did more near work were more likely to be myopic. The second sub-group reported on the association with myopia and dioptre-hours per week. The collective increased odds suggested that myopia increased by 2% for every one dioptre-hour of close work.
Conclusions
如果长时间或过度的近工作是近视发病率和进展的原因，那么孩子每周在近距离工作上花费的“二极管小时”的数量应受到限制，并且与在户外度过的时间保持平衡。
Eye care practitioners would value having clear guidance as to how much near work is too much, but as the rate of myopic progression will vary for each child it may not be possible to have a blanket cut-off point which applies to all.
从这项荟萃分析中收集的信息可以帮助眼部护理从业人员评估单个孩子近工作活动的强度，并确定对他们的过度，尤其是关于对他们可能拥有的任何近视的倾向。
Abstract
我的opia has a multifactorial etiology, although environmental factors are predominant in determining its current patterns. Currently, associations between near work activities and myopia have not been consistently observed. Therefore, we performed a systematic review to quantify the effect of near work activities on myopia in children. Relevant articles published between 1989 and 2014 were identified in MEDLINE, Embase, and the Cochrane Library, and the citation lists were reviewed. Twelve cohort studies and 15 cross-sectional studies were included (25,025 children aged between 6 and 18 years). TheI2statistic was used to assess heterogeneity. Study-level data were pooled using a random-effects model or a fixed-effects model (when less than 5 studies were included). We found that more time spent on near work activities was associated with higher odds of myopia (odds ratio [OR] = 1.14; 95% confidence interval [CI] = 1.08–1.20) and that the odds of myopia increased by 2% (OR:1.02; 95% CI = 1.01–1.03) for every one diopter-hour (hr) more of near work per week. Therefore, the development of a strategy to reduce the impact of near work on myopia would be important for preventing myopia in children.
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关于Ailsa
Ailsa Lane is a contact lens optician based in Kent, England. She is currently completing her Advanced Diploma In Contact Lens Practice with Honours, which has ignited her interest and skills in understanding scientific research and finding its translations to clinical practice.
References
- Sherwin JC, Reacher MH, Keogh RH, Khawaja AP, Mackey DA, Foster PJ. The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis.Ophthalmol.2012;119（10）：2141-51。
