[The relationship between classroom environment and myopia].

Objective: Based on a cohort and intervention study of the Eastern Chinese Student Surveillance, Cohort and Intervention Study (ES-SCI), this research aims to explore the correlation between monitor of the school environment and longitudinal data on myopia and provide evidence for the government myopia intervention strategy. Methods: This survey adopts the stratified cluster sampling method with the school as the unit. Students from grade 1 to grade 3 were selected according to the whole class to monitor the school environment in the classroom. Students will use the full-automatic computer optometer (TOPCON RM800) to conduct optometry from 2019 to 2021 under the condition of mydriasis to perform refractive eye examinations. Meantime eye axis length monitoring was also conducted. Cox proportional risk regression model was used to explore the relationship between school environmental monitoring and the occurrence and development of students' myopia. Results: From 2019 to 2021, 2 670 students from 77 classrooms participated in the observation study. The students' diopter after right/left eye mydriasis decreased in varying degrees (P<0.001), and the axial length of the right/left eye increased in various degrees (P<0.001). The weighted qualified rate of per capita area of primary school classrooms increased from 18.0% in 2019 to 26.0% in 2021, the weighted average illuminance pass rate of blackboard surface increased from 23.8% in 2019 to 26.4% in 2021, and the weighted average illuminance pass rate of classroom table decreased from 86.7% in 2019 to 77.5% in 2021. The trend chi-square test was significant (P<0.05). Cox proportional risk regression showed that after correcting for the grade, gender, parental myopia, diet, sleep, near work (sitting posture, working time, electronic mobile equipment, eye exercises), and outdoor activities, the per capita area of 1.36- m2 was the protective factor of eye axis length (HR=0.778, 95%CI: 0.659-0.918, P=0.003); The average reflection ratio of blackboard 0.15-0.19 was the protective factor of eye axis length (HR=0.685, 95%CI: 0.592-0.793, P<0.001); The average illumination of the blackboard 150-, 300-, 500- lx was the protective factor of the eye axis length (HR=0.456, 95%CI: 0.534-0.761, P<0.001; HR=0.794, 95%CI: 0.705-0.895, P<0.001; HR=0.690, 95%CI: 0.619-0.768, P<0.001). The blackboard evenness 0.40-0.59 was the risk factor of eye axis length (HR=1.528, 95%CI: 1.018-2.293, P=0.041), and the blackboard evenness 0.80- was the protection factor of eye axis length (HR=0.542, 95%CI: 0.404-0.726, P<0.001). The evenness of the desktop 0.40-0.59 was the protective factor of eye axis length (HR=0.820, 95%CI: 0.698-0.965, P=0.017). The average illuminance of 150-, 300-, 500- lx was the protective factor of a diopter (HR=0.638, 95%CI: 0.534-0.761, P<0.001; HR=0.911, 95%CI: 0.848-0.978, P=0.011; HR=0.750, 95%CI: 0.702-0.801, P<0.001). The average illumination of desktop 500- lx was a protective factor of a diopter (HR=0.855, 95%CI: 0.763-0.958, P=0.007). Conclusion: School environmental monitoring indicators, such as meeting per capita area standards, passing blackboard, and desk top-related indicators, all play protective effects on myopia development in students.目的： 基于江苏省学生常见病监测、队列及干预研究，探索学校环境监测与近视纵向数据的关联性。 方法： 采用以学校为单位的分层整群抽样方法，按整班抽取1~3年级的学生，对教室进行了学校环境监测，学生采用全自动电脑验光仪于散瞳（复方托吡卡胺滴眼液）情况下于2019、2020、2021年分别进行屈光度验光检查。同时还行眼轴长度监测。采用Cox比例风险回归模型探索学校环境监测与学生近视发生发展的关系。 结果： 共有77间教室2 670名学生纳入了研究，2019-2021年学生右/左眼散瞳后屈光度均有不同程度的下降（P<0.001），右/左眼眼轴长度均有不同程度的增长（P<0.001），小学教室人均面积加权合格率由2019年的18.0%升高至2021年的26.0%，黑板面平均照度加权合格率由2019年的23.8%升高至2021年的26.4%，课桌面平均照度加权合格率由2019年的86.7%降低至2021年的77.5%（趋势χ2检验P<0.05）。Cox比例风险回归分析显示，在调整年级、性别、父母近视、饮食、睡眠、视近工作（坐姿、作业时间、电子移动设备、眼保健操）、户外活动后，人均面积1.36~ m2是眼轴长度的保护因素（HR=0.778，95%CI：0.659~0.918，P=0.003）；黑板平均反射比0.15~0.19是眼轴长度的保护因素（HR=0.685，95%CI：0.592~0.793，P<0.001）；黑板平均照度150~、300~、500~ lx是眼轴长度的保护因素（HR=0.456，95%CI：0.534~0.761，P<0.001；HR=0.794，95%CI：0.705~0.895，P<0.001；HR=0.690，95%CI：0.619~0.768，P<0.001）；黑板均匀度0.40~0.59是眼轴长度的危险因素（HR=1.528，95%CI：1.018~2.293，P=0.041），黑板均匀度0.80~是眼轴长度的保护因素（HR=0.542，95%CI：0.404~0.726，P<0.001）。课桌面均匀度0.40~0.59是眼轴长度的保护因素（HR=0.820，95%CI：0.698~0.965，P=0.017）。平均照度150~、300~、500~ lx是屈光度的保护因素（HR=0.638，95%CI：0.534~0.761，P<0.001；HR=0.911，95%CI：0.848~0.978，P=0.011；HR=0.750，95%CI：0.702~0.801，P<0.001）。课桌面平均照度500~ lx是屈光度的保护因素（HR=0.855，95%CI：0.763~0.958，P=0.007）。 结论： 学校环境监测指标，如人均面积达标、黑板及课桌面相关指标对学生近视发生发展具有保护作用。.