| Objective:To evaluate the effect of integrated people-centred eye care on the prevention and control of myopia in children and adolescents in China.Furthermore,to compare the effects of integrated people-centred eye care in myopia prevention and control among children and adolescents of different age groups,sex,and initial myopia levels.Methods:This study is a retrospective cohort study.From October 2018 to March 2022,380 children and adolescents aged 3-17 who received integrated people-centred eye care at He Eye Specialist Hospital(hereinafter referred to as the intervention group)were included in the study,and 1520 children and adolescents who did not participate in integrated people-centred eye care in the same time period(hereinafter referred to as the control group)were matched at a ratio of 1:4 according to their baseline characteristics including age,sex,initial spherical equivalent(SE)diopter(D)and correction type.All the participants were followed up for one year.Only right eyes were included in analysis.The difference of one-year equivalent SE diopter change and whether the myopia aggravates in two groups of children and adolescents were compared retrospectively.The normality test was performed on the continuous variable data.The measurement data that did not conform to the normal distribution were expressed as the median(quartile)[median(Q1,Q3)],and the non-parametric rank sum test(Mann-Whitney U test)was used for comparative analysis.Measurement data that conformed to the normal distribution were expressed as mean standard deviation(mean±SD).Independent sample t-test was used for comparative analysis of normal variance homogeneity,and Welch ttest was used for comparative analysis of normal variance heterogeneity.Categorical data were presented as frequency(percentage)[N(%)] using Pearson chi-square test analysis.Single-factor linear regression was used to analyze whether the four variables including participants in the integrated people-centred eye care,sex,age,and initial SE diopter were associated with the changes of equivalent spherical diopter change.The differences-indifferences(DID)was used to analyze the prevention and control effect of integrated people-centered eye care on myopia under the condition of eliminating the influence of two groups of primary differences.Multiple linear regression was used to analyze whether there was interaction between age,sex,initial SE diopter and participation in integrated people-centred eye care,and the variables with interaction were further used to correct the interaction using hierarchical analysis.Multivariate logistic regression was used to analyze the relationship between integrated people-centered eye care,sex,age,initial SE diopter and myopia severity,and the factors of single-factor logistic regression analysis results P<0.2 were included in the multivariate logistic regression model to analyze the influence of integrated people-centred eye care on myopia severity.Results:A total of 1900(380 eyes in the intervention group and 1520 eyes in the control group)right eyes of children and adolescents aged 3-17 years old were included in the study,including 380 eyes in the intervention group and 1520 eyes in the control group.There was no statistical difference between the two groups in baseline data(P>0.05).The average age of participants in the intervention group was 9.45±2.52 years old,and the average initial SE diopter was-1.50D(-2.25 D,-0.44D),among which 51.32% were male students.The percentages of early myopia and mild myopia in the intervention group were 25.00% and 73.68%,respectively,and the average observation interval was349.61±41.52 days.In the control group,the average age of admission was 9.51±2.16 years old,and the average initial SE diopter power was-1.63D(-2.50 D,-0.50D),among which 47.50% were male students.The percentages of early myopia and mild myopia in the admission group were 23.16% and 75.79%,respectively.The average observation interval was 353.47±34.79 days.In the two groups,those who were not wearing glasses or wearing framed glasses in the admission group were 41.58% and 58.16%,respectively.The one-year change in equivalent spherical lens power of the control group [-0.75D(-0.25 D,-1.12D)],and that of the intervention group [-0.50D(0D,-0.75D)],in one year,showed that the SE power of the intervention group decreased less than that of the control group by-0.25D(P<0.01).The results of differences-in-differences analysis show that comprehensive eye care based on people can significantly slow down the decline of equivalent spherical lens power of children and adolescents(DID=0.25,P<0.05).Age and sex had no effect on the protection of integrated people-centred eye care(interaction P>0.05);There was an interaction between the initial SE diopter and participation in integrated people-centred eye care(P=0.03).According to the stratification analysis of the initial myopia degree,the initial myopia degree was pre-myopia(-0.50D<SE≤+0.75D),and the participation in integrated people-centred eye care decreased less than that in the control group by-0.50D(P<0.01)in one year.The initial myopic degree was low myopia(-6.00D<SE≤-0.50D),and the one-year decrease in SE degree participating in integrated people-centred eye care was less than that in the control group by-0.25D(P<0.01),and the one-year change in SE degree when the initial myopic degree was high myopia(SE≤-6.00D)showed no significant difference between the two groups(P>0.05).Multivariate logistic regression analysis showed that participation in integrated people-centred eye care was an independent protective factor.When the age and initial SE diopter were fixed,the risk of aggravated myopia in the intervention group was 57% lower than that in the control group(OR=0.43,P<0.01).Conclusion:Integrated people-centred eye care,as a new model of eye health care,can effectively delay the progression of myopia in children and adolescents,and reduce the risk of increasing the degree of myopia.Furthermore,earlier intervention was found to be better for preventing and controlling myopia. |
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