Design and methodology of the Shanghai child and adolescent large-scale eye study (SCALE)

Importance: Nearly half of children suffering vision impairment reside in China with myopia accounting for the vast majority. Background: To describe the design and methodology of the Shanghai Child and Adolescent Large-scale Eye Study (SCALE). Design: The SCALE was a city wide, school-based, prospective survey. Participants: Children and adolescents aged 4–14 years from kindergarten (middle and senior), primary schools and junior high schools of all 17 districts and counties of the city of Shanghai, China were examined in 2012–2013. Methods: Each enrolled child underwent vision assessment (distance visual acuity; uncorrected and with corrective device if worn) and their parent/carer completed a questionnaire designed to elicit risk factors associated with myopia. Additionally, non-cycloplegic autorefraction and ocular axial length was measured in a subset of the larger sample. Main Outcome Measures: Prevalence and the associated factors of vision impairment, myopia and high myopia in Shanghai. Results: In 2012–2013, a total of 910 245 of the eligible 1 196 763 children and adolescents identified from census (76%, mean age 9.0 ± 2.7 years [4–14 years]) were enrolled with visual acuity screened in the city of Shanghai. Of these, 610 952 children (67% of the entire sample) underwent non-cycloplegic autorefraction and 219 188 (24% of the entire sample) had both non-cycloplegic autorefraction and axial length measurements. Conclusions and Relevance: The study results will provide insights on the burden of vision impairment, myopia and high myopia in children and adolescents in a metropolitan area of China, and contribute to the policies and strategies to address and limit the burden. © 2017 The Authors Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists