Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

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

Eye volume 37, pages 1625–1632 (2023)Cite this article

Subjects

Abstract

Objectives

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

Methods

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).

Results

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).

Conclusion

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

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).

Similar content being viewed by others

References

  1. Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P. et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123:1036–42. https://doi.org/10.1016/j.ophtha.2016.01.006.

    Article  PubMed  Google Scholar 

  2. Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W. et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115:1279–85. https://doi.org/10.1016/j.ophtha.2007.12.019.

    Article  PubMed  Google Scholar 

  3. He M, Xiang F, Zeng Y, Mai J, Chen Q, Zhang J. et al. Effect of time spent outdoors at school on the development of myopia among children in China. JAMA. 2015;314:1142. https://doi.org/10.1001/jama.2015.10803.

    Article  CAS  PubMed  Google Scholar 

  4. Ip JM, Saw SM, Rose KA, Morgan IG, Kifley A, Wang JJ. et al. Role of near work in myopia: findings in a sample of Australian school children. Investig Opthalmology Vis Sci. 2008;49:2903. https://doi.org/10.1167/iovs.07-0804.

    Article  Google Scholar 

  5. Nickels S, Hopf S, Pfeiffer N, Schuster AK. Myopia is associated with education: Results from NHANES 1999-2008. PLoS One. 2019;14:e0211196 https://doi.org/10.1371/journal.pone.0211196.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wong TY, Ferreira A, Hughes R, Carter G, Mitchell P. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review. Am J Ophthalmol. 2014;157:9–25.e12. https://doi.org/10.1016/j.ajo.2013.08.010.

    Article  PubMed  Google Scholar 

  7. Polling JR, Klaver C, Tideman JW. Myopia progression from wearing first glasses to adult age: the DREAM Study. Br J Ophthalmol. 2021; https://doi.org/10.1136/bjophthalmol-2020-316234.

    Article  PubMed  Google Scholar 

  8. Fan DS, Lam DS, Lam RF, Lau JT, Chong KS, Cheung EY. et al. Prevalence, incidence, and progression of myopia of school children in Hong Kong. Investig Opthalmology Vis Sci. 2004;45:1071. https://doi.org/10.1167/iovs.03-1151.

    Article  Google Scholar 

  9. Tricard D, Marillet S, Ingrand P, Bullimore MA, Bourne RRA, Leveziel N. Progression of myopia in children and teenagers: a nationwide longitudinal study. Br J Ophthalmol. 2021. https://doi.org/10.1136/bjophthalmol-2020-318256.

    Article  PubMed  Google Scholar 

  10. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith EL A, Holden B. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012;89:27–32. https://doi.org/10.1097/OPX.0b013e3182357f79.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yam JC, Jiang Y, Tang SM, Law AKP, Chan JJ, Wong E. et al. Low-concentration atropine for myopia progression (LAMP) study: a randomized, double-blinded, placebo-controlled trial of 0.05%, 0.025%, and 0.01% atropine eye drops in myopia control. Ophthalmology. 2019;126:113–24. https://doi.org/10.1016/j.ophtha.2018.05.029.

    Article  PubMed  Google Scholar 

  12. Yen MY, Liu JH, Kao SC, Shiao CH. Comparison of the effect of atropine and cyclopentolate on myopia. Ann Ophthalmol. 1989;21:180–2, http://www.ncbi.nlm.nih.gov/pubmed/2742290.

    CAS  PubMed  Google Scholar 

  13. Yi S, Huang Y, Yu SZ, Chen XJ, Yi H, Zeng XL. Therapeutic effect of atropine 1% in children with low myopia. J Am Assoc Pediatr Ophthalmol Strabismus. 2015;19:426–9. https://doi.org/10.1016/j.jaapos.2015.04.006.

    Article  Google Scholar 

  14. Wang Y, Bian HL, Wang Q. Atropine 0.5% eyedrops for the treatment of children with low myopia. Med (Baltim). 2017;96:e7371 https://doi.org/10.1097/MD.0000000000007371.

    Article  CAS  Google Scholar 

  15. Chua WH, Balakrishnan V, Chan YH, Tong L, Ling Y, Quah BL. et al. Atropine for the treatment of childhood myopia. Ophthalmology. 2006;113:2285–91. https://doi.org/10.1016/j.ophtha.2006.05.062.

    Article  PubMed  Google Scholar 

  16. Ma Y, Zou H, Lin S, Xu X, Zhao R, Lu L. et al. Cohort study with 4-year follow-up of myopia and refractive parameters in primary schoolchildren in Baoshan District, Shanghai. Clin Exp Ophthalmol. 2018;46:861–72. https://doi.org/10.1111/ceo.13195.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pärssinen O, Lyyra AL. Myopia and myopic progression among schoolchildren: a three-year follow-up study. Invest Ophthalmol Vis Sci. 1993;34:2794–802. http://www.ncbi.nlm.nih.gov/pubmed/8344801.

    PubMed  Google Scholar 

  18. Loh KL, Lu Q, Tan D, Chia A. Risk factors for progressive myopia in the atropine therapy for myopia study. Am J Ophthalmol. 2015;159:945–9. https://doi.org/10.1016/j.ajo.2015.01.029.

    Article  CAS  PubMed  Google Scholar 

  19. Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K. The prevalence of refractive errors among schoolchildren in Dezful, Iran. Br J Ophthalmol. 2007;91:287–92. https://doi.org/10.1136/bjo.2006.099937.

    Article  PubMed  Google Scholar 

  20. Norouzirad R, Hashemi H, Yekta A, Nirouzad F, Ostadimoghaddam H, Yazdani N. et al. The prevalence of refractive errors in 6- to 15-year-old schoolchildren in Dezful, Iran. J Curr Ophthalmol. 2015;27:51–55. https://doi.org/10.1016/j.joco.2015.09.008.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Emamian MH, Hashemi H, Khabazkhoob M, Malihi S, Fotouhi A. Cohort Profile: Shahroud Schoolchildren Eye Cohort Study (SSCECS. Int J Epidemiol. 2019;48:27–27f. https://doi.org/10.1093/ije/dyy250.

    Article  PubMed  Google Scholar 

  22. Cruickshank FE, Logan NS. Optical ‘dampening’ of the refractive error to axial length ratio: implications for outcome measures in myopia control studies. Ophthalmic Physiol Opt. 2018;38:290–7. https://doi.org/10.1111/opo.12457.

    Article  PubMed  Google Scholar 

  23. Hyman L. Relationship of age, sex, and ethnicity with myopia progression and axial elongation in the correction of myopia evaluation trial. Arch Ophthalmol. 2005;123:977. https://doi.org/10.1001/archopht.123.7.977.

    Article  PubMed  Google Scholar 

  24. Jong M, Jonas JB, Wolffsohn JS, Berntsen DA, Cho P, Clarkson-Townsend D. et al. IMI 2021 yearly digest. Investig Opthalmology Vis Sci. 2021;62:7 https://doi.org/10.1167/iovs.62.5.7.

    Article  Google Scholar 

  25. Jones-Jordan LA, Sinnott LT, Chu RH, Cotter SA, Kleinstein RN, Manny RE. et al. Myopia progression as a function of sex, age, and ethnicity. Invest Ophthalmol Vis Sci. 2021;62:36. https://doi.org/10.1167/iovs.62.10.36.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year randomized clinical trial of MiSight lenses for myopia control. Optom Vis Sci. 2019;96:556–67. https://doi.org/10.1097/OPX.0000000000001410.

    Article  PubMed  Google Scholar 

  27. Breslin KMM, O’Donoghue L, Saunders KJ. A prospective study of spherical refractive error and ocular components among Northern Irish schoolchildren (The NICER study). Investig Opthalmology Vis Sci. 2013;54:4843. https://doi.org/10.1167/iovs.13-11813.

    Article  Google Scholar 

  28. Khor WB, Aung T, Saw SM, Wong TY, Tambyah PA, Tan AL. et al. An outbreak of Fusarium keratitis associated with contact lens wear in Singapore. JAMA. 2006;295:2867–73. https://doi.org/10.1001/jama.295.24.2867.

    Article  CAS  PubMed  Google Scholar 

  29. Saw SM, Tong L, Chua WH, Chia KS, Koh D, Tan DT. et al. Incidence and progression of myopia in Singaporean school children. Investig Opthalmology Vis Sci. 2005;46:51. https://doi.org/10.1167/iovs.04-0565.

    Article  Google Scholar 

  30. Jones-Jordan LA, Sinnott LT, Cotter SA, Kleinstein RN, Manny RE, Mutti DO. et al. Time outdoors, visual activity, and myopia progression in Juvenile-onset myopes. Investig Opthalmology Vis Sci. 2012;53:7169. https://doi.org/10.1167/iovs.11-8336.

    Article  Google Scholar 

  31. Saw SM, Nieto FJ, Katz J, Schein OD, Levy B, Chew SJ. Factors related to the progression of myopia in Singaporean children. Optom Vis Sci. 2000;77:549–54. http://www.ncbi.nlm.nih.gov/pubmed/11100893.

    Article  CAS  PubMed  Google Scholar 

  32. Li SM, Li H, Li SY, Liu LR, Kang MT, Wang YP. et al. Time outdoors and myopia progression over 2 years in Chinese children: the anyang childhood eye study. Investig Opthalmology Vis Sci. 2015;56:4734. https://doi.org/10.1167/iovs.14-15474.

    Article  Google Scholar 

  33. Wu PC, Tsai CL, Wu HL, Yang YH, Kuo HK. Outdoor activity during class recess reduces myopia onset and progression in school children. Ophthalmology. 2013;120:1080–5. https://doi.org/10.1016/j.ophtha.2012.11.009.

    Article  PubMed  Google Scholar 

  34. Saxena R, Vashist P, Tandon R, Pandey RM, Bhardawaj A, Gupta V, et al. Incidence and progression of myopia and associated factors in urban school children in Delhi: The North India Myopia Study (NIM Study). PLoS One. 2017;12:e0189774 https://doi.org/10.1371/journal.pone.0189774.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Zhou WJ, Zhang YY, Li H, Wu YF, Xu J, Lv S. et al. Five-year progression of refractive errors and incidence of myopia in school-aged children in western China. J Epidemiol. 2016;26:386–95. https://doi.org/10.2188/jea.JE20140258.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Lee SS, Lingham G, Sanfilippo PG, Hammond CJ, Saw SM, Guggenheim JA. et al. Incidence and progression of myopia in early adulthood. JAMA Ophthalmol. 2022;140:162–9. https://doi.org/10.1001/jamaophthalmol.2021.5067.

    Article  PubMed  Google Scholar 

Download references

Funding

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

Author information

Authors and Affiliations

  1. Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal

    Carla Lanca

  2. Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal

    Carla Lanca

  3. Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran

    Mohammad Hassan Emamian

  4. R&D AMERA, Essilor International, Singapore, Singapore

    Yee Ling Wong

  5. Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran

    Hassan Hashemi

  6. Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mehdi Khabazkhoob

  7. Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland

    Andrzej Grzybowski

  8. Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland

    Andrzej Grzybowski

  9. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore

    Seang Mei Saw

  10. Duke-NUS Medical School, Singapore, Singapore

    Seang Mei Saw

  11. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Seang Mei Saw

  12. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Akbar Fotouhi

Authors
  1. Carla Lanca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammad Hassan Emamian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yee Ling Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hassan Hashemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehdi Khabazkhoob
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrzej Grzybowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seang Mei Saw
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Akbar Fotouhi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Mohammad Hassan Emamian.

Ethics declarations

Competing interests

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

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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 37, 1625–1632 (2023). https://doi.org/10.1038/s41433-022-02219-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-022-02219-8

This article is cited by

Search

Advanced search

Quick links