Premyopia Management With Ophthalmic Referral Slows Myopic Shift After School Entry: A Population-Based Longitudinal Study in Taiwan.

Background: This study aimed to evaluate the impact of early ophthalmic referral for premyopic preschoolers on myopic spherical equivalent (SE) shift after school entry; and to identify risk factors for nonadherence to follow-up care.

Methods: A population-based longitudinal study followed 742 premyopic preschoolers (-0.5 D < SE ≤ +0.75 D) from a countywide screening in Yilan, Taiwan (2021-2022), into first or second grade in elementary school (2023). Cycloplegic autorefraction and caregiver questionnaires were collected at baseline and follow-up. Children screened in 2022 comprised the intervention cohort, while those screened in 2021 formed the comparison cohort. Multiple regression analyses assessed factors associated with myopic SE shift and nonadherence to follow-up care.

Results: Amongst 742 premyopic children (mean [SD] age at follow-up, 7.2 [0.4] years; 57.8% boys), the overall SE progression was -0.19 (0.39) D/year and the incidence of myopia was 14.8 per 100 person-years. The intervention cohort had a slower myopic SE shift than the comparison cohort (-0.15 vs. -0.22 D/year; p = 0.009). Referral at baseline was independently associated with slower SE progression (β = 0.070; p = 0.03). Amongst those referred in the intervention cohort, 63.2% adhered to follow-up care. Nonadherence was associated with greater baseline hyperopia (adjusted OR, 3.77; 95% CI, 1.69-8.41) and rural residency (adjusted OR, 2.01; 95% CI, 1.23-3.30).

Conclusions: Early ophthalmic referral reduced myopic progression, but follow-up adherence was suboptimal, especially in children with greater hyperopia or living in rural areas.