Behavioral characteristics associated with refractive states and biometrics among urban preschool children in Wuxi, China

Behavioral characteristics and activities could contribute to visual development in children. This study aims to investigate behavioral characteristics associated with refractive state and biometrics among urban preschooler children in Wuxi, China. Eye screenings were conducted in 11 kindergartens, and 888 children aged 3–7 years were enrolled in the study. Non-cycloplegic autorefraction was performed. Demographic information and behavior characteristics were collected via questionnaires. The prevalence of hyperopia, myopia, premyopia, astigmatism and anisometropia was 50.3%, 6.8%, 42.9%, 62.0%, and 20.0%, respectively. Longer daily screen duration was associated with higher odds of astigmatism and anisometropia (OR = 1.23 and 1.30, respectively), and was correlated with larger spherical equivalent refraction (SER), spherical errors (SE) and SER differences in between eyes (SERD) (β = 0.16, 0.19, and 0.11, respectively). Light exposure during sleep was associated with greater SERD and SE (β 0.34 and 0.31, respectively), whereas longer daily outdoor activity duration was associated with lower odds of astigmatism (OR = 0.85). The correction of pen-holding posture as well as table and chair heights were associated with lower cylindrical errors (β = -0.24) and SERD (β = -0.22), respectively. The prevalence of refractive errors in preschool children was high in Wuxi. Meanwhile, the results of this study suggested the association of behavior characteristics with refractive states and biometrics among preschoolers in Wuxi, which could provide new insight into behavioral effects on refractive error.