Association between Chinese eye exercises and myopia onset in children and adolescents: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Chongchao ^1,2 ,  LING Ling ³ , ZHOU Wentian ³

1. The Affiliated Eye Hospital, Nanjing Medical University, Nanjing 210029, P. R. China;
2. The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing 210029, P. R. China;
3. Affiliated Eye Hospital of Nanchang University, Nanchang 330006, P. R. China;

Corresponding author：

LING Ling, Email: 404581662@qq.com

Keywords：

Eye exercises; Myopia; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.202205121

Video：

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Objective To systematically review the association between Chinese eye exercises and myopia onset in children and adolescents to provide a theoretical basis for clinical prevention of myopia. Methods The PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP, WanFang Data and CBM databases were searched from inception to March 2022 to collect observational studies about the association between Chinese eye exercises and myopia onset in children and adolescents. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 28 studies were included, including 217 112 subjects. The results of meta-analysis showed that doing eye exercises, doing eye exercises ≥2 times per day, doing eye exercises regularly or consistently, doing eye exercises seriously and doing eye exercises correctly and normatively were the protective factors of myopia onset in children and adolescents. Conclusion Current evidence shows that doing eye exercises, doing eye exercises ≥2 times per day, doing eye exercises regularly or consistently, doing eye exercises seriously, doing eye exercises correctly and normatively can prevent myopia onset in children and adolescents. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： YANG Chongchao, LING Ling, ZHOU Wentian. Association between Chinese eye exercises and myopia onset in children and adolescents: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(1): 59-66. doi: 10.7507/1672-2531.202205121 Copy

1.	Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet, 2012, 379(9827): 1739-1748.
2.	Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology, 2016, 123(5): 1036-1042.
3.	Chua SY, Sabanayagam C, Cheung YB, et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt, 2016, 36(4): 388-394.
4.	Dirani M, Chan YH, Gazzard G, et al. Prevalence of refractive error in Singaporean Chinese children: the strabismus, amblyopia, and refractive error in young Singaporean Children (STARS) study. Invest Ophthalmol Vis Sci, 2010, 51(3): 1348-1355.
5.	Morgan IG, French AN, Ashby RS, et al. The epidemics of myopia: aetiology and prevention. Prog Retin Eye Res, 2018, 62: 134-149.
6.	Ikuno Y. Overview of the complications of high myopia. Retina, 2017, 37(12): 2347-2351.
7.	Flitcroft DI, He M, Jonas JB, et al. IMI - defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci, 2019, 60(3): M20-M30.
8.	Wong TY, Ferreira A, Hughes R, et al. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review. Am J Ophthalmol, 2014, 157(1): 9-25.
9.	Foo LL, Lanca C, Wong CW, et al. Cost of myopia correction: a systematic review. Front Med (Lausanne), 2021, 8: 718724.
10.	宋亮. 眼保健操: 是是非非50年. 教育, 2012, (31): 19-20.
11.	陈嘉荣, 卢阳佳, 黄泳, 等. 针灸治疗近视取穴规律文献研究. 中医杂志, 2011, 52(16): 1413-1416.
12.	雷建明. 眼保健操前后彩色多普勒观察眼球血流动力学改变. 中国超声诊断杂志, 2004, 5(6): 446-447.
13.	李美红, 陈方红, 朱丽民. 理视健眼操对眼动脉血流影响的观察. 眼科新进展, 1999, 19(4): 238-239.
14.	边红霞, 边梦婷, 郭宓, 等. 包头市小学生近视现况调查及相关因素分析. 国际眼科杂志, 2021, 21(10): 1834-1838.
15.	史浩楠. 2012年与2019年乌鲁木齐市中小学生近视患病率对比及影响因素分析. 乌鲁木齐: 新疆医科大学, 2021.
16.	杜燕, 白宁艳, 徐浩, 等. 贵州省兴义市农村和城市儿童青少年近视状况及相关因素分析. 中华眼视光学与视觉科学杂志, 2021, 23(3): 205-210.
17.	付齐齐, 李炳辉, 吴洁, 等. 2019年青岛市中小学生近视现状及其影响因素分析. 预防医学论坛, 2021, 27(8): 564-568, 571.
18.	高青, 刘懿卿, 叶茜雯, 等. 辽宁省学生近视情况及其影响因素. 中华疾病控制杂志, 2021, 25(2): 222-226.
19.	梁文静. 罗定市中小学学生近视现状及影响因素分析. 基层医学论坛, 2021, 25(7): 1017-1019.
20.	韦秀清, 陈希龙, 邹竹芳. 江西省武宁县中小学生近视现状调查及其影响因素分析. 山西医药杂志, 2021, 50(11): 1806-1809.
21.	尹乐, 展天寅, 王文菁, 等. 内蒙古自治区赤峰市青少年近视现状及影响因素. 国际眼科杂志, 2021, 21(6): 1112-1119.
22.	王绍华, 王卓凡, 张镇权, 等. 2018年北京市延庆区儿童青少年近视影响因素分析. 首都公共卫生, 2021, 15(3): 143-146.
23.	樊爱平, 赵爱华, 陆华, 等. 泰安市儿童青少年近视流行现状及影响因素. 中国校医, 2021, 35(12): 881-884, 887.
24.	谌丁艳, 李晓恒, 周丽, 等. 深圳市中小学生近视影响因素分析. 中国学校卫生, 2020, 41(4): 583-587.
25.	张娟娟, 赵吉飞, 刘小毛, 等. 咸阳市小学生近视现况调查与影响因素分析. 实用预防医学, 2020, 27(11): 1387-1390.
26.	Liang YB, Vasudevan B, Lin Z, et al. The effect of eye exercises of acupoints on myopia progression: a 3-year cohort report from the Beijing myopia progression study. Risk Manag Healthc Policy, 2020, 13: 2793-2799.
27.	杨义, 张文芳, 李玉婷, 等. 甘肃省城乡中小学生近视及影响因素的流行病学调查. 中华眼视光学与视觉科学杂志, 2019, 21(5): 327-333.
28.	Du DD, Xu WL, Yang LH, et al. A risk score system for myopia symptom warning. Curr Med Sci, 2019, 39(3): 455-462.
29.	杨倩, 龚潇, 林惠军, 等. 成都市龙泉驿区高三学生近视的流行病学特征. 眼科学报, 2018, 33(3): 154-160.
30.	张金红, 张文芳, 杨义, 等. 武威市中小学生近视现况及相关因素分析. 中国斜视与小儿眼科杂志, 2018, 26(1): 8-10, 4.
31.	杜丹丹. 武汉市视力健康管理学校中小学生视力发展状况及影响因素分析. 武汉: 华中科技大学, 2017.
32.	陈思铧. 用眼习惯因素对邯郸市区小学生近视状况影响的调查研究. 保定: 河北大学, 2016.
33.	Lin Z, Vasudevan B, Fang SJ, et al. Eye exercises of acupoints: their impact on myopia and visual symptoms in Chinese rural children. BMC Complement Altern Med, 2016, 16(1): 349.
34.	Kang MT, Li SM, Peng X, et al. Chinese eye exercises and myopia development in school age children: a nested case-control study. Sci Rep, 2016, 6: 28531.
35.	You X, Wang L, Tan H, et al. Near work related behaviors associated with myopic shifts among primary school students in the Jiading district of Shanghai: a school-based one-year cohort study. PLoS One, 2016, 11(5): e0154671.
36.	顾长美. 武汉市中小学生近视发生风险模型研究. 武汉: 华中科技大学, 2014.
37.	潘旭斌, 余宏刚, 贺福虎. 新疆阿合奇县柯尔克孜族中小学生2013年屈光状态的研究. 中国妇幼保健, 2014, 29(7): 1079-1082.
38.	周然, 张文芳, 杨义, 等. 兰州市城区小学生近视现况及相关因素分析. 国际眼科杂志, 2014, 14(5): 903-907.
39.	吴含春, 付玲玲. 克拉玛依市不同民族中小学生近视眼危险因素分析. 国际眼科杂志, 2014, 14(7): 1298-1302.
40.	韩霞, 苗海玲, 黄丹. 青海省高海拔藏族地区初中生近视率的调查研究. 国际眼科杂志, 2014, 14(5): 913-915.
41.	Lin Z, Vasudevan B, Jhanji V, et al. Eye exercises of acupoints: their impact on refractive error and visual symptoms in Chinese urban children. BMC Complement Altern Med, 2013, 13: 306.
42.	Dong L, Kang YK, Li Y, et al. Prevalence and time trends of myopia in children and adolescents in China: a systematic review and meta-analysis. Retina, 2020, 40(3): 399-411.
43.	Li SM, Ji YZ, Wu SS, et al. Multifocal versus single vision lenses intervention to slow progression of myopia in school-age children: a meta-analysis. Surv Ophthalmol, 2011, 56(5): 451-460.
44.	Li SM, Kang MT, Wu SS, et al. Efficacy, safety and acceptability of orthokeratology on slowing axial elongation in myopic children by meta-analysis. Curr Eye Res, 2016, 41(5): 600-608.
45.	Li SM, Wu SS, Kang MT, et al. Atropine slows myopia progression more in Asian than white children by meta-analysis. Optom Vis Sci, 2014, 91(3): 342-350.
46.	Zhu Z, Chen Y, Tan Z, et al. Interventions recommended for myopia prevention and control among children and adolescents in China: a systematic review. Br J Ophthalmol, 2021. DOI: 10.1136/bjophthalmol-2021-319306.
47.	Lu Z, Ouyang M, Zhang R, et al. Association between Chinese eye exercises and onset of myopia: a meta-analysis. Int J Clin Exp Med, 2010, 12(5): 4580-4588.
48.	教育部, 国家卫生健康委员会, 国家体育总局, 等. 综合防控儿童青少年近视实施方案. 中国学校卫生, 2018, 39(9): 1279-1280.
49.	田飞飞, 刘丽娟, 郭寅, 等. 眼保健操对初中学生眼轴增长的影响. 中华流行病学杂志, 2021, 42(9): 1621-1627.
50.	郝志红, 郭慧红, 马兴爱, 等. 中小学生眼放松行为现状及其对视力的影响. 中国学校卫生, 2015, 36(9): 1310-1312.
51.	傅雯. 规范眼保健操对学龄儿童近视防控效果的观察. 南宁: 广西中医药大学, 2021.
52.	Gwiazda J, Thorn F, Held R. Accommodation, accommodative convergence, and response AC/A ratios before and at the onset of myopia in children. Optom Vis Sci, 2005, 82(4): 273-278.
53.	Li SM, Kang MT, Peng XX, et al. Efficacy of Chinese eye exercises on reducing accommodative lag in school-aged children: a randomized controlled trial. PLoS One, 2015, 10(3): e0117552.
54.	熊日强, 刘青. 学生眼保健操操作不规范情况调查. 中国学校卫生, 2001, 22(6): 566.
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57.	徐贤得, 方青剑, 陈靓, 等. 学生眼保健操在实际操作中的有效性与合理性探究. 科技资讯, 2020, 18(14): 187-188.

1. Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet, 2012, 379(9827): 1739-1748.
2. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology, 2016, 123(5): 1036-1042.
3. Chua SY, Sabanayagam C, Cheung YB, et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt, 2016, 36(4): 388-394.
4. Dirani M, Chan YH, Gazzard G, et al. Prevalence of refractive error in Singaporean Chinese children: the strabismus, amblyopia, and refractive error in young Singaporean Children (STARS) study. Invest Ophthalmol Vis Sci, 2010, 51(3): 1348-1355.
5. Morgan IG, French AN, Ashby RS, et al. The epidemics of myopia: aetiology and prevention. Prog Retin Eye Res, 2018, 62: 134-149.
6. Ikuno Y. Overview of the complications of high myopia. Retina, 2017, 37(12): 2347-2351.
7. Flitcroft DI, He M, Jonas JB, et al. IMI - defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci, 2019, 60(3): M20-M30.
8. Wong TY, Ferreira A, Hughes R, et al. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review. Am J Ophthalmol, 2014, 157(1): 9-25.
9. Foo LL, Lanca C, Wong CW, et al. Cost of myopia correction: a systematic review. Front Med (Lausanne), 2021, 8: 718724.
10. 宋亮. 眼保健操: 是是非非50年. 教育, 2012, (31): 19-20.
11. 陈嘉荣, 卢阳佳, 黄泳, 等. 针灸治疗近视取穴规律文献研究. 中医杂志, 2011, 52(16): 1413-1416.
12. 雷建明. 眼保健操前后彩色多普勒观察眼球血流动力学改变. 中国超声诊断杂志, 2004, 5(6): 446-447.
13. 李美红, 陈方红, 朱丽民. 理视健眼操对眼动脉血流影响的观察. 眼科新进展, 1999, 19(4): 238-239.
14. 边红霞, 边梦婷, 郭宓, 等. 包头市小学生近视现况调查及相关因素分析. 国际眼科杂志, 2021, 21(10): 1834-1838.
15. 史浩楠. 2012年与2019年乌鲁木齐市中小学生近视患病率对比及影响因素分析. 乌鲁木齐: 新疆医科大学, 2021.
16. 杜燕, 白宁艳, 徐浩, 等. 贵州省兴义市农村和城市儿童青少年近视状况及相关因素分析. 中华眼视光学与视觉科学杂志, 2021, 23(3): 205-210.
17. 付齐齐, 李炳辉, 吴洁, 等. 2019年青岛市中小学生近视现状及其影响因素分析. 预防医学论坛, 2021, 27(8): 564-568, 571.
18. 高青, 刘懿卿, 叶茜雯, 等. 辽宁省学生近视情况及其影响因素. 中华疾病控制杂志, 2021, 25(2): 222-226.
19. 梁文静. 罗定市中小学学生近视现状及影响因素分析. 基层医学论坛, 2021, 25(7): 1017-1019.
20. 韦秀清, 陈希龙, 邹竹芳. 江西省武宁县中小学生近视现状调查及其影响因素分析. 山西医药杂志, 2021, 50(11): 1806-1809.
21. 尹乐, 展天寅, 王文菁, 等. 内蒙古自治区赤峰市青少年近视现状及影响因素. 国际眼科杂志, 2021, 21(6): 1112-1119.
22. 王绍华, 王卓凡, 张镇权, 等. 2018年北京市延庆区儿童青少年近视影响因素分析. 首都公共卫生, 2021, 15(3): 143-146.
23. 樊爱平, 赵爱华, 陆华, 等. 泰安市儿童青少年近视流行现状及影响因素. 中国校医, 2021, 35(12): 881-884, 887.
24. 谌丁艳, 李晓恒, 周丽, 等. 深圳市中小学生近视影响因素分析. 中国学校卫生, 2020, 41(4): 583-587.
25. 张娟娟, 赵吉飞, 刘小毛, 等. 咸阳市小学生近视现况调查与影响因素分析. 实用预防医学, 2020, 27(11): 1387-1390.
26. Liang YB, Vasudevan B, Lin Z, et al. The effect of eye exercises of acupoints on myopia progression: a 3-year cohort report from the Beijing myopia progression study. Risk Manag Healthc Policy, 2020, 13: 2793-2799.
27. 杨义, 张文芳, 李玉婷, 等. 甘肃省城乡中小学生近视及影响因素的流行病学调查. 中华眼视光学与视觉科学杂志, 2019, 21(5): 327-333.
28. Du DD, Xu WL, Yang LH, et al. A risk score system for myopia symptom warning. Curr Med Sci, 2019, 39(3): 455-462.
29. 杨倩, 龚潇, 林惠军, 等. 成都市龙泉驿区高三学生近视的流行病学特征. 眼科学报, 2018, 33(3): 154-160.
30. 张金红, 张文芳, 杨义, 等. 武威市中小学生近视现况及相关因素分析. 中国斜视与小儿眼科杂志, 2018, 26(1): 8-10, 4.
31. 杜丹丹. 武汉市视力健康管理学校中小学生视力发展状况及影响因素分析. 武汉: 华中科技大学, 2017.
32. 陈思铧. 用眼习惯因素对邯郸市区小学生近视状况影响的调查研究. 保定: 河北大学, 2016.
33. Lin Z, Vasudevan B, Fang SJ, et al. Eye exercises of acupoints: their impact on myopia and visual symptoms in Chinese rural children. BMC Complement Altern Med, 2016, 16(1): 349.
34. Kang MT, Li SM, Peng X, et al. Chinese eye exercises and myopia development in school age children: a nested case-control study. Sci Rep, 2016, 6: 28531.
35. You X, Wang L, Tan H, et al. Near work related behaviors associated with myopic shifts among primary school students in the Jiading district of Shanghai: a school-based one-year cohort study. PLoS One, 2016, 11(5): e0154671.
36. 顾长美. 武汉市中小学生近视发生风险模型研究. 武汉: 华中科技大学, 2014.
37. 潘旭斌, 余宏刚, 贺福虎. 新疆阿合奇县柯尔克孜族中小学生2013年屈光状态的研究. 中国妇幼保健, 2014, 29(7): 1079-1082.
38. 周然, 张文芳, 杨义, 等. 兰州市城区小学生近视现况及相关因素分析. 国际眼科杂志, 2014, 14(5): 903-907.
39. 吴含春, 付玲玲. 克拉玛依市不同民族中小学生近视眼危险因素分析. 国际眼科杂志, 2014, 14(7): 1298-1302.
40. 韩霞, 苗海玲, 黄丹. 青海省高海拔藏族地区初中生近视率的调查研究. 国际眼科杂志, 2014, 14(5): 913-915.
41. Lin Z, Vasudevan B, Jhanji V, et al. Eye exercises of acupoints: their impact on refractive error and visual symptoms in Chinese urban children. BMC Complement Altern Med, 2013, 13: 306.
42. Dong L, Kang YK, Li Y, et al. Prevalence and time trends of myopia in children and adolescents in China: a systematic review and meta-analysis. Retina, 2020, 40(3): 399-411.
43. Li SM, Ji YZ, Wu SS, et al. Multifocal versus single vision lenses intervention to slow progression of myopia in school-age children: a meta-analysis. Surv Ophthalmol, 2011, 56(5): 451-460.
44. Li SM, Kang MT, Wu SS, et al. Efficacy, safety and acceptability of orthokeratology on slowing axial elongation in myopic children by meta-analysis. Curr Eye Res, 2016, 41(5): 600-608.
45. Li SM, Wu SS, Kang MT, et al. Atropine slows myopia progression more in Asian than white children by meta-analysis. Optom Vis Sci, 2014, 91(3): 342-350.
46. Zhu Z, Chen Y, Tan Z, et al. Interventions recommended for myopia prevention and control among children and adolescents in China: a systematic review. Br J Ophthalmol, 2021. DOI: 10.1136/bjophthalmol-2021-319306.
47. Lu Z, Ouyang M, Zhang R, et al. Association between Chinese eye exercises and onset of myopia: a meta-analysis. Int J Clin Exp Med, 2010, 12(5): 4580-4588.
48. 教育部, 国家卫生健康委员会, 国家体育总局, 等. 综合防控儿童青少年近视实施方案. 中国学校卫生, 2018, 39(9): 1279-1280.
49. 田飞飞, 刘丽娟, 郭寅, 等. 眼保健操对初中学生眼轴增长的影响. 中华流行病学杂志, 2021, 42(9): 1621-1627.
50. 郝志红, 郭慧红, 马兴爱, 等. 中小学生眼放松行为现状及其对视力的影响. 中国学校卫生, 2015, 36(9): 1310-1312.
51. 傅雯. 规范眼保健操对学龄儿童近视防控效果的观察. 南宁: 广西中医药大学, 2021.
52. Gwiazda J, Thorn F, Held R. Accommodation, accommodative convergence, and response AC/A ratios before and at the onset of myopia in children. Optom Vis Sci, 2005, 82(4): 273-278.
53. Li SM, Kang MT, Peng XX, et al. Efficacy of Chinese eye exercises on reducing accommodative lag in school-aged children: a randomized controlled trial. PLoS One, 2015, 10(3): e0117552.
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Association between Chinese eye exercises and myopia onset in children and adolescents: a meta-analysis

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