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Three-year change in refractive error and its risk factors: results from the Shahroud School Children Eye Cohort Study



To determine spherical equivalent (SE) progression among children in the Shahroud School Children Eye Cohort Study.


A prospective cohort study recruited children aged 6 to 12 years in 2015 (baseline) with a follow-up in 2018. Cycloplegic autorefraction and axial length (AL) measurements were included. SE progression over 3 years was analysed in non-myopic (SE ≥ + 0.76 D), pre-myopic (PM; SE between +0.75 D and –0.49 D), low myopic (LM; SE between −0.5 D and −5.99 D), and high myopic (HM; SE ≤ − 6 D) eyes. Age, sex, near work, outdoor time, living place, parental myopia, mother’s education, and baseline SE were evaluated as risk factors for SE progression (≤ −0.50 D).


Data were available for 3989 children (7945 eyes). At baseline, 40.3% (n = 3205), 3.4% (n = 274) and 0.1% (n = 7) eyes had PM, LM and HM, respectively. At the 3-year follow-up, 40.5% (n = 3216), 7.5% (n = 599) and 0.2% (n = 15) eyes had PM, LM, and HM, respectively. SE progression in eyes with LM and HM was −1.08 ± 0.76 D and −1.60 ± 1.19 D, respectively. SE progression was associated with age at baseline (Odds Ratio [OR] = 1.14; 95% confidence interval [CI], 1.08–1.21), female sex (OR = 1.80; 95% CI: 1.48–2.18), near work (OR = 1.08; 95% CI: 1.02–1.14), parental myopia (OR = 1.20; 95% CI: 1.01–1.42) and baseline SE (OR = 2.28; 95% CI: 1.88–2.78).


A myopic shift was associated with older age, female sex, near work, parental myopia and greater myopic baseline SE. These results help identifying children at risk of progression that may benefit from treatment and lifestyle counselling.

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Fig. 1: The mean SE and AL progression over the 3-year period as a function of baseline age groups (top) and baseline spherical equivalent categories (bottom) (n = 3989 children; 7945 eyes).


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This work was supported by the Noor Ophthalmology Research Centre and Shahroud University of Medical Sciences (Grant Number: 960351).

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CL and MHE contributed to the conception and design of the study. CL and MHE performed the data analyses. CL wrote the manuscript. Manuscript revision: YL, MK, HH, AG, SSM and AF. Final approval of the manuscript: all authors.

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Correspondence to Mohammad Hassan Emamian.

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YLW is an employee of Essilor International, Singapore. Other authors have no conflict of interests to declare.

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Lanca, C., Emamian, M.H., Wong, Y.L. et al. Three-year change in refractive error and its risk factors: results from the Shahroud School Children Eye Cohort Study. Eye (2022).

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