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Refractive change and incidence of myopia among rural Chinese children: the Handan Offspring Myopia Study
  1. Zhong Lin1,2,
  2. Balamurali Vasudevan3,
  3. Tieying Gao4,
  4. Hongjia Zhou1,2,
  5. Kenneth J Ciuffreda5,
  6. Yuanbo Liang1,2
  1. 1The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
  2. 2National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
  3. 3College of Optometry, Midwestern University, Glendale, AZ, USA
  4. 4Handan Eye Hospital, Handan, Hebei, China
  5. 5Department of Biological and Vision Sciences, SUNY College of Optometry, New York, NY, USA, New York, NY, USA
  1. Correspondence to Dr Yuanbo Liang, The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China; yuanboliang{at}


Purpose To assess the refractive change and incidence of myopia, as well as their risk factors, among Chinese rural children aged 6–17 years.

Methods Children who completed the baseline vision examination of the Handan Offspring Myopia Study were re-examined, including both cycloplegic and non-cyloplegic autorefraction, with a mean follow-up time of 42.4±1.47 months.

Results A total of 601 children (68.5%) who completed both baseline and the follow-up examinations were enrolled. The cumulative refractive change and axial length change were −0.53±1.03 diopter and 0.39±0.46 mm (−0.15 diopter/year and 0.11 mm/year), respectively. A hundred and five out of the 469 non-myopic children at baseline become myopic at the follow-up, yielding a cumulative myopia incidence of 22.4% (95% CI: 18.6% to 26.2%), or annual myopia incidence of 6.3%. After adjustment, younger age (β=0.08, p<0.001), more myopic baseline refraction (β=0.31, p<0.001), larger difference between cycloplegic and non-cycloplegic refraction (β=−0.20, p=0.007) and more myopic paternal refraction (β=0.09, p=0.007) were found to be associated with more rapid myopic refractive change. More myopic baseline refraction (relative risk (RR), 95% CI: 0.19, 0.13–0.28, p<0.001) and more myopic paternal refraction (RR, 95% CI: 0.92, 0.84–1.00, p=0.039) were also associated with myopia incidence.

Conclusion Relatively low myopic refractive change and myopia incidence were found in this study cohort. Children’s refraction and paternal refraction were associated with both myopic refractive change and myopia incidence. Such information will be helpful for further comparisons in other rural versus urban areas of China, and other countries.

  • optics and refraction

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  • Contributors YBL had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. ZL, TYG and YBL contributed to study concept and design. ZL, TYG and HJZ contributed to acquisition, analysis or interpretation of data. ZL and BV contributed to drafting of the manuscript. YBL and KJC contributed to administrative, technical or material support. YBL contributed to study supervision.

  • Funding The study was supported by the Wenzhou Medical University R&D Fund (No. QTJ13009), Zhejiang Provincial Natural Science Foundation of China (No. LQ18H120004) and the Key Technologies R&D Program (No. 1113108019) from Bureau of Science and Technology of Handan City, Hebei Province, China.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study followed the tenets of the Declaration of Helsinki and was approved by the Ethics Committee of the Handan Eye Hospital (HandanTH200901).

  • Data availability statement Data are available upon reasonable request through Dr Lin Zhong (, once the manuscript is accepted.

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