{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T16:36:31Z","timestamp":1793118991087,"version":"4.5.0"},"reference-count":24,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82171100"],"award-info":[{"award-number":["82171100"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82273648"],"award-info":[{"award-number":["82273648"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Excellent Academic Leader of Shanghai Science and Technology Commission","award":["22XD1422900"],"award-info":[{"award-number":["22XD1422900"]}]},{"name":"Talent Program of Shanghai Municipal Health and Health Commission","award":["2022XD032"],"award-info":[{"award-number":["2022XD032"]}]},{"name":"Key Discipline Construction Project of the Sixth Three-Year Action Plan for Public Health System Construction in Shanghai","award":["GWVI-11.1-30"],"award-info":[{"award-number":["GWVI-11.1-30"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,9,20]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate the effect of time outdoors on myopic shift among premyopic children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Post-hoc analysis was nested in a cluster-randomised trial of the Shanghai Time Outside to Reduce Myopia (STORM) study. 6- to 9-year-old participants without myopia from the STORM study, who wore wristwatches to monitor time outdoors from 2017 to 2018, were included. Participants were all examined with cycloplegic refraction. Daily time outdoors was objectively monitored with the wearable smartwatch. Premyopia was defined as a cycloplegic spherical equivalent (SE) from \u22120.50 to +0.75 (inclusive) dioptres (D). Myopic shift was SE change from baseline to 1\u2009year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3194 participants (1369 premyopic; mean age 8.2\u00b10.6 years; 49.5% boys), there were no statistical differences between premyopic and hyperopic children in time outdoors (p=0.303). Hyperopes showed reduced myopic shift with increasing outdoor time (plateau at about 120\u2009min\/day). However, premyopes exhibited a J-shaped relationship between time outdoors and myopic shift. In comparison to the subgroup with daily time outdoors &lt;60\u2009min, the difference in SE change in the other subgroups was not statistically significant (61\u201390\u2009min\/d: \u22120.03 (95% CI \u22120.10 to 0.05); 91\u2013120\u2009min\/d: \u22120.03 (95% CI \u22120.11 to 0.05)). The reduced myopic shift was only observed with time outdoors &gt;120\u2009min\/d, although it was still not statistically significant (&gt;120\u2009min\/d: 0.04 (95% CI \u22120.05 to 0.14)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among premyopic children, increased time outdoors has a limited protective effect on myopic shift, suggesting longer duration of time outdoors or additional interventions to prevent or delay myopia onset in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-327768","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T17:20:29Z","timestamp":1759944029000},"page":"363-369","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Time outdoors prevents myopia in hyperopic children, but protection is weaker in premyopic children: a post-hoc analysis of a cluster-randomised trial"],"prefix":"10.1136","volume":"110","clinical-trial-number":[{"clinical-trial-number":"nct02980445","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Jun","family":"Chen","sequence":"first","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3611-8778","authenticated-orcid":false,"given":"Ziyi","family":"Qi","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4548-3574","authenticated-orcid":false,"given":"Ian","family":"Morgan","sequence":"additional","affiliation":[{"name":"Research School of Biology, Australian National University, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2851-4145","authenticated-orcid":false,"given":"Kathryn","family":"Rose","sequence":"additional","affiliation":[{"name":"Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9897-1192","authenticated-orcid":false,"given":"Zhuoting","family":"Zhu","sequence":"additional","affiliation":[{"name":"Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohu","family":"Ding","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2279-9514","authenticated-orcid":false,"given":"Jingjing","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linlin","family":"Du","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4031-7040","authenticated-orcid":false,"given":"Jinliuxing","family":"Yang","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4453-611X","authenticated-orcid":false,"given":"Jianfeng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Gao","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haidong","family":"Zou","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingguang","family":"He","sequence":"additional","affiliation":[{"name":"The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4246-4343","authenticated-orcid":false,"given":"Xun","family":"Xu","sequence":"additional","affiliation":[{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8938-1879","authenticated-orcid":false,"given":"Xiangui","family":"He","sequence":"additional","affiliation":[{"name":"Shanghai Eye Diseases Prevention &Treatment Center\/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China"},{"name":"National Clinical Research Center for Eye Diseases, Shanghai, China"},{"name":"Shanghai Engineering Research Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China"},{"name":"Eye Public Health Research Center, School of Medicine, Tongji University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"2026032002151785000_110.4.363.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60272-4\/ATTACHMENT\/0F5F6EBF-EF8E-40A2-976A-151807B53A81\/MMC1.PDF"},{"key":"2026032002151785000_110.4.363.2","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.62.5.2","article-title":"IMI Impact of Myopia","volume":"62","author":"Sankaridurg","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026032002151785000_110.4.363.3","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000002590"},{"key":"2026032002151785000_110.4.363.4","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.18-25957"},{"key":"2026032002151785000_110.4.363.5","first-page":"1314","article-title":"Epidemiology of premyopia among children aged 6-8 in Shanghai","volume":"43","author":"Qi","year":"2022","journal-title":"Chin J Sch Health"},{"key":"2026032002151785000_110.4.363.6","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.06-0562"},{"key":"2026032002151785000_110.4.363.7","doi-asserted-by":"crossref","first-page":"3091","DOI":"10.1167\/iovs.18-26247","article-title":"Axial Growth and Lens Power Loss at Myopia Onset in Singaporean Children","volume":"60","author":"Rozema","year":"2019","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026032002151785000_110.4.363.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.01.017"},{"key":"2026032002151785000_110.4.363.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.10803"},{"key":"2026032002151785000_110.4.363.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.12.011"},{"key":"2026032002151785000_110.4.363.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2022.06.024"},{"key":"2026032002151785000_110.4.363.12","doi-asserted-by":"publisher","DOI":"10.1111\/aos.13403"},{"key":"2026032002151785000_110.4.363.13","doi-asserted-by":"crossref","first-page":"100140","DOI":"10.1016\/j.apjo.2025.100140","article-title":"Outdoor activity during class recess prevents myopia onset and shift in premyopic children: Subgroup analysis in the recess outside classroom study","volume":"14","author":"Wu","year":"2025","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2026032002151785000_110.4.363.14","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/ceo.13391","article-title":"Shanghai Time Outside to Reduce Myopia trial: design and baseline data","volume":"47","author":"He","year":"2019","journal-title":"Clinical Exper Ophthalmology"},{"key":"2026032002151785000_110.4.363.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12967-019-2057-2","article-title":"Discrimination of indoor versus outdoor environmental state with machine learning algorithms in myopia observational studies","volume":"17","author":"Ye","year":"2019","journal-title":"J Transl Med"},{"key":"2026032002151785000_110.4.363.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2004.08.008"},{"key":"2026032002151785000_110.4.363.17","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1038\/eye.2013.276","article-title":"Emmetropisation and the aetiology of refractive errors","volume":"28","author":"Flitcroft","year":"2014","journal-title":"Eye (Lond)"},{"key":"2026032002151785000_110.4.363.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.11.009"},{"key":"2026032002151785000_110.4.363.19","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.14-15474"},{"key":"2026032002151785000_110.4.363.20","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2024.24595","article-title":"Smartwatch Measures of Outdoor Exposure and Myopia in Children","volume":"7","author":"Chen","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2026032002151785000_110.4.363.21","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-022-26323-7","article-title":"Myopia: why the retina stops inhibiting eye growth","volume":"12","author":"Swiatczak","year":"2022","journal-title":"Sci Rep"},{"key":"2026032002151785000_110.4.363.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.visres.2024.108402"},{"key":"2026032002151785000_110.4.363.23","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.11-9379"},{"key":"2026032002151785000_110.4.363.24","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1167\/iovs.16-20894","article-title":"Time Outdoors at Specific Ages During Early Childhood and the Risk of Incident Myopia","volume":"58","author":"Shah","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2025-327768","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T09:16:10Z","timestamp":1773998170000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2025-327768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,8]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,3,20]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bjo-2025-327768"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2025-327768","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,8]]}}}