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Risk factors for myopia progression in second-grade primary school children in Taipei: a population-based cohort study
  1. Chih-Chien Hsu1,2,
  2. Nicole Huang3,
  3. Pei-Yu Lin2,4,
  4. Shao-You Fang5,
  5. Der-Chong Tsai4,6,
  6. Shing-Yi Chen7,
  7. Ching-Yao Tsai4,8,
  8. Lin-Chung Woung4,8,
  9. Shih-Hwa Chiou1,2,4,9,10,
  10. Catherine Jui-ling Liu2,4
  1. 1 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
  2. 2 Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
  3. 3 Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
  4. 4 Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
  5. 5 Institution of Public Health, National Yang-Ming University, Taipei, Taiwan
  6. 6 Department of Ophthalmology, National Yang-Ming University Hospital, I-Lan, Taiwan
  7. 7 Department of Health, Taipei City Government, Taipei, Taiwan
  8. 8 Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
  9. 9 Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
  10. 10 Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
  1. Correspondence to Dr Catherine Jui-ling Liu, Department of Ophthalmology, Taipei Veterans General Hospital, No.201, Shih-Pai Road, Section 2, Taipei 112, Taiwan; jlliu{at}


Purpose To evaluate the 1-year progression of myopia and associated risk factors in second-grade primary school children.

Methods The myopia investigation study in Taipei provided semiannual visual acuity testing and cycloplegic refraction for all second-grade primary school children (mean age: 7.49 years) in Taipei who provided parental consent. A questionnaire was distributed to the participants’ parents before the first and third examinations. We evaluated 1-year follow-up data for children noted to have myopia on the first examination. Multinomial logistic regression models were applied to assess risk factors associated with myopia progression. Myopia progression was categorised, based on the change in spherical equivalent (ΔSE) over 1 year, as slow (ΔSE>−0.5 dioptres (D)), moderate (−1.0 D<ΔSE≤−0.5 D) or fast (ΔSE≤−1.0 D). Of the 4214 myopic children, data were analysed for 3256 (77.3%) who completed the 1-year follow-up evaluation.

Results The baseline SE was −1.43±1.1 D. The average ΔSE was −0.42±0.85 D, with 46.96%, 28.50% and 24.54% of the study subjects showing slow, moderate and fast myopia progression, respectively. When compared with slow myopia progression, fast myopia progression was associated with a greater myopic SE at baseline (OR: 0.67, 95% CI: 0.61 to 0.72) and a shorter eye–object distance when doing near work (OR: 1.45, 95% CI: 1.18 to 1.78). More outdoor activity time and self-reported cycloplegic treatment were not associated with slow myopia progression.

Conclusions Children with fast annual myopia progression were more myopic at baseline and had a shorter reading distance. Our study results highlight the importance of having children keep a proper reading distance.

  • cycloplegic
  • myopia progression
  • population-based study

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  • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data for the work: C-CH, NH, P-YL, S-YF, D-CT, S-YC, C-YT, L-CW, S-HC, CJ-LL. Drafting the work or revising it critically for important intellectual content: C-CH, NH, P-YL, S-YF, D-CT, S-YC, C-YT, L-CW, S-HC, CJ-LL. Final approval of the version to be published: C-CH, NH, P-YL, S-YF, D-CT, S-YC, C-YT, L-CW, S-HC, CJ-LL. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: C-CH, NH, P-YL, S-YF, D-CT, S-YC, C-YT, L-CW, S-HC, CJ-LL.

  • Competing interests None declared.

  • Ethics approval Taipei City Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. The affiliation of Professor Lin-Chung Woung hs changed to “4,8” not “8”.