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Refractive power was measured with non-cycloplegic autorefraction over a 2-year follow-up period. FAR was objectively evaluated using geographical information system technology. Mixed-effects logistic regression models were constructed to examine the association of FAR with a 2-year cumulative incidence of myopia among individuals without baseline myopia; multiple linear regression model, with a 2-year cumulative incidence rate of myopia at each school.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 101\u2009624 non-myopic children (56.3% boys; mean (SE) age, 7.657\u00b11.182 years) included in the study, 26\u2009391 (26.0%) of them developed myopia after 2 years. In the individual-level analysis adjusting for demographic, socioeconomic and greenness factors, an IQR in FAR was associated with a decreased risk of 2-year myopia incidence (OR 0.898, 95% CI 0.866 to 0.932, p&lt;0.001). Similar findings were observed in the analysis additionally adjusted for genetic and behavioural factors (OR 0.821, 95% CI 0.766 to 0.880, p&lt;0.001). In the school-level, an IQR increase in FAR was found to be associated with a 2.0% reduction in the 2-year incidence rate of myopia (95%\u2009CI 1.3% to 2.6%, p&lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Exposure to higher FAR was associated with a decreased myopia incidence, providing insights into myopia prevention through school built environments in China.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjo-2024-325448","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T17:20:31Z","timestamp":1719940831000},"page":"146-151","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Shaping school for childhood myopia: the association between floor area ratio of school environment and myopia in 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