Background Military personnel in high-altitude regions often experience dry eye and visual fatigue, and visual fatigue is one of the important factors affecting their visual function.

Objective To investigate the prevalence and influencing factors of visual fatigue among soldiers stationed in plateau areas for an extended period, and to provide a theoretical foundation for promoting eye health care and enhancing measures to prevent visual fatigue.

Methods From September 2022 to September 2023, 840 military personnel in high-altitude regions were selected through cluster random sampling for eye examination and survey, including visual acuity, intraocular pressure, and Visual Fatigue Scale (VFS), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Pittsburgh Sleep Quality Index (PSQI). A logistic regression model was employed to analyze the factors influencing asthenopia. Identified influencing factors were incorporated into a decision tree model for predictive analysis, and a receiver operating characteristic curve was generated to assess prediction accuracy.

Results A total of 840 questionnaires were distributed and 820 questionnaires were recovered, with an effective recovery rate of 97.62%, of whom 740 were male and 80 were female. There were 342 cases of visual fatigue were identified (41.71%), 209 cases of poor vision (25.49%), 179 cases of positive depressive symptoms (21.83%), 243 cases of positive anxiety synmptoms (29.63%), 214 cases of sleep disorders (26.10%), and 66 cases of abnormal intraocular pressure (8.05%). There were statistically significant differences in working hours, electronic screen time, visual acuity, depressive symptom, sleep quality, and intraocular pressure between the visual fatigue group and the non-visual fatigue group (P < 0.05). The results of logistic regression indicated that electronic screen time ≥6 h, positive depressive symptom, sleep disorder, and low vision were the influencing factors of visual fatigue (OR=10.101, 5.043, 2.306, 1.559, P<0.05). The decision tree model showed that electronic screen time was the main risk factor of visual fatigue. The positive visual fatigue rate was 92.63% among the soldiers with ≥ 6 h electronic screen time, depressive symptoms, and sleep disorders, while the positive rate was 2.47% (the probability of no visual fatigue was 97.53%) among the individuals with electronic screen time < 6 h, normal vision, and no sleep disorders. The overall prediction accuracy was 83%, with sensitivity and specificity of 0.775 and 0.746, respectively.

Conclusions Electronic screen time of 6 h or more, along with depression and sleep disorders, can significantly increase the risk of visual fatigue among soldiers stationed in plateau areas for extended periods. It is crucial to pay attention to the mental state and lifestyle behaviors of these soldiers. Fostering good eye hygiene and maintaining a positive and healthy emotional state can enhance the eye health of soldiers in plateau regions.