Abstract / Summary
Myopia is a common refractive error among children and adolescents and represents a major global public health concern due to its high prevalence and associated risk of vision-threatening complications. Lifestyle factors, including outdoor physical activity, screen exposure, and sleep duration, have been suggested to play important roles in its development. A large-scale cross-sectional study was conducted in Leshan, China, from May to November 2025, using a multistage stratified random cluster sampling design. A total of 8,762 school-aged participants (6–18 years) were included. Myopia was defined as a spherical equivalent refractive error of less than − 0.50 diopters in at least one eye based on non-cycloplegic autorefraction. Information on outdoor activity, screen time, sleep duration, and potential confounders was collected using standardized questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with myopia. The overall prevalence of myopia was 76.19%. Multivariable logistic regression showed that engaging in more than one hour of outdoor activity per day was associated with a lower risk of myopia (OR = 0.849, 95% CI: 0.766–0.942). In contrast, screen time exceeding two hours per day (OR = 1.135, 95% CI: 1.022–1.259) and insufficient sleep (OR = 1.139, 95% CI: 1.032–1.257) were significantly associated with higher odds of myopia after adjustment for confounders. Myopia is highly prevalent among school-aged children and adolescents in Leshan. Insufficient sleep and prolonged screen time are significant risk factors, whereas increased outdoor physical activity appears to be protective. These findings highlight the importance of promoting healthy lifestyle behaviors for myopia prevention and control. Longitudinal studies are needed to further clarify causal relationships.