PurposeTo evaluate the relationship of both near work and outdoor activities with refractive error in rural children in China. Methods In this cross-sectional study, 572 (65.1%) of 878 children (6-18 years of age) were included from the Handan Offspring Myopia Study (HOMS). Information from the parents on these children, as well as the parent’s non-cycloplegic refraction, were obtained from the database of the Handan Eye Study conducted in the years 2006-2007. A comprehensive vision examination, including cycloplegic refraction, and a related questionnaire were conducted to all children. ResultsThe overall time spent on near work and outdoor activity in the children was 4.8 ± 1.6 and 2.9 ± 1.4 hours per day, respectively. Myopic children spent more time on near work (5.0 ± 1.7 hours vs.4.7 ± 1.6 hours, p=0.049), while no significant difference was found in outdoor activity hours (2.8 ± 1.3 hours vs. 3.0 ± 1.4 hours, p=0.38), as compared to non-myopic children. In the multiple logistic analysis, in general, no association between near work and myopia was found after adjusting for the children’s age, gender, parental refractive error, parental educational level, and daily outdoor activity hours [odds ratio (OR), 95% confidence interval (CI): 1.10, 0.94-1.27]. However, a weak protective effect of the outdoor activity on myopia was found (OR, 95% CI: 0.82, 0.70-0.96), after adjusting for similar confounders. Conclusions In general, no association between near work and myopia was found, except possibly for the high near work subgroup with moderate outdoor activity levels. A weak protective effect of outdoor activity on myopia in Chinese rural children was observed.
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