Boao Manifesto on Myopia Prevention and Control Version 3.0 (China Eye Valley)
Academic Committee, Vision China 2021 Chinese Optometric Association, Chinese Ophthalmological Society Optometry Group, Chinese Ophthalmologist Association
Abstract： On December 1, 2017, the Chinese Optometric Association, Chinese Ophthalmological Society, Chinese Center for Disease Control and Prevention, and relevant experts together published the 2017 Boao Manifesto on Myopia Prevention and Control (hereafter referred to as "Boao Manifesto 2017"). It was the first recommendation to include myopia prevention and control into the chronic care management category where suggestions were proposed for visual health initiatives. These included increasing outdoor activities, easing the near-range workload of the eyes, standardizing the correction of myopia, scientifically controlling myopia, and attaching importance to the harm of high myopia. The Boao Manifesto 2017 has been well received ever since, pushing the release of the national Implementation Plan of Comprehensive Myopia Prevention and Control for Children and Adolescents and other measures. In 2018, President Xi Jinping gave a series of instructions on the issue of myopia among children and adolescents, proposing "together we should care for children' s eyes to give them a bright future". In August, the joint issuance of the Implementation Plan of Comprehensive Myopia Prevention and Control for Children and Adolescents by eight national ministries and commissions including the Ministry of Education elevated the undertaking to a national strategy
In December 2019, the 2019 Boao Manifesto on Myopia Prevention and Control ("Boao Manifesto 2019") was formulated by a follow-up expert forum based on the progress made through the Implementation Plan of Comprehensive Myopia Prevention and Control for Children and Adolescents, the Boao Manifesto 2017, and an expert consensus from the Xiangshan Science Conference. The Boao Manifesto 2019 adhered to studies on the mechanisms of the cause and development of myopia and promoted "more outdoor activities and a reduced ocular workload" for myopia prevention and control. It also moved forward with a proposal for effective myopia screening for children and adolescents along with health management and safe correction, propelling the cultivation of special talents and the formulation of inspection standards for myopia prevention and control technologies, and recommending the dissemination of myopia knowledge. The Boao Manifesto 2019 also called for fully implementing assessment mechanisms from leading organizations, including the Ministry of Education and the National Health Commission, to ensure concrete results and deliver long-term benefits to keep myopia at bay or under control for youths in China
Taken as a whole, the state's undertaking on myopia prevention and control for children and adolescents has yielded preliminary progress. To cope with the impact of COVID-19 and tackle the myopia problem of the young with tight and pragmatic efforts, in May 2021, fifteen departmental organizations, including the Ministry of Education, jointly compiled the "Bright Action Scheme for Myopia Prevention and Control for Children and Adolescents" (2021-2025) ("Bright Action Scheme"). To keep up with scientific progress on full myopia prevention and control and to update the prevention and treatment system for this eye problem among our youths therefore contributing to their vision health, the Boao Manifesto of Myopia Prevention and Control Version 3.0 (China Eye Valley) is issued as following.
Since myopia is an issue concerning national strategy and people's well-being, closely related to national health, economic development, and social progress, the prevention and control of it becomes a systematic project involving basic theoretical research, practical transfer of clinical research, engineering technology development, and public policy formulation. In recent years, the Chinese government at all levels has issued a series of policies, systems, and implementation plans to enhance visual health. Professional research institutions have announced a number of standards, guidelines, and technical specifications for the prevention and control of myopia and schools, hospitals, families, and society have taken a range of actions to promote eye health. All sectors of society have jointly established a comprehensive prevention and control system for myopia among children and adolescents that has achieved remarkable results. However, tackling this issue for minors is an uphill battle, particularly due to the challenge of the COVID-19 outbreak. To ensure child and adolescent myopia prevention and control work to achieve results, the Bright Action Scheme is an opportunity to deepen various measures uninterruptedly to this end, and especially, in the study of the mechanisms of myopia, configure a featured, all-inclusive plan to make our efforts more targeted, science-based and long-lasting.
Through in-depth discussions, all the involved experts reached the following consensus and suggestions:
1 Deepen the implementation of a national strategy to demonstrate the success of the Bright Action Scheme
Given the new circumstances since the impact of the pandemic, the Ministry of Education and fourteen other departments and commissions put forward the Bright Action Scheme after the Implementation Plan issued in 2018, jointly conducting eight specific operations by focusing on key areas, core elements, and critical articulations of myopia prevention and control. In the process of advancing the Bright Action Scheme, it is proposed to:
(1) implement a strict data reporting procedure to ensure the accuracy and thoroughness of the spring and autumn semester data collected for the Ministry of Education, providing scientific support for the prevention and control and accurate assessment of progress.
(2) enhance the examination and approval mechanism with matching systems to safeguard the sustainability of the operation and a long-term mechanism to grapple with the myopia issue in youths.
(3) recommend a national-level institution and commission to coordinate multiple departments and commissions. It is also suggested that the National Healthcare Security Administration, the Ministry of Industry and Information Technology, and other relevant organizations join this campaign.
2 Actively replicate the "double-reduction" policy to create a healthy ambience for eyes
Uphold the Ministry of Education's "doublereduction" policy to reduce the burdens of homework and the eyes' workload with joint efforts made by home and school. Guidance should be given to families to specifically ease their children's academic burden by reducing indiscriminate extracurricular training and respecting their children's interests and hobbies, instead of cutting the burden at schools, which increases the stress at home. Improve lighting conditions in classrooms and homes, equip desks and chairs ergonomically for children and teenagers, and set up good indoor and outdoor environments for visual health; strengthen sports and improve sports facilities, especially for schools with after-class care and evening self-study, and make practical plans o ensure that students have two hours of outside activities per day.
3 Begin comprehensive screening and archiving data for an information-based prevention and control operation
Launch scientific and efficient myopia screenings and eye health management for children and adolescents by establishing and improving standard procedures for their eye health archiving, myopia prevention and control, and health knowledge promotion. Make full use of big data, artificial intelligence, and the internet to make standardized and operable implementation plans. Optimize the information system for myopia prevention and control, support cohort studies on myopia among children and adolescents in order to achieve intelligent and personalized myopia solutions and early warning. It is suggested that a national big data management plan be established to standardize data storage, making the storage of big data from the nationwide screening for myopia safe and regulated, while analytically using the big data to guide the formulation and improvement of national myopia prevention and control policies.
4 Push prevention and control forward to curb the trend in the early onset of myopia
Adopt vision screening as the starting point to push the prevention and control of myopia forward to achieve an annual coverage rate of eye health care and vision examinations of over 90% of children aged 0-6 years through early monitoring, early detection, early warning, and early intervention. The actual work should be conducted early and aimed at the young, taking precision measures for different school-age groups. Preschool is the critical period of refractive development when parents take the main responsibility for young children's eye health and should take the initiative to have vision screening included in newborn health examinations. For the 3-6 age group, the work is to control the time spent watching TV and playing on mobile phones. Since primary school is the golden period for the prevention and control of myopia, parents, children, and schoolteachers shall take principal responsibility by emphasizing efforts to develop healthy habits for eye use and to cultivate a wide range of sports hobbies. Middle school is a peak period for vision work, and youths themselves should be responsible for actively learning scientific knowledge about eye health, properly balancing work and rest and limiting electronic screen exposure.
5 Emphasize early intervention to avoid ocular damage resulting from high myopia
(1) Further embrace vision screening to ensure the timely detection of risk factors and intervention as much as possible to avoid high myopia or even pathological myopia.
(2) Deepen the public's scientific understanding of high myopia, raise awareness among high myopes to be alert, conduct routine follow-up examinations, avoid strenuous activities, and adapt certain medical strategies for timely intervention to prevent deterioration from the disease.
6 Advance appropriate technologies and make diagnosis and treatment standardized and safe
(1) Enhance the management of myopia prevention and control in institutions by formulating basic clinical criteria for such institutions, including personnel qualification, site, equipment, and other requirements.
(2) Enhance the training of ophthalmology professionals by promoting their professional education, improving the career development system for ophthalmologists, and establishing a series of development systems for professional titles in ophthalmology.
(3) Improve an array of myopia prevention and control technical standards by developing and improving standards for tools in this regard, such as testing equipment, corrective instruments, lighting, desks, and chairs, to make these efforts effective and safe. Comprehensively optimize myopia prevention and control-related technical specifications, and help establish a number of institutions for ophthalmological standardization, testing, education, and training so that the entire industry can improve its development and quality.
(4) Launch a national R&D strategy for myopia prevention and control by organizing joint efforts to research and develop medical devices, drugs and appropriate technologies with independent intellectual property rights to contain the myopia problem, breaking through existing bottlenecks to attain remarkable results. Meanwhile, by strengthening the industrial management of myopia prevention and control, to form a clear evaluation system, gradually taking devices and methods that control and mitigate myopia under the medical devices and clinical technologies management system, which should be at the disposal of medical institutions with prescription rights.
7 Enhance education outreach and improve the availability of the scientific knowledge of myopia prevention and control
Promote the scientific knowledge of myopia prevention and control in the education system, guide relevant departments to identify substandard products for refractive correction and improper treatment methods, assist relevant market supervision and crack down on false marketing, inferior products and services so as to safeguard the scientific and authoritative reputation of anti-myopia knowledge. Formulate various models and efficient mechanisms conducive to the spread of knowledge on myopia prevention and control to make it more commonly accepted and easier to learn, building a strong atmosphere of national participation in this course. It is suggested to teach parents about myopia prevention and control in children, that regular popular science campaigns about eye care should be carried out, and that safety awareness in the battle against myopia should be raised, especially for standardized vision correction, which must be diagnosed and performed in qualified medical institutions, and that timely followup visits should be scheduled.
8 Strive for breakthroughs in scientific research and promote science-based prevention and control methods
(1) Despite achievements made on the genetic and environmental mechanisms of myopia, further research, especially basic research, remains necessary for further breakthroughs. It is advised to conduct a large-scale (a magnitude of one million or more), multi-center research on the genetic mechanisms of myopia and environmental factors that affect myopia to identify the interaction between genetic and environmental risk factors, providing scientific guidance to battle myopia.
(2) Formulate a proposal by exploring the mechanisms and operability of myopia prevention and control through outdoor sports and conducting largescale field studies to identify how outdoor activities can duly adjust eye development, then "prescribe" a practical guide for outdoor activities and suggest a timetable for it.
(3) It is advised to conduct a large-scale investigation and research on the school classroom teaching environment (daylight, lamp light, desks, and chairs), learning situation, home eye vision workload, and living style (diet, sleep, etc.), to identify the impact of environments and postures on vision health as well as living habits, etc., on the cause of myopia, and quantify a criterion for eye use based on science.
(4) Identify a more effective clinical prevention and control formula based on the latest myopia remedial medicine, optical methods and other realworld studies (RWS) as well as clinical intervention research.
(5) Perform genealogical in-depth analysis of genomes in families with high myopia, guide early clinical intervention in susceptible populations, study effective medical methods and means of controlling high myopia, and establish a diagnostic model of early complications of high myopia based on multi-omics big data research and artificial intelligence to reduce the risk of inflicted blindness.
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