Objective To investigate the visual health status and its trends and influencing factors among children and adolescents in Macao.

Methods Utilizing visual acuity data from the Macao Child and Adolescent Physical Fitness Surveillance (2005–2020), this study analyzed the visual health status of 16 688 participants aged 6–18 years. The trend χ² test was conducted to assess changes in the detection rate of poor vision. Univariate analysis and multivariate logistic regression were employed to identify the factors associated with poor vision.

Results The overall normal vision rate declined from 39.7% in 2005 to 29.2% in 2010 (trend χ² = 108.3, P < 0.01) and then increased to 30.1% in 2015 and 30.7% in 2020. Concurrently, the severe poor vision rate exhibited a continuous upward trend, rising from 36.4% in 2005 to 46.3% in 2020 (trend χ² = 79.0, P < 0.01). Results of the 2020 vision analysis revealed that the prevalence of normal vision in males (33.0%) was higher than that (28.0%) in females (χ² = 9.9, P < 0.05). Multivariate analysis revealed that low-intensity physical education (PE) classes (OR = 1.92, 95%CI: 1.08–3.41), zero extracurricular physical activity sessions per week (OR = 2.52, 95%CI: 1.10–5.78), and sleep duration < 8 h per day (OR = 2.08, 95%CI: 1.03–4.21) were associated with an increased risk of poor vision. Conversely, limiting the daily electronic device use within 30 min (OR = 0.63, 95%CI: 0.41–0.97), moderate-intensity PE classes (OR = 0.51, 95%CI: 0.30–0.88), and shorter homework completion time (OR = 0.44, 95%CI: 0.25–0.78; reference: ≥ 180 min) were associated with a reduced risk of poor vision.

Conclusions From 2005 to 2020, the visual health issues among children and adolescents in Macao were characterized by a declining normal vision rate and an increasing trend towards severity. These trends are primarily influenced by lifestyle factors, lack of physical activity, and academic pressure.