Association Between Refractive Status and Ocular Biometric Parameters Among Children and Adolescents — 10 PLADs, China, 2020–2024

Ruoyi Gao^1,2; Huijuan Luo²; Yaqing Meng³; Liru Wang⁴; Suyun Li⁵; Bingjie Sun²; Xin Guo^1,6,#

1. School of Public Health, Capital Medical University, Beijing, China;

2. Beijing Center for Disease Prevention and Control, Beijing, China;

3. Shanxi Provincial Center for Disease Control and Prevention, Taiyuan City, Shanxi Province, China;

4. Henan Provincial Center for Disease Control and Prevention, Zhengzhou City, Henan Province, China;

5. Shandong Provincial Center for Disease Control and Prevention, Jinan City, Shandong Province, China;

6. Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Xin Guo, guoxin@chinacdc.cn.

This study examined the refractive status of 60,270 children and adolescents aged 5–18 years across ten provincial-level administrative divisions (PLADs) and municipalities nationwide using cycloplegic optometry between November 2020 and July 2024. We analyzed differences in spherical equivalent refraction (SER), axial length (AL), corneal radius (CR), and axial length-to-corneal radius ratio (AL/CR) among students of different school stages and genders. The study evaluated relationships among AL, AL/CR, and SER across age groups Correlation analysis revealed that AL/CR demonstrated stronger associations with SER (R=-0.750, P<0.001) compared to AL alone (R=-0.657, P<0.001). The study assessed the predictive capacity of AL and AL/CR for determining refractive status in children and adolescents, with the objective of establishing a foundation for early warning systems and myopia management strategies.

儿童青少年屈光度与眼部生物学参数的关联 — 10省份，中国，2020–2024

高若伊^1,2；罗慧娟²；孟亚清³；王丽茹⁴；李素云⁵；孙冰洁²；郭欣^1,6,#

1.首都医科大学公共卫生学院，北京市，中国；

2.北京市疾病预防控制中心，北京市，中国；

3.山西省疾病预防控制中心，太原市，山西省，中国；

4.河南省疾病预防控制中心，郑州市，河南省，中国；

5.山东省疾病预防控制中心，济南市，山东省，中国；

6.中国疾病预防控制中心，北京市，中国。

^# 通讯作者：郭欣，guoxin@chinacdc.cn。

本研究于2020年11月至2024年7月期间，采用睫状肌麻痹验光的方式对中国10个省份60,270位5至18岁儿童青少年的屈光度进行调查。分析不同学段、性别学生等效球镜度数、眼轴长度、角膜曲率半径、轴率比的差异。评估不同年龄组的眼轴长度（AL）、眼轴长度与角膜半径比（AL/CR）和球面等效屈光度（SER）之间的关系，相关性分析显示，相较于单独使用AL指标（R=-0.657，P<0.001），AL/CR与SER的关联性更强（R=-0.750，P<0.001）。并采用AL和AL/CR预测儿童青少年的屈光状况，以期为早期预警和近视管理提供依据。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.214

Current Status of Hyperopic Reserve Among Children and Adolescents — 10 PLADs, China, 2020–2024

Huijuan Luo¹; Ruoyi Gao^1,2; Ting Li¹; Ming Wu³; Yabin Qu⁴; Yaqing Meng⁵; Bingjie Sun¹; Ran Qin¹; Xin Guo^2,6,#

1. Beijing Center for Disease Prevention and Control, Beijing, China

2. School of Public Health, Capital Medical University, Beijing, China

3. Liaoning Provincial Center for Disease Control and Prevention, Shenyang City, Liaoning Province, China

4. Guangdong Provincial Center for Disease Control and Prevention, Guangzhou City, Guangdong Province, China

5. Shanxi Provincial Center for Disease Control and Prevention, Taiyuan City, Shanxi Province, China

6. Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Xin Guo, guoxin@chinacdc.cn.

To investigate the distribution characteristics of hyperopic reserve across 10 provincial-level administrative divisions (PLADs) in China and characterize the levels and developmental patterns of spherical equivalent after cycloplegic refraction in children and adolescents aged 5–18 years by sex, the National Disease Control and Prevention Administration of China conducted a comprehensive cross-sectional study between 2020 and 2024. The study included 61,076 students from kindergarten through high school across 10 PLADs in China. Median (Q1, Q3) values were used to describe spherical equivalent (SE), and the Mann–Whitney U test was employed to compare SE between males and females within the same age group. Results demonstrated that median SE decreased progressively with age among all participants, with females showing a steeper decline than males. The median SE for males reached ≤ -0.5 D starting at age 12, while females reached this threshold at age 11. Among non-myopic participants, both sexes exhibited a consistent pattern of declining median SE from ages 5–12, followed by stable fluctuations from ages 13–18. However, the magnitude of both decline and fluctuations was greater in females than in males. Hyperopic reserve among Chinese children and adolescents aged 5–18 years is substantially insufficient, with myopia onset occurring at increasingly younger ages, particularly among females approaching puberty and younger children overall. Myopia prevention and control initiatives must be implemented earlier, with systematic monitoring of hyperopic reserve to prevent premature depletion.

儿童青少年远视储备现状 — 10省份，中国，2020–2024年

罗慧娟¹；高若伊^1,2；李婷¹；吴明³；曲亚斌⁴；孟亚清⁵；孙冰洁¹；秦冉¹；郭欣^2,6,#

1. 北京市疾病预防控制中心，北京市，中国；

2. 公共卫生学院，首都医科大学，北京市，中国；

3. 辽宁省疾病预防控制中心，沈阳市，辽宁省，中国；

4. 广东省疾病预防控制中心，广州市，广东省，中国；

5. 山西省疾病预防控制中心，太原市，山西省，中国；

6. 中国疾病预防控制中心，北京市，中国。

^# 通信作者：郭欣，guoxin@chinacdc.cn。

为调查我国10省（市）儿童青少年远视储备分布特征，掌握5–18岁不同性别儿童青少年散瞳验光后等效球镜度数的水平及变化规律，国家疾控局2020–2024年期间在全国10省（市）开展了一项全面调查，共纳入61,076名幼儿园至高中阶段学生。本研究采用M（Q1，Q3）描述不同性别、年龄等效球镜度数情况，采用 Mann-Whitney U 检验比较同一年龄组内不同性别等效球镜度数的差异。结果显示，等效球镜度数中位数随着年龄的增长而下降，女生下降速度比男生更快，男女生等效球镜度数中位数分别从12岁和11岁开始≤-0.5 D。在非近视者中，男女生等效球镜度数中位数都在5–12岁随着年龄的增长逐渐下降，但在13–18岁时，等效球镜度数中位数都呈现稳定波动的总体趋势，但女生的下降幅度和波动幅度都大于男生。我国5–18岁儿童青少年远视储备严重不足，且近视发病年龄呈低龄化趋势，即将进入青春期的女孩和低龄儿童的情况尤为突出。近视防控工作必须尽早开展，及时监测远视储备，并防止其过早消耗。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.215

Regional Heterogeneity in Screen Time and Usage Habits Associated with Insufficient Hyperopic Reserve in Schoolchildren — 9 PLADs, China, 2020–2024

Yuwei Zhang^1,&;  Huijuan Luo^2,&;  Shuaixing Song¹;  Ran Qin²;  Yanhua Chen³;  Ming Wu⁴; Liru Wang⁵;  Ciyong Lu^1,#;  Xin Guo^6,7,#

1. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou City, Guangdong Province, China;

2. Beijing Center for Disease Prevention and Control, Beijing, China;

3. Hunan Provincial Center for Disease Control and Prevention, Changsha City, Hunan Province, China;

4. Liaoning Provincial Center for Disease Control and Prevention, Shenyang City, Liaoning Province, China;

5. Henan Provincial Center for Disease Control and Prevention, Zhengzhou City, Henan Province, China;

6. Chinese Center for Disease Control and Prevention, Beijing, China;

7. School of Public Health, Capital Medical University, Beijing, China.

& Joint first authors.

^# Corresponding author: Xin Guo, guoxin@chinacdc.cn; Ciyong Lu, luciyong@mail.sysu.edu.cn.

This study investigated regional variations in the association between screen use and insufficient hyperopic reserve among Chinese schoolchildren aged 6 to 12 years, providing evidence for region-specific myopia prevention strategies. Data from 28,993 children across 9 provincial-level administrative divisions (PLADs) were analyzed. The overall prevalence of insufficient hyperopic reserve was 49.0%. Both prolonged screen time [odds ratio (OR)=1.21, 95% confidence interval 95% (CI): 1.14, 1.29] and poor screen use habits (OR=1.19, 95% CI: 1.12, 1.27) were significantly associated with increased risk. Notably, children from regions with lower gross domestic product (GDP) demonstrated higher susceptibility, particularly girls. These findings emphasize the importance of developing tailored myopia prevention strategies that account for regional socioeconomic differences.

学龄儿童屏幕使用时间和使用习惯与远视储备不足之间关系的地区差异性 — 中国9省份，2020–2024年

张雨薇^1,&；罗慧娟^2,&；宋帅星¹；秦冉²；陈艳华³；吴明⁴；王丽茹⁵；卢次勇^1,#；郭欣^6,7,#

1. 流行病与卫生统计学系，公共卫生学院，中山大学，广州市，广东省，中国;

2. 北京市疾病预防控制中心，北京，中国;

3. 湖南省疾病预防控制中心，长沙市，湖南省，中国;

4. 辽宁省疾病预防控制中心，沈阳市，辽宁省，中国;

5. 河南省疾病预防控制中心，郑州市，河南省，中国;

6. 中国疾病预防控制中心，北京，中国;

7. 公共卫生学院，首都医科大学，北京，中国。

& 共同第一作者

^# 通讯作者: 郭欣，guoxin@chinacdc.cn；卢次勇，luciyong@mail.sysu.edu.cn。

本研究旨在探究中国6至12岁学龄儿童屏幕使用与远视储备不足之间关系的地区差异性，为制定针对不同地区的近视预防策略提供依据。通过对来自九个省的28,993名儿童数据进行分析，发现远视储备不足总体检出率为49.0%。长时间屏幕使用 (OR=1.21, 95% CI: 1.14, 1.29) 和不良屏幕使用习惯（OR=1.19, 95% CI: 1.12, 1.27）均与风险增加显著相关。值得注意的是，低GDP地区儿童，尤其是女孩，表现出更高的风险。这些结果突出表明，有必要根据地区社会经济差异制定有针对性的近视预防措施。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.216

Predicting Cycloplegic Spherical Equivalent Refraction Among Children and Adolescents Using Non-cycloplegic Data and Machine Learning — China, 2020–2024

Keke Liu^1,2,&;  Ran Qin^2,&;  Huijuan Luo²;  Huining Kuang^1,2;  Ranbo E^1,2;  Chenyu Zhang^1,2;  Bingjie Sun²;  Xin Guo^1,3,#

1. School of Public Health, Capital Medical University, Beijing, China;

2. Beijing Center for Disease Control and Prevention, Beijing, China;

3. Chinese Center for Disease Control and Prevention, Beijing, China.

& Joint first authors.

# Corresponding author: Xin Guo, guoxin@chinacdc.cn.

Cycloplegic refraction is the gold standard for assessing refractive error in children. However, logistical constraints hinder its implementation in large-scale surveys. Data obtained from a nationwide ocular health survey conducted in ten provincial-level administrative divisions in China were analyzed (2020–2024). Participants aged 5–18 years underwent standardized non-cycloplegic and cycloplegic autorefraction, axial length (AL), corneal radius (CR), and AL/CR measurements. Random forest and XGBoost models were trained to predict the cycloplegic spherical equivalent (SE) using non-cycloplegic SE, uncorrected visual acuity (UCVA), and biometric parameters. Performance was evaluated using R², root mean square error (RMSE), and Bland–Altman analysis. Both models exhibited a strong predictive performance. In the test set, random forest achieved R²⁼0.88 and RMSE=0.55D, whereas XGBoost achieved R²⁼0.89 and RMSE=0.54D. Non-cycloplegic SE, AL/CR ratio, AL, and UCVA were consistently the top predictors. The predicted SE exhibited strong agreement with the cycloplegic SE, with minimal residual bias. Machine learning models incorporating noncycloplegic SE and ocular biometrics accurately estimate cycloplegic SE in children and adolescents, providing a practical alternative for large-scale refractive-error surveillance when cycloplegia is impractical.

使用睫状肌麻痹数据和机器学习预测儿童和青少年的散瞳等效球镜屈光度 — 中国，2020–2024年

刘珂珂^1,2,&；秦冉^2,&；罗慧娟²，邝惠宁^1,2；鄂博然^1,2；张辰宇^1,2；孙冰洁²；郭欣^1,3,#

1. 公共卫生学院，首都医科大学，北京，中国；

2. 北京市疾病预防控制中心，北京，中国；

3. 中国疾病预防控制中心，北京，中国。

^& 共同第一作者

^# 通讯作者: 郭欣，guoxin@chinacdc.cn。

睫状肌麻痹验光是评估儿童屈光不正的金标准；然而，由于实施上的限制，其在大规模流行病学调查中难以广泛应用。 本研究基于2020–2024年中国10个省级行政区开展的全国性眼健康调查数据，纳入5–18岁参与者。所有受试者均接受标准化的非睫状肌麻痹自动验光、睫状肌麻痹自动验光、眼轴长度（AL）、角膜曲率半径（CR）及AL/CR比值测量。采用随机森林和XGBoost模型，基于非睫状肌麻痹球镜当量（SE）、裸眼视力（UCVA）及生物测量参数，预测睫状肌麻痹SE。模型性能通过R²、均方根误差（RMSE）及Bland–Altman分析进行评估。两种模型均表现出较强的预测性能。在测试集中，随机森林的R²=0.88，RMSE=0.55 D；XGBoost的R²=0.89，RMSE=0.54 D。非睫状肌麻痹SE、AL/CR比值、AL和UCVA 始终是重要性最高的预测变量。预测SE与睫状肌麻痹SE具有高度一致性，且残留偏差极小。结合非睫状肌麻痹SE和眼部生物力学参数的机器学习模型，可准确估计儿童和青少年的睫状肌麻痹SE，为在无法实施睫状肌麻痹的大规模屈光不正筛查提供了一种实用的替代方案。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.217