June 6 this year is the 28th National "Eye Day", the theme of the event is "Focus on universal eye health", ophthalmologists recommend focusing on children and adolescents and other key groups -
Adolescent myopia, how to prevent and treat?
Wang Yanbo is currently in the third grade at a primary school in Kunming, Yunnan Province. Every six months, father Wang Yu will take his child to the hospital for a vision examination. "The last time I went for an examination, the doctor reminded that the child's farsightedness reserve was close to the critical value, which should be paid attention to, but I did not expect that the child's vision really declined." Wang Yu said.
At the ophthalmology clinic of Beijing Children's Hospital, although it is not yet summer, the examination room is already full of children. Most of them wore glasses, the oldest was 15 years old and the youngest was 6 years old.
In the interview, the reporter found that there are more and more adolescents with myopia, and the overall characteristics of "small, high, and deep" - the age is getting younger and younger, the incidence is getting higher and higher, and the degree is getting deeper and deeper. According to a survey by the National Health Commission, the overall myopia rate of children and adolescents in mainland China is 52.7%, of which 14.3% are 6-year-old children, 35.6% are primary school students, 71.1% are junior high school students, and 80.5% are high school students.
Adolescents have a high incidence of myopia, how to step on the "brakes"? It has become a question that the whole society must answer well.
The pressure on the eyes is increasing
Yang Junning, a fourth-grade student at a primary school in Beijing's Xicheng District, was found to be myopic two years ago, and now it is 300 degrees.
"I woke up in the morning and did a page of exercises before going to school, and I was still silently writing words at night when I went to sleep. Too much use of the eyes, too little play, where can the child's eyes rest? Junning's father, Mr. Yang, sighed with emotion. But her mother, Ms. Feng, was unimpressed: "How many students are not myopic? Now that the technology is so mature, it is not enough to have an operation after the college entrance examination. ”
Indeed, students who have not yet been myopic after the baptism of the college entrance examination are a minority.
"Compared with the world's major economies, the rate of myopia among children and adolescents in mainland China is at a high level, and the situation of myopia prevention and control is grim." According to Qu Jia, director of the State Key Laboratory of Optometry and Vision Science, there are four main reasons for the high rate of myopia among children and adolescents in mainland China. First, students' high learning pressure leads to greater eye intensity; Second, outdoor activities and physical exercise time are not enough, and the sunshine is insufficient, which is easy to cause the development of myopia; Third, excessive use of electronic products; Fourth, some parents do not pay enough attention to the correction and control of their children's vision, especially the harm of high myopia.
"There are many harms of myopia, and if not controlled, the incidence of many complications such as cataract and glaucoma will increase, especially after developing high myopia, it is easy to lead to myopic macular degeneration, retinal detachment, etc., and in severe cases, blindness." Qu Jia particularly reminded, "Myopia laser surgery reduces or eliminates the degree of myopia by cutting the cornea, but the changes or lesions of the retina and vitreous caused by myopia still exist, and the risk of various lesions that may occur with high myopia will not be reduced." ”
Many teachers and parents have reported that after the "double reduction", many primary and secondary schools have launched childcare services, but during this extended school time, most of the students are also doing homework, or are tutored by teachers of different subjects on the spot.
"It's equivalent to students staying in the classroom longer. School used to end at 5 p.m., but now it has become 5:40, and at 6:20 p.m., I start studying late again, and I am very nervous about dinner. Ms. Peng, a third-grade Chinese teacher in a middle school in Chongqing, told reporters, "Although there are fewer extracurricular classes now, the students' time in school has become longer, and the pressure on the eyes has actually increased." ”
So, in rural areas where the pressure of learning is not so great, what about children's myopia?
Ni Hailong, director of the Optometry Center of the Second Affiliated Hospital of Zhejiang University, told reporters that over the years, he has repeatedly traveled to remote areas such as Yunnan's Hani Yi Autonomous Prefecture to do science popularization, and according to what he saw, the myopia of rural children is also worrying.
"Many children in remote areas are left-behind children, their parents are not around for many years, the elderly lack scientific eye knowledge, their use of mobile phones and other electronic products is not restricted, and there is no guarantee of regular vision checks." Ni Hailong suggested that more popular science publicity should be made to promote myopia prevention and control knowledge to rural and underdeveloped areas. "On the one hand, the growth rate of myopia is higher than that in cities, and on the other hand, the rate of dispensing glasses does not exceed 30%, and rural children have early onset, rapid progression, and poor intervention, which requires families, schools and society to jointly respond."
With healthy eyes, these habits can not be less
"The aviation class must first have good eyesight, which is the basic requirement for pilots, and there are 49 students in our class, and only 1 is currently short-sighted." Shao Qiyun is a student of Aviation Class 15 of Henan Provincial Experimental Middle School. In order to successfully pass the physical examination of Zhaofei, he attaches great importance to the protection of his eyesight.
"Run around the playground 3 times between classes in the morning, do sunshine exercises between classes in the afternoon, and do reverse shooting exercises between self-study classes in the evening. We also have a dedicated physical training session once a week. Class teachers often remind us to sit up straight and not get too close to the desk. Shao Qiyun told reporters that they have systematic eye examinations 2 to 3 times a year.
"Not long ago, 83 aviation class graduates participated in the physical examination before the college entrance examination, and most of them passed successfully." Huang Ying, head of the aviation class of Henan Experimental Middle School, told reporters that the pilot's physical examination is comprehensive and strict, but there are very few cases where students cannot pass due to myopia.
"The school has set up a leading group for myopia prevention and control, which carries out work from teaching, logistics, sports, medical treatment and other aspects, and the health station has made detailed statistics on the vision health status of students of all grades and established electronic files." According to Xia Chaosheng, director of the Henan Provincial Experimental Middle School Discipline Teaching Office, "The special eye protection lamps installed in the aviation class classrooms have now been popularized in the whole school, and the running exercises and eye exercises between classes are all normalized. In addition, the school has a myopia prevention and control publicity and education month every semester, and reminds students to use scientific eyes through theme classes. ”
How to balance students' eye health in their busy studies? The approach of aviation classes can give us some inspiration.
Lesson 1: Find ways to make up 2 hours of outdoor exercise time.
"We generally advocate that children and adolescents spend no less than 2 hours of outdoor exercise a day, so as to effectively prevent and control the occurrence and development of myopia." But how to achieve these 2 hours? Zhang Fengju, doctoral supervisor of ophthalmology at Beijing Tongren Hospital affiliated to Capital Medical University, introduced that it can be composed of a 45-minute physical education class or group recess exercise every day, plus a number of 10-minute recesses, and teachers should actively encourage and guide students to walk out of the classroom after class.
"Schools can make full use of social resources, carry out a variety of after-school care forms, organize more sports events, art activities, science and technology activities, special club activities, etc., and do not 'trap' students in the classroom for safety and other reasons." Qu Jia believes that physical education classes should also achieve the required activity intensity in accordance with the curriculum standards, cultivate 1 to 2 sports skills for students, and help them develop a good habit of lifelong exercise.
Lesson 2: Check your vision regularly to prevent high myopia.
How did you find out that your child was myopic? During the interview, the reporter found that many parents' answers started with "that day" and "once", and accidentally found that the child was "almost lying on TV" and "squinting and pulling the corners of the eyes" before realizing that the child may be short-sighted.
"A child's vision development is a process of transitioning from farsightedness to orthoopia and then to myopia. The key to preventing myopia is for parents to know the farsightedness reserve of children of different ages. As the child grows older, especially after primary school, the rate of depletion of the child's farsighted reserve will accelerate, so from the age of 3, parents should take them to the hospital to establish a refractive development file and regularly check their vision. Zhang Fengju said.
"Through visual acuity examination, if regulatory myopia (commonly known as pseudomyopia) is found, it can be eliminated by mydriatic refraction; If early myopia is found, parents should strengthen the monitoring of their children's eye behavior to prevent the rapid growth of myopia leading to high myopia or pathological damage. Zhang Fengju especially reminded that we should also pay attention to the refractive state of the child, especially children under the age of 9, and pay attention to whether there is a possibility of amblyopia.
Enlightenment 3: Improve learning lighting conditions and develop healthy eye habits.
In recent years, many schools have gradually improved the lighting conditions of classrooms, anti-blue light, anti-glare, anti-strobe LED lights have solved the problem of insufficient light and unstable flickering when the traditional fluorescent lamps are rainy days and unstable voltage, and the illumination and light uniformity from the blackboard to the desk have been greatly improved.
Unlike the one-time investment of hardware improvement, the cultivation of eye habits takes a long time. Zhang Fengju said that teachers and parents should urge children to develop scientific eye habits, which can maximize the role of protecting eyesight. "The first is the reading and writing posture, everyone knows to maintain the principle of 'one fist, one foot and one inch'; the second is to avoid long-term close use of the eyes, every 20 minutes after using the eyes, looking away from 5 meters away for more than 20 seconds; again is the choice of reading and writing environment, avoid reading in direct sunlight, dim, shaky environment. Also, be sure to get enough sleep. ”
Prevention and control of artifacts, play a good "combination fist"
There is a "little glasses" at home, and parents are often bitter.
With the advancement of theory and technology in the field of myopia prevention and control, many new technologies and new products have been launched. While facing more choices, the high price, the efficacy of "Schrödinger", and the massive amount of information that floods the Internet all make parents feel confused.
"The means of myopia prevention and control include optics, drugs, and behavioral interventions. The drug means carry the main expectations of parents, but unfortunately the magic potion that can cure myopia with a drop does not yet exist. Lu Fan, head of the optometry group of the Ophthalmology Branch of the Chinese Medical Association, said, "Low-concentration atropine is the only proven drug for the prevention and control of myopia, and its effectiveness is between 28% and 60% compared with single-vision glasses. ”
Whether a child is suitable for low-concentration atropine needs to be decided by a professional doctor based on his own characteristics and the parent's ability to supervise. Lv Fan said: "In the consensus study on the use of low-concentration atropine for myopia prevention and control, age is the most concerned issue. We propose in the expert consensus that children over 4 years old can use it, because the perception of young children is not strong enough, parents need to strengthen monitoring when taking medication, and doctors should also increase the frequency of follow-up. ”
In addition to drug intervention, orthokeratology lenses (commonly known as OK lenses) that can be worn at night and removed during the day and defocusing lenses that can control the development of myopia are two "heavyweights" in optical means. Orthokeratology lenses do not hinder movement and do not affect aesthetics, while defocusing lenses are easy to wear, but the safety and efficacy of the two are controversial.
"Instead of directly touching and rubbing the cornea, orthokeratology lenses use the pressure of the eyelid on the cornea and use the fluid mechanics generated by the tear layer to help shape the cornea." In the view of Jia Ding, vice chairman of the Optometry Professional Committee of Shanxi Medical Doctor Association, safety is relative, and only reasonable and standardized use can ensure the safe and effective function of orthokeratology lenses. "The so-called reasonable norm is to go to a regular diagnosis and treatment institution to fit, pay attention to hygiene when using, do a good job in cleaning and nursing lenses, and strictly achieve regular follow-up, and visit a doctor at any time with special circumstances."
"Not all defocusing lenses have a good myopia prevention and control effect. At present, it has been found that the control effect of defocusing lenses designed with microlenses is relatively good in clinical practice. Clinically, the key factor affecting the wearing effect of defocusing lenses is the length of wear, and only wearing them all day can achieve a better control effect. Zhang Xiaoxiao, executive member of Guangdong Hospital Association, said that from the available data, the control effect of defocusing lenses and orthokeratology lenses is very close, generally speaking, children over 8 years old can wear orthokeratology lenses, and their lenses have higher requirements for children's hygiene habits.
"Although there are many clinical control methods for myopia correction, these have their own indications, potential side effects or limitations, and create a continuous investment burden." Ni Hailong said, "For the control of myopia, there is no single artifact and miracle medicine, and it is necessary to make a personalized assessment between eye habits, optical means, and drugs, and play a good combination box." (Reporter Chen Yu)
Source: Guang Ming Daily