Effects of genetic factors and visual behaviors on interventions for myopia prevention and control in children: a systematic review and meta-analysis.

Background: Childhood myopia has become a global public health problem and is growing rapidly in incidence, especially in East Asia. This study examined the prevention and control of myopia in children by systematically evaluating the interaction between genetic factors and visual behaviors to optimize prevention strategies.

Methods: Relevant articles were screened from PubMed and Web of Science. The search period was from January 2000 to January 2024. Inclusion criteria were children aged 6-18 years with clear stratification into intervention groups (receiving specific measures: health education, ≥1 hour daily outdoor activity, optical correction, or 0.01% atropine) and control groups (receiving routine care or no intervention). Both groups were matched for age (±1 year), baseline refractive error (within 0.50 D), and family history of myopia. Including health education, behavior adjustment, outdoor activities, clinically and research-proven interventions for myopia progression delay (including optical interventions such as frame glasses and orthokeratology, and pharmacological interventions such as low-concentration atropine). Outcome indicators included incidence of myopia, change in refractive power (D), and change in axial length (mm). Data were analyzed via RevMan 5.4 (Cochrane) and Stata 16 (StataCorp), and the effects of interventions were assessed using a random-effects model. This article defines the terms randomized controlled trials (RCTs), standardized mean difference (SMD), relative risk (RR), and confidence interval (CI).

Results: Twelve high-quality studies that examined the intervention effects of multiple genetic factors and visual behavior were ultimately included, with a total sample of 6,342 cases. The results showed that interventions significantly slowed myopia progression in the genetic high-risk group compared to its control, though the absolute effect remained weaker than in the general population, especially in terms of changes in refractive power (diopters, D) and axial length (millimeters, mm) (SMD =-0.32; 95% CI: -0.5 to -0.13). Among the interventions, health education and outdoor activities were the most effective for myopia prevention and control, with a reduction in the incidence of myopia of approximately 12% (myopia incidence rate =0.88; 95% CI: 0.81-0.96). Adherence to intervention was closely related to the effect of intervention, and the group with higher adherence experienced better control of myopia progression.

Conclusions: Genetic factors and visual behavior have significant effects on the prevention and control of myopia in children. The prevention and control of myopia among genetic high-risk population are significantly improved after the application of health education and outdoor activity plan interventions. Improving the compliance of intervention is the key factor to enhancing the effect of childhood intervention. This meta-analysis provides a scientific basis for the optimization of childhood intervention strategies for the prevention and control of myopia in children.