{
  "abstract": "Purpose To explore intergenerational changes in the myopia epidemic in China in a sample of twins and their parents.Methods Longitudinal cohort study. A total of 686 children with baseline age from 7 to 15 years were followed annually from 2006 to 2018. Cycloplegic refractions and ocular biometry of the children and non-cycloplegic refractions and ocular biometry of the parents were measured.Results The myopia prevalence in the young adult children was 78.0%, while it was 42.1% in the parents. The prevalence of high myopia (9.6% vs 5.2%) and moderate myopia (38.8% vs 9.9%) was higher in the children, while the percentage of mild hyperopia (9.5% vs 16.3%) and emmetropia (10.6% vs 40.0%) was lower. No significant difference was found in extremely high myopia (2.2% vs 1.9%) and severe hyperopia (1.9% vs 1.6%). The distribution of refraction in the younger generation had a marked plateau in the zone of −6.0 D to −0.5 D, rather than the tighter peak around −1.0 D in parents. The correlation between the percentile position in the distributions of refraction of the parents and children was low (about 0.30). The distribution of axial length changed significantly, but there was little change in lens power, corneal power and corneal radius of curvature.Conclusions Major increases in the prevalence and severity of myopia between generations in China are largely due to increased axial elongation in the children. These increases are consistent with the known causal impacts of increased educational pressures and decreased time outdoors.",
  "authors": [
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, GD, People's Republic of China"
      ],
      "name": "Xin Chen"
    },
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, GD, People's Republic of China"
      ],
      "name": "Yin Hu"
    },
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, GD, People's Republic of China",
        "Research School of Biology, Australian National University, Canberra, Australian Capital Territory, Australia"
      ],
      "name": "Ian Morgan"
    },
    {
      "affiliations": [
        "School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, People's Republic of China",
        "Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong, People's Republic of China",
        "Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, People's Republic of China"
      ],
      "name": "Mingguang He"
    },
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, GD, People's Republic of China"
      ],
      "name": "Xiaohu Ding"
    }
  ],
  "title": "Intergenerational change in China’s epidemic of myopia: the impact of the social environment",
  "uid": "2203bfb4-60c0-5291-bff3-22b521592c0f"
}