Role of lens in early refractive development: evidence from a large cohort of Chinese children

Xiaotong Han, Ruilin Xiong, Ling Jin, Shuai Chang, Qianyun Chen, Decai Wang, Xiang Chen, Yabin Qu, Weijia Liu, Mingguang He, Ian Morgan, Yangfa Zeng, Yizhi Liu

Research output: Journal article publicationJournal articleAcademic researchpeer-review


Aims: To document longitudinal changes in spherical equivalent refraction (SER) and related biometric factors during early refractive development. Methods: This was a prospective cohort study of Chinese children, starting in 2018 with annual follow-ups. At each visit, children received cycloplegic autorefraction and ocular biometry measurements. Lens power (LP) was calculated using Bennett's formula. Children were divided into eight groups based on baseline age: the 3-year-old (n=426, 49.77% girls), 4-year-old (n=834, 47.36% girls), 6-year-old (n=292, 46.58% girls), 7-year-old (n=964, 43.46% girls), 9-year-old (n=981, 46.18% girls), 10-year-old (n=1181, 46.32% girls), 12-year-old (n=504, 49.01%) and 13-year-old (n=644, 42.70%) age groups. Results: This study included right-eye data from 5826 children. The 3-year-old and 4-year-old age groups demonstrated an inflection point in longitudinal SER changes at a mild hyperopic baseline SER (+1 to +2 D), with children with more myopic SER showing hyperopic refractive shifts while those with more hyperopic SER showing myopic shifts. The hyperopic shift in SER was mainly attributed to rapid LP loss and was rarely seen in the older age groups. Axial elongation accelerated in the premyopia stage, accompanied by a partially counter-balancing acceleration of LP loss. For children aged 3-7 years, those with annual SER changes <0.25 D were all mildly hyperopic at baseline (mean: 1.23 D, 95% CI 1.20 to 1.27 D). Conclusion: Our findings suggest that during early refractive development, refractions cluster around or above +1.00 D. There is a pushback process in which increases in the rate of LP occur in parallel with increases in axial elongation.
Original languageEnglish
Article number324882
JournalBritish Journal of Ophthalmology
Publication statusPublished - 10 Apr 2024


  • Epidemiology
  • Lens and zonules
  • Optics and Refraction

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience


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