BACKGROUND Due to high prevalence myopia has gained importance in epidemiological studies. Children with early onset are at particular risk of complications associated with myopia, as progression over time might result in high myopia and myopic macular degeneration. Both genetic and environmental factors play a role in the increasing prevalence of myopia. The aim of this study is to review the current literature on epidemiology and risk factors for myopia in school children (aged 6-19 years) around the world. MAIN BODY PubMed and Medline were searched for the following keywords: prevalence, incidence, myopia, refractive error, risk factors, children and visual impairment. English language articles published between Jan 2013 and Mar 2019 were included in the study. Studies were critically reviewed for study methodology and robustness of data. Eighty studies were included in this literature review. Myopia prevalence remains higher in Asia (60%) compared with Europe (40%) using cycloplegic refraction examinations. Studies reporting on non-cycloplegic measurements show exceptionally high myopia prevalence rates in school children in East Asia (73%), and high rates in North America (42%). Low prevalence under 10% was described in African and South American children. In recent studies, risk factors for myopia in schoolchildren included low outdoor time and near work, dim light exposure, the use of LED lamps for homework, low sleeping hours, reading distance less than 25 cm and living in an urban environment. CONCLUSION Low levels of outdoor activity and near work are well-established risk factors for myopia; this review provides evidence on additional environmental risk factors. New epidemiological studies should be carried out on implementation of public health strategies to tackle and avoid myopia. As the myopia prevalence rates in non-cycloplegic studies are overestimated, we recommend considering only cycloplegic measurements.

中文翻译：

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全球学龄儿童近视流行病学综述。

背景由于高流行率，近视在流行病学研究中变得越来越重要。早发儿童特别容易出现与近视相关的并发症，因为随着时间的推移可能会导致高度近视和近视黄斑变性。遗传和环境因素都在近视患病率的增加中起作用。本研究的目的是回顾当前关于世界各地学龄儿童（6-19 岁）近视流行病学和危险因素的文献。主体 PubMed 和 Medline 搜索了以下关键词：患病率、发病率、近视、屈光不正、危险因素、儿童和视力障碍。该研究纳入了 2013 年 1 月至 2019 年 3 月期间发表的英语文章。对研究的研究方法和数据的稳健性进行了严格审查。该文献综述包括八十项研究。与使用散瞳验光检查的欧洲 (40%) 相比，亚洲 (60%) 的近视患病率仍然较高。关于非散瞳测量的研究报告显示，东亚学童近视患病率异常高（73%），北美高近视患病率（42%）。非洲和南美儿童的患病率低于 10%。在最近的研究中，学童近视的危险因素包括户外时间短和工作时间短、光线昏暗、使用 LED 灯做作业、睡眠时间短、阅读距离小于 25 厘米以及生活在城市环境中。结论 低水平的户外活动和近距离工作是公认的近视危险因素；该审查提供了有关其他环境风险因素的证据。应就实施应对和避免近视的公共卫生战略开展新的流行病学研究。由于非散瞳研究中的近视患病率被高估，我们建议仅考虑散瞳测量。