近视前期的危险因素识别及干预策略研究进展

Risk Factors Identification and Intervention Strategies for Premyopia

摘要: 近视前期作为近视防控的关键窗口期，以远视储备快速消耗、眼轴增长加速为核心特征，其防控对于降低近视发生风险具有重要临床意义。近年来，随着儿童青少年近视患病率持续上升，近视前期的流行病学特征、危险因素及干预措施受到广泛关注。现有研究表明，遗传因素、近距离用眼负荷增加、户外活动不足及屈光储备下降等与近视前期发生密切相关。行为与环境干预、光学及药物干预均被证实可在一定程度上延缓近视发生，其中周边离焦光学设计、低浓度阿托品及新型光学疗法在近视前期人群中的应用显示出较为稳定的防控效果。近年来，多模式联合干预及个体化干预策略逐渐成为研究热点，但其长期疗效、安全性及适用人群仍有待高质量研究进一步明确。本文系统综述近视前期的流行病学特征、主要危险因素及最新干预研究进展，为儿童青少年近视的早期防控提供循证依据。

Abstract: Premyopia represents a critical transitional stage preceding the onset of myopia and is characterized by accelerated axial elongation and progressive depletion of hyperopic reserve. Early identification and intervention during this period may reduce the risk of myopia development. With the rising prevalence of myopia among children and adolescents, increasing attention has been directed toward the epidemiology, associated risk factors, and preventive interventions for premyopia. Current evidence suggests that genetic susceptibility, increased near-work exposure, insufficient outdoor activity, and reduced hyperopic reserve are key factors associated with the development of premyopia. A range of interventions, including behavioral and environmental modifications, optical approaches, and pharmacologic treatments, have demonstrated varying degrees of efficacy in delaying myopia onset. In particular, peripheral defocus-based optical designs, low-dose atropine, and emerging optical therapies have shown consistent preventive effects in premyopic populations. Recently, multimodal and individualized intervention strategies have been proposed; however, robust evidence regarding their long-term efficacy, safety, and optimal target populations remains limited. This review summarizes current evidence on the epidemiology, major risk factors, and recent advances in intervention strategies for premyopia, providing an evidence-based framework for early myopia prevention in children and adolescents.