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Associations of incident myopia and its development with related factors among school-aged children across different grades: a four-year longitudinal study

Eye volume 39, pages 725–733 (2025)Cite this article

Subjects

Abstract

Objective

To assess the progression of myopia across different academic grades and investigate the associations between potential myopia-related factors and the incidence of myopia at various grade levels.

Methods

We utilized data from an ongoing longitudinal study that began with grade 1 students across 12 schools. Four waves of annual eye examinations and questionnaire surveys were conducted. Longitudinal analyses were performed on three groups: Group 1 (n = 1223, non-myopic in grade 1) examined factors in grade 1 associated with incident myopia in grade 2; Group 2 (n = 653, non-myopic in grade 2) investigated factors in grade 2 related to incident myopia in grade 3; and Group 3 (n = 746, non-myopic in grade 3) evaluated factors in grade 3 associated with incident myopia in grade 4.

Results

The incidence of myopia increased from 4.3% in grade 2 to 21.6% in grade 4. Our findings revealed a consistent positive association between the number of myopic parents and incident myopia in grades 2, 3, and 4, respectively. Outdoor activity in earlier grades showed significant protective effects, reducing the risk of incident myopia in the subsequent grades 2 and 3 (e.g., in Group 1, adjusted HR 0.46 [95% CI 0.24 ~ 0.86]). However, no significant association was observed between outdoor activity in grade 3 and incident myopia in grade 4.

Conclusions

It is important to consider the grade level of schoolchildren when addressing myopia control. Implementing early-phase interventions, particularly those emphasizing outdoor activities, may help mitigate the onset and progression of myopia during the earlier school years.

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Fig. 1
Fig. 2: Association diagram.

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Data availability

The dataset for this specific manuscript is available from the corresponding author upon request.

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Acknowledgements

The authors, contributors, and members of the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, helped us do this research. We acknowledge the support of the Health Promotion Center for Primary and Secondary Schools of Guangzhou Municipality; the 12 primary schools involved in the projects, the help of the headteachers and school nurses within the participating schools, the contributions of the participating children and their parents, and the support of many other individuals on the project.

Funding

This research was supported by a grant from the Natural Science Foundation of Guangdong Province (2021A1515111184), and Guangzhou Health Science and Technology Project (2023A031003).

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Author notes

  1. These authors contributed equally: Lan Guo, Jiayu Zhang

Authors and Affiliations

  1. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China

    Lan Guo, Jiayu Zhang & Ciyong Lu

  2. Health Promotion Center for Primary and Secondary Schools of Guangzhou Municipality, Guangzhou, China

    Yangfeng Guo

  3. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China

    Yin Hu, Lili Wang & Xiao Yang

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  1. Lan Guo
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Contributions

LG, JYZ, XY, and CYL were responsible for the conception, organization, and execution of the study. LG, JYZ, YFG, YH, and LLW were responsible for the data collection. LG and JYZ were responsible for the statistical analysis and verification of the underlying data. LG and JYZ were responsible for the manuscript preparation. LG, JYZ, XY, and CYL were responsible for the manuscript revision. XY and CYL were responsible for project supervision. All authors had full access to all the data in the study and confirmed their responsibility for the decision to submit it for publication.

Corresponding authors

Correspondence to Xiao Yang or Ciyong Lu.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Sun Yat-Sen University School of Public Health institutional review board and conducted in accordance with the Declaration of Helsinki. After the study had been fully explained in detail, written informed consent was obtained from each student and one of their legal guardians in school seminars.

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Guo, L., Zhang, J., Guo, Y. et al. Associations of incident myopia and its development with related factors among school-aged children across different grades: a four-year longitudinal study. Eye 39, 725–733 (2025). https://doi.org/10.1038/s41433-024-03467-6

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