{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T18:07:16Z","timestamp":1779127636672,"version":"3.51.4"},"reference-count":35,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Asia Cornea Foundation","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"crossref","award":["NMRC 006\/2016-00"],"award-info":[{"award-number":["NMRC 006\/2016-00"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,4,26]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Identification of risk factors associated with incident myopia at 1 and 2 years in eyes of young pre-myopic children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>150 eyes of 75 placebo-treated pre-myopic children (spherical equivalent (SER) \u22120.49 to +1.0D) from the Atropine Treatment of Myopia (ATOM3) study were analysed. Cycloplegic SER and axial length (AL) were assessed at 6 month intervals. Univariate and multivariate logistic analyses were used to study associations between myopia incidence and demographic factors, SER, AL, parental myopia and lifestyle factors. Generalised estimating equations (GEE) were used to account for clustering of eyes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>35 (23%) and 59 (39%) eyes became myopic by 1 and 2 years, respectively, with 91 (60%) remaining emmetropic. 74% of eyes with SER of \u22120.49 to 0.01D became myopic within 1 year. In eyes with SER of 0 to +0.50D, 32% and 55% became myopic at 1 and 2 years, respectively; while only 13% with SER&gt;+0.5D became myopic at 2 years. Myopia progression was greater 6 months prior to myopia onset in eyes becoming myopic (\u22120.73\u00b10.39D or 0.34\u00b10.15\u2009mm) compared with eyes remaining emmetropic (\u22120.17\u00b10.28D or 0.13\u00b10.08\u2009mm). Myopia progressions of &gt;0.3\u2009mm or \u22120.5D within the first year showed the best sensitivity-specificity balance in predicting myopia onset over 1\u20132 years. No associations were noted with baseline AL, parental myopia, books read and time outdoors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Eyes of children aged 5\u20139 years with a cycloplegic SER &lt;\u00b10.5D and myopic shift more\/equal to 0.30\u2009mm or \u22120.5D within the first year were at higher risk of becoming myopic within the next 2 years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2026-329682","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:20:20Z","timestamp":1779124820000},"page":"bjo-2026-329682","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors associated with myopia onset in pre-myopic children aged 5\u20139 years old: ATOM3"],"prefix":"10.1136","author":[{"given":"Kai-Lyn","family":"Loh","sequence":"first","affiliation":[{"name":"Singapore National Eye Centre, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Burkill","sequence":"additional","affiliation":[{"name":"Singapore Clinical Research Institute, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7166-796X","authenticated-orcid":false,"given":"Seang-Mei","family":"Saw","sequence":"additional","affiliation":[{"name":"Duke-NUS Medical School, National University of Singapore, Singapore"},{"name":"Singapore Eye Research Institute, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8166-4575","authenticated-orcid":false,"given":"Audrey","family":"Chia","sequence":"additional","affiliation":[{"name":"Singapore National Eye Centre, Singapore"},{"name":"Singapore Eye Research Institute, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"2026051810201134000_bjo-2026-329682v1.1","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":"2026051810201134000_bjo-2026-329682v1.2","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.66.12.39"},{"key":"2026051810201134000_bjo-2026-329682v1.3","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13051506","article-title":"Efficacy and Safety of Low-Dose Atropine on Myopia Prevention in Premyopic Children: Systematic Review and Meta-Analysis","volume":"13","author":"Lee","year":"2024","journal-title":"J Clin Med"},{"key":"2026051810201134000_bjo-2026-329682v1.4","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ajo.2024.08.020","article-title":"Spectacle Lenses With Highly Aspherical Lenslets for Slowing Axial Elongation and Refractive Change in Low-Hyperopic Chinese Children: A Randomized Controlled Trial","volume":"269","author":"Zhang","year":"2025","journal-title":"Am J Ophthalmol"},{"key":"2026051810201134000_bjo-2026-329682v1.5","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1080\/02713683.2025.2516007","article-title":"Effect of Repeated Intense Foveal Red-Light Therapy in Children with Pre-Myopia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"50","author":"Leber","year":"2025","journal-title":"Curr Eye Res"},{"key":"2026051810201134000_bjo-2026-329682v1.6","doi-asserted-by":"publisher","DOI":"10.1111\/opo.12305"},{"key":"2026051810201134000_bjo-2026-329682v1.7","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.04-0565"},{"key":"2026051810201134000_bjo-2026-329682v1.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12886-021-02045-8","article-title":"Prediction of premyopia and myopia in Chinese preschool children: a longitudinal cohort","volume":"21","author":"Liu","year":"2021","journal-title":"BMC Ophthalmol"},{"key":"2026051810201134000_bjo-2026-329682v1.9","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1016\/j.ophtha.2022.03.017","article-title":"Premyopia at Preschool Age: Population-based Evidence of Prevalence and Risk Factors from a Serial Survey in Taiwan","volume":"129","author":"Wang","year":"2022","journal-title":"Ophthalmology"},{"key":"2026051810201134000_bjo-2026-329682v1.10","doi-asserted-by":"crossref","unstructured":"Deng YB , Wang XY , Xiao LG , et al . 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