{
  "abstract": "Background Cycloplegic autorefraction may offer higher diagnostic accuracy than uncorrected visual acuity (VA) screening. We aimed to evaluate diagnostic yield and risk factors for previously unrecognised myopia.Methods This repeated cross-sectional study analysed data from 33 642 kindergarteners aged 5–6 years enrolled in the Yilan Myopia Prevention and Vision Improvement Program from 2014 to 2024. Participants underwent uncorrected VA testing and on-site cycloplegic autorefraction. Caregivers completed questionnaires on myopia-related behaviours. Previously unrecognised or newly detected myopia (NDM), defined as spherical equivalent ≤−0.50 dioptres without prior diagnosis. The main outcome was diagnostic yield, defined as the proportion of NDM among at-risk participants by different screening methods.Results Among 33 642 participants (mean age, 5.23±0.41 years; 51.7% boys), 3206 (9.5%) were identified myopic, including 2303 (6.8%) who were newly detected through cycloplegic autorefraction, yielding a diagnostic rate of 7.03% (95% CI 6.76% to 7.32%). Only 47.9% children with NDM met the reduced VA referral criterion (uncorrected VA <6/7.5 in either eye), and the diagnostic yield of VA screening was 3.37% (95% CI 3.18% to 3.57%; area under the ROC curve: 0.743). NDM was significantly associated with weekend behaviours including digital screen time ≥2 hours/day (OR, 1.13; 95% CI 1.03 to 1.23) and outdoor time ≥2 hours/day (OR, 0.85; 95% CI 0.78 to 0.94). In contrast, previously detected myopia showed no association with these modifiable factors.Conclusions Preschool myopia screening using cycloplegic autorefraction significantly improves early detection compared with VA screening. Timely diagnosis raises parental awareness and empowers children to modify myopia-related behaviours.",
  "authors": [
    {
      "affiliations": [
        "Department of Ophthalmology, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan"
      ],
      "name": "Chiao-Yu Wang"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan",
        "Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan"
      ],
      "name": "Yu-Chieh Yang"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan",
        "Department of Ophthalmology, Yuanshan and Suao Branch, Taipei Veterans General Hospital, Yilan, Taiwan",
        "Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"
      ],
      "name": "Hsin-Yu Yang"
    },
    {
      "affiliations": [
        "Center for Healthcare Policy and Research, University of California Davis, Davis, California, USA"
      ],
      "name": "Shao-You Fang"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan",
        "Department of Ophthalmology, Yuanshan and Suao Branch, Taipei Veterans General Hospital, Yilan, Taiwan"
      ],
      "name": "Mong-Ping Shyong"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Fu Jen Catholic University Hospital, New Taipei, Taiwan",
        "School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan"
      ],
      "name": "Chia-Wei Lee"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, Lo-Hsu Medical Foundation Lotung Poh-Ai Hospital, Yilan, Taiwan"
      ],
      "name": "Pei-Wei Huang"
    },
    {
      "affiliations": [
        "Public Health Bureau, Yilan County, Taiwan"
      ],
      "name": "Yen-Lin Chen"
    },
    {
      "affiliations": [
        "Public Health Bureau, Yilan County, Taiwan",
        "Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan",
        "School of Medcine, National Yang Ming Chiao Tung University, Taipei, Taiwan",
        "National Yang Ming Chiao Tung University Institute of Public Health, Taipei City, Taiwan"
      ],
      "name": "Nai-Wei Hsu"
    },
    {
      "affiliations": [
        "Department of Ophthalmology, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan",
        "School of Medcine, National Yang Ming Chiao Tung University, Taipei, Taiwan",
        "National Yang Ming Chiao Tung University Institute of Public Health, Taipei City, Taiwan"
      ],
      "name": "Der-Chong Tsai"
    }
  ],
  "title": "Cycloplegic autorefraction doubles diagnostic yield of myopia compared to vision testing: findings from a decade-long screening programme",
  "uid": "87c895cb-bfad-5e8a-9986-3edd49d73965"
}