Preschool is the key period of children's visual function development, which is called the "critical period of visual development plasticity". Any abnormal stimulus during this period can have an adverse impact on children's vision. Ametropia is the main cause of poor vision in preschool children. There are many reasons for ametropia. This paper reviews the influencing factors of ametropia in preschool children in recent years, which are classified into three aspects: demographic factors, physiological factors, and lifestyle factors

Zhang, Xinyue

English

Advanced Emergency Medicine (E-Journal)

Volume 11 | Issue 3 - 233 -Research Progress on Influencing Factors of Refractive Error inPreschool ChildrenXinyue ZhangHuzhou College, Huzhou 313000, China.Abstract: Preschool is the key period of children's visual function development, which is called the "critical period of visualdevelopment plasticity". Any abnormal stimulus during this period can have an adverse impact on children's vision.Ametropia is the main cause of poor vision in preschool children. There are many reasons for ametropia. This paper reviewsthe influencing factors of ametropia in preschool children in recent years, which are classified into three aspects:demographic factors, physiological factors, and lifestyle factors.Keywords: Influencing Factors; Ametropia; Preschool Children1. Definition and research status of ametropiaAmetropia refers to that the parallel light cannot accurately focus on the retina of the fundus to result in a blurred imageafter the refraction of the refractive system of the eye. If the light is focused in front of the retina, it‘s myopia; When the lightis focused behind the retina, it’s hyperopia; Light cannot converge into focus, which is astigmatism; All three will lead toblurred vision.In recent years, with the wide use of electronic products and bad eye habits, more and more preschool children withametropia have been detected. The National Health Commission released the survey results of myopia among children andadolescents in 2018. The results showed that the overall myopia rate among adolescents was 53.6% in 2018. Therefore, it isnecessary to carry out myopia screening, correction and health guidance for children and adolescents in China from thepre-school stage.2. Influencing factors of refractive errors in preschool children2.1 Demographic factors2.1.1 AgeThe detection rate of refractive abnormalities in children is related to age distribution. According to the visual acuityscreening of 3352 infants aged 6 months to 3 years, Chen L.S. [1] found that before the age of 3, the abnormal rate graduallydecreased with the increase of age (P<0.01). Zhang G.Y. [2] 's survey of 4~7 years old children found that with the increase ofage, the incidence rate of hyperopia decreased, and the incidence rate of myopia increased.2.1.2 GanderThe differences in the investigation and statistics of refractive errors of children of different genders are not uniform.According to Gao H.Q. [3]’s research, the abnormal rate of total anisometropia in girls (2.3%) was higher than that in boys(1.9%). However, some studies [4] show that refractive errors of preschool children have nothing to do with gender, whichmay be related to regional differences and too few research samples.2.1.3 RaceAdvanced Emergency Medicine- 234 -Research [5] shows that in the United States, there are differences in the myopia rate of children of different descent. Thehighest myopia rate is 18.5% for Asians, while only 4.4% and 6.6% for whites and black Americans. It points out that this isjointly affected by genetic and environmental factors. This may be due to related to the fact that Asian children are undermore study pressure and the differences in educational methods between Asia and some western countries.2.1.4 Regional distributionThe detection rate of ametropia in children is unevenly distributed in various regions, and the difference between urbanand rural areas is obvious. The results of study [6] show that the detection rate of refractive errors in urban children is higherthan that in rural children. There are significant differences in the prevalence of myopia between urban and rural children,and they all show an upward trend. This may be related to the gap between urban and rural economic income levels, heavystudy tasks for urban children, more exposure to electronic products, more rural population, but less testing.2.2 Physiological factors2.2.1 Genetic factorsParental myopia is a risk factor for ametropia in preschool children. At present, the genetic patterns of abnormal visionin clinic are mainly divided into autosomal inheritance and X-chromosome inheritance. Autosomal inheritance has nothing todo with gender, and the prevalence of children is 50%. In X-chromosome inheritance, the prevalence of women and theprobability of carrying disease genes are higher than that of men. Zhang G.Y. [2] study showed that the incidence rate ofabnormal vision in all age groups was significantly higher than that in family history without myopia and relatedophthalmopathy (x²= 48.08, P<0.001), which is consistent with the results of Long Qi [7].2.2.2 Perinatal factorsPreterm birth, low-birth-weight infants, history of fetal protection treatment during pregnancy, history of asphyxia andoxygen inhalation in children, and history of smoking in mother's pregnancy are the influencing factors of children'sametropia. According to the screening of 7886 ametropic children in Haiyan County by Zhou Y.L. [8], children with a historyof preterm birth and low birth weight have a high rate of refractive abnormalities. Some studies believe that it is due to theimprovement of the current technical level, the survival rate of some low-birth-weight infants and preterm infants has alsoincreased, the incidence of retinopathy in preterm infants is higher, and the blindness rate is significantly higher than that offull-term infants. The investigation results of Fan T, Shi H.Q. [9] and others showed that the infection of Toxoplasma gondii,rubella virus and other microorganisms during pregnancy and adverse drugs in patients with a history of pregnancy fetalprotection treatment would lead to a higher rate of visual impairment during pregnancy than those without that, and thedifference was significant. The research of Zhang G.Y. [2] shows that the rate of low visual acuity of those with intrapartumasphyxia is higher than those without asphyxia, and the difference is significant. Therefore, avoiding intrapartum asphyxiacan reduce the ultraviolet radiation in neonatal warm box phototherapy and reduce the occurrence of fundus lesions. At thesame time, At the same time, a study [8] found that the proportion of abnormal refraction of babies born to pregnant womenwith smoking and alcohol history was higher than that of normal children (P<0.05). Therefore, it is very important to preventametropia in children and carry out health care and physical examination during pregnancy.2.3 Lifestyle factors2.3.1 Activity factorsOutdoor activities, bad eye habits, use of electronic products and participation in after-school interest classes are theinfluencing factors of children's ametropia. Bad eye habits, including long-time eye use, not paying attention to active rest,too close eye use, etc., lead to excessive or harmful eye use, which will lead to abnormal vision of children. Tang M.H. [10]'sVolume 11 | Issue 3 - 235 -research shows that outdoor exercise is a protective factor for ametropia because appropriate outdoor activities are conduciveto reducing the synthesis of melatonin in the retina and increasing the content of dopamine. Long Qi [7] showed that manykinds or long time of bad eye use are independent factors affecting children's abnormal vision. Xie J.Y.'s research shows thatchildren who participate in after-school interest classes are more likely to have abnormal vision. This result may be related tothe fact that children who participate in after-school interest classes spend too much time with their eyes and do not payattention to maintaining good eye habits.2.3.2 Disease factorsSome disease factors may also lead to abnormal vision, which may be caused by the transmission of some pathogens tothe eyes. For example, Jia Wei [4] found that allergic rhinitis is an independent risk factor for ametropia in children. Allergicrhinitis can lead to long-term eyes without rest and visual development disorders.2.3.3 Dietary factorsChildren's picky eating and chewing will affect children's nutritional status, resulting in abnormal vision. Xie J.Y. [11]found that children with picky eating habits will lead to abnormal vision (x²= 6.398, P<0.05). Picky eating habits will lead tothe lack of some trace elements (such as selenium, zinc, chromium, and other elements closely related to the incidence ofmyopia), and damage the structure of eye fundus tissue, thus affecting vision. Picky eating habits may also lead to children'slight weight. Zhang G.Y. [2] found that the abnormal visual acuity rate of children in the group with weight lower than twostandard deviations was higher than that in the group with normal weight (X²= 7.70，P<0.05). Zhou M.Y. [12] showed thatregular eating of green vegetables (OR=0.122) and hard food (OR=0.357) are the protective factors of children's refractiveerror.2.3.4 Sleep factorsChildren have enough sleep time is the protective factor of ametropia. Fan T [9] found that sleep time (≥8 hours) is aprotective factor for children's vision. Less sleep time can affect people's overall mental state and physical constitution, whichis associated with myopia.2.3.5 Family environmental factorsFamily environmental factors include physical environmental factors such as family lighting environment, socialenvironmental factors such as parents' educational level and income level, parents' cognitive behavior of children's visionprotection, etc. Some studies have pointed out that led lamps at home are more likely to cause myopia in children thanincandescent lamps or fluorescent lamps. The reason is related to the continuous flashing light of LED lamps. Experimentshave proved that the continuous flashing light can induce the binding of 5-HT and 5-HT2A receptor, resulting in progressivemyopia in guinea pigs. Zhang G.Y.'s research shows that the children of fathers with higher education have a higher rate ofnormal vision. This may be related to the fact that parents with higher educational level pay more attention to their children'svision protection and can scientifically arrange their children's learning and activity time. Zhou Y.L.'s survey showed that theproportion of children with refractive abnormalities in low-income families was higher than that in other families (P < 0.05).This is contrary to the results of Xu LAN [13]. The reason may be that parents with higher education have high demands onchildren's study, which increases the length of children's eye use, and children in high-income families may use moreelectronic products.ConclusionPreschool children are the key period of visual development, in which demographic factors, physiological factors andlifestyle factors have important influence on children's visual development. Therefore, it is of great significance to strengthenthe visual screening of preschool children, publicize the knowledge of perinatal prevention and health care and the basicAdvanced Emergency Medicine- 236 -health knowledge of correct eye use, to improve the adverse environment and take active outdoor activities, these are of greatsignificance in restoring the visual development of preschool children.References[1] Chen, LS., Analysis of the results of vision screening for 3352 infants aged 6 months to 3 years [J]. China Health Industry,2019, 16(26): 188-189. DOI: 10.16659/j.cnki.1672-5654.2019 .26.188.[2] Zhang, GY., Analysis of factors affecting visual development of preschool children [J]. China Journal of Child Health,2005(02):174-176.[3] Gao, HQ., Wang, Y., You, JH., Zhu, H., Analysis of the refractive status of preschool children in Suzhou High-tech Zone[J]. Chinese School Health, 2022, 43(01): 133-136. DOI: 10.16835/j. cnki.1000-9817.2022.01. 030.[4] Jia, W., He, Z., Gui, MR., Xiao, LJ., Analysis of the results of the survey on the refractive status of preschool children inBao'an District, Shenzhen for 3 consecutive years [J]. Chinese and Foreign Medicine, 2021, 40(07): 41-43+ 53. DOI:10.16662/j.cnki.1674-0742.2021.07.041.[5] Kleinstein Robert N, Jones Lisa A, Hullett Sandral, Kwon Soonsi, Lee Robert J, Friedman Nina E, Manny Ruth E, MuttiDonald O, Yu Julie A, Zadnik Karla. Refractive error and ethnicity in children. [J]. Archives of ophthalmology (Chicago, Ill.:1960),2003,121(8).[6] Tian, F., Zou, ZX., Ying, L., Zhao, Q., Zhou, SR., Research progress on the incidence and influencing factors of myopiain left-behind children [J]. Sichuan Medicine, 2021, 42(12): 1276-1280. DOI: 10.16252/j .cnki. issn1004-0501-2021.12.020.[7] Long, Q., Tang, XR., Wu, JJ., Tian, M., Zhang, JM., Investigation and analysis of myopia status and its influencingfactors in preschool children [J]. Nursing Practice and Research, 2022, 19(03): 355-358.[8] Zhou, YL., Yang, WH., Shen, XF., Analysis of refractive abnormalities in preschool children and its influencing factors[J]. China Maternal and Child Health, 2015, 30 (17): 2759-2762.[9] Shi, HQ., Wang, J., Hu, XY., Wang, HB., Chen, JJ., Analysis of the current situation and influencing factors of refractivedevelopment of preschool children in urban areas of Shanghai [J]. China Journal of Child Health, 2017, 25(08): 809 -812.[10] Tang, MH., Zhao, GM., Jiang, YG., Zhu, H., Li, YM., Chen, NE., He, YP., Yao, CX., Analysis of the current situationand influencing factors of vision health among 2036 children and adolescents in Songjiang District, Shanghai [J]. ChinaJournal of Child Health, 2022, 30(03):319-324.[11] Xie, JY., Yan, XQ., Zeng, J., Zhou, J., Liu, QJ., Analysis of 20327 cases of 6-year-old children's vision screening resultsand related factors [J]. China Primary Health Care, 2020, 34(08): 60-62.[12] Zhou, MY., Mo, BQ., Yan, Y., Analysis of living environment factors for children with refractive errors in Chuzhou City[J]. Practical Preventive Medicine, 2018, 25(12): 1445-1447.[13] Xu, L., Xue, LL., Analysis of the current situation and influencing factors of visual acuity among 12 972 preschoolchildren in Minhang District, Shanghai [J]. China Primary Health Care, 2021, 35(04): 74-76.

Research Progress on Influencing Factors of Refractive Error in Preschool Children

https://aem.usp-pl.com/index.php/aem/article/download/296/276

Research Progress on Influencing Factors of Refractive Error in Preschool Children

Abstract

Similar works

Full text

Available Versions

Advanced Emergency Medicine (E-Journal)