Study: Myopia develops in 1 in 4 nonmyopic male high school students in China

Published online August 5, 2026, in Ophthalmic and Physiological Optics, an 8-year retrospective study found that approximately 1 in 4 initially nonmyopic male students enrolled in specialized senior high schools in China developed myopia during 3 years of follow-up. Students entering high school with spherical equivalent refraction (SER) of −0.25 to +0.50 D had the greatest incidence.¹

The findings suggest that clinically meaningful myopia onset continues during later adolescence, particularly among students with limited hyperopic reserve. Although the investigators projected a modest decline in incidence through 2030, the results support continued refractive surveillance during senior high school rather than assuming ocular growth and myopia risk have stabilized.

Study overview

The multiregional analysis included 5440 male students attending 16 Teenager Aviation Schools in 15 Chinese cities between September 2018 and September 2025. Participants were nonmyopic at enrollment and underwent annual visual acuity testing and cycloplegic refraction during 3 years of high school.¹

Eligibility required SER between −0.25 and +2.00 D and uncorrected visual acuity better than 6/6 in each eye. Students with vision-affecting ocular disease, trauma, or surgery were excluded, as were those receiving atropine, orthokeratology, corneal refractive surgery, or other myopia-control treatment. Myopia was defined as SER of −0.50 D or less.

The primary outcomes were incident myopia and refractive change over 3 years. Historical data were also analyzed using Gaussian process regression to project incidence and SER trends from 2026 through 2030.

Myopia incidence increased in later grades

Among 5218 students completing follow-up, 1279 developed myopia, corresponding to a 3-year incidence of 24.51%. Mean SER shifted from +0.46 D at baseline to +0.12 D after 3 years, an average myopic change of −0.34 D.¹

Incidence increased substantially across the high school period. It was 1.36% during the first year, 4.49% during the second year, and 19.74% during the third year. The investigators suggested that intensive near work before the college entrance examination may help explain the concentration of new cases in the final year, although near-work exposure was not measured.

Baseline refraction differentiated risk. Three-year incidence was 31.59% among students with baseline SER from −0.25 to +0.50 D, compared with 9.48% for SER greater than +0.50 to +1.00 D and 4.87% for SER greater than +1.00 D. These findings are consistent with prior evidence identifying less hyperopic baseline refraction as a predictor of juvenile-onset myopia.²

Across entry cohorts, incidence peaked at 32.87% in 2020 and reached a low of 13.20% in 2024. The authors linked the 2020 peak plausibly—but not causally—to pandemic-related home confinement, increased indoor activity, and reduced outdoor exposure. Previous research also documented increased myopic shifts among Chinese schoolchildren during COVID-19 restrictions.³

Clinical interpretation and limitations

Myopia remains highly prevalent among Chinese adolescents; national data cited by the investigators estimated prevalence at 81% among senior high school students. The International Myopia Institute defines premyopia as SER greater than −0.50 D and +0.75 D or less when other risk factors indicate sufficient likelihood of future myopia.⁴ The current results indicate that older adolescents near emmetropia may remain an important group for monitoring and preventive counseling.

The study’s forecasting model projected declining incidence through 2030. However, the article contains inconsistent estimates: the main results report a decrease from 22.64% in 2026 to 21.90% in 2030, whereas the abstract reports a decline from 19.23% to 16.06%. This discrepancy limits interpretation of the forecast.

Generalizability is also constrained by the all-male, highly selected population and the schools’ semi-closed structure, standardized living conditions, and daily outdoor training. The study did not measure parental myopia, near work, screen exposure, outdoor time, socioeconomic status, or educational intensity. Additionally, 222 students were lost to follow-up, and external validation of the predictive model was not reported.

Future studies should include female students and typical school populations, measure relevant environmental and familial exposures, and externally validate projections. For optometrists, the clearest immediate finding is that students entering senior high school with SER below +0.50 D may warrant closer follow-up, particularly during the final academic year.

References

1. Chen S, Yao L, Wan Y, et al. Trend of myopia incidence among adolescents (2018–2025) in senior high school: an 8-year retrospective study in multi-regions of China, with projections to 2030. Ophthalmic Physiol Opt. Published online August 5, 2026. https://doi.org/10.1007/s44402-026-00141-0

2. Zadnik K, Sinnott LT, Cotter SA, et al. Prediction of juvenile-onset myopia. JAMA Ophthalmol. 2015;133:683-689. https://doi.org/10.1001/jamaophthalmol.2015.0471

3. Wang J, Li Y, Musch DC, et al. Progression of myopia in school-aged children after COVID-19 home confinement. JAMA Ophthalmol. 2021;139:293-300. https://doi.org/10.1001/jamaophthalmol.2020.6239

4. Flitcroft DI, He M, Jonas JB, et al. IMI—defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci. 2019;60:M20-M30. https://doi.org/10.1167/iovs.18-25957