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. 2025 Jun 2;66(6):48.
doi: 10.1167/iovs.66.6.48.

Myopia Development During Transition From Kindergarten to Early Grades in Elementary School: Population-Based Evidence From an Epidemic Area in Taiwan

Yu-Chieh Yang  1   2 , Der-Chong Tsai  2   3   4 , Shao-You Fang  5 , Hsin-Yu Yang  2   6   7 , Chiao-Yu Wang  2 , Chia-Wei Lee  8   9 , Pei-Wei Huang  10 , Mong-Ping Shyong  2   6 , Yen-Lin Chen  11 , Nai-Wei Hsu  3   4   11   12
Affiliations

Myopia Development During Transition From Kindergarten to Early Grades in Elementary School: Population-Based Evidence From an Epidemic Area in Taiwan

Yu-Chieh Yang et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: The purpose of this study was to investigate the incidence of myopia, its association, and refractive progression among kindergarten non-myopic children after entering elementary schools in Yilan, Taiwan.

Methods: A cohort study was conducted on first- and second-grade elementary school students. Ocular examinations and caregiver-administered questionnaires were performed between December 2023 and March 2024, with data linked to kindergarten records from Yilan Myopia Vision Improvement Program (YMVIP). Myopia was defined as spherical equivalent (SE) ≤ -0.5 diopters (D), and premyopia as -0.5 D < SE ≤ 0.75 D.

Results: Of 1754 enrolled students, 1680 (95.73%) underwent ocular examinations, and 1554 (88.55%) were linked to kindergarten data. Among 1428 non-myopic preschoolers, the incidence density of myopia was 8.70% per person-year (95% confidence interval [CI] = 7.60%-9.80%). Children with incident myopia had a more negative baseline SE (0.33 ± 0.50 D vs. 1.02 ± 0.80 D, P < 0.001) and greater annual myopic progression (-0.60 ± 0.42 D/year vs. -0.20 ± 0.34 D/year). A multiple logistic regression model identified risk factors for incident myopia as premyopia in preschool (odds ratio [OR] = 9.641, 95% CI = 5.936-15.660, P < 0.001), having two myopic parents (OR = 1.819, 95% CI = 1.003-3.297, P = 0.049), and older age at the time of the elementary school examination (OR = 1.635, 95% CI = 1.224-2.183, P = 0.001). Spending more than 30 minutes/day outdoors on weekdays in preschool was protective against myopia (OR = 0.528, 95% CI = 0.366-0.762, P = 0.001).

Conclusions: The incidence density of myopia in Yilan County was 8.70% per person-year. Risk factors included premyopia, having myopic parents, and less outdoor time in kindergarten.

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Conflict of interest statement

Disclosure: Y.-C. Yang, None; D.-C. Tsai, None; S.-Y. Fang, None; H.-Y. Yang, None; C.-Y. Wang, None; C.-W. Lee, None; P.-W. Huang, None; M.-P. Shyong, None; Y.-L. Chen, None; N.-W. Hsu, None

Figures

Figure 1.
Figure 1.
Flowchart of the subjects participating in the study.
Figure 2.
Figure 2.
Changes in lifestyle behaviors before and after entering elementary school. (A, B) Homework time on weekdays and weekends. (C, D) Screen time on weekdays and weekends. (E, F) Outdoor time on weekdays and weekends.
See this image and copyright information in PMC

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