{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:16:30Z","timestamp":1787940990220,"version":"build-2784847793"},"reference-count":35,"publisher":"BMJ","funder":[{"name":"Collaborative Research Fund","award":["C7149-20G"],"award-info":[{"award-number":["C7149-20G"]}]},{"DOI":"10.13039\/501100005847","name":"Health and Medical Research Fund","doi-asserted-by":"publisher","award":["5160836"],"award-info":[{"award-number":["5160836"]}],"id":[{"id":"10.13039\/501100005847","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CUHK Jockey Club Children\u2019s Eye Care Programme","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"General Research Fund","award":["14103419"],"award-info":[{"award-number":["14103419"]}]},{"name":"General Research Fund","award":["14111515"],"award-info":[{"award-number":["14111515"]}]},{"DOI":"10.13039\/501100008391","name":"UBS Optimus Foundation","doi-asserted-by":"publisher","award":["8984"],"award-info":[{"award-number":["8984"]}],"id":[{"id":"10.13039\/501100008391","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centaline Myopia Fund","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Direct Grants of the Chinese University of Hong Kong","award":["4054121"],"award-info":[{"award-number":["4054121"]}]},{"name":"Direct Grants of the Chinese University of Hong Kong","award":["4054199"],"award-info":[{"award-number":["4054199"]}]},{"name":"Direct Grants of the Chinese University of Hong Kong","award":["4054762"],"award-info":[{"award-number":["4054762"]}]},{"DOI":"10.13039\/501100010428","name":"Innovation and Technology Fund","doi-asserted-by":"publisher","award":["7010590"],"award-info":[{"award-number":["7010590"]}],"id":[{"id":"10.13039\/501100010428","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CUHK Jockey Club Myopia Prevention Programme","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Lim Por-yen Eye Genetics Research Centre","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,8,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/aims<\/jats:title>\n                    <jats:p>To investigate temporal trends in refractive and corneal astigmatism (CA) in adults and examine their association with the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This population-based cross-sectional study included adults (\u226518 years) recruited from parents participating in the Hong Kong Children\u2019s Eye Study who underwent comprehensive ocular examinations at two academic centres (2015\u20132024). Refractive error of the worse eye and corresponding CA were measured using an autorefractor and optical biometry without cycloplegia. Age-standardised prevalence was calculated annually. Logistic regression assessed associations between the pandemic period and astigmatism, adjusting for age, sex, axial length and spherical equivalent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 29\u2009583 adults (mean age 40.6\u00b15.6 years; 35.3% men) were included. Age-standardised prevalence of refractive astigmatism (RA) increased from 41.7% in 2015 to 46.2% in 2024 (p=0.002) and CA from 45.0% to 52.9% (p=0.002). Compared with 2015, the adjusted odds of RA in 2024 increased by 52% (OR 1.52, 95%\u2009CI 1.30 to 1.76; p=9.34\u00d710\n                      <jats:sup>\u22128<\/jats:sup>\n                      ), and CA by 47% (OR 1.47, 95%\u2009CI 1.27 to 1.71; p\n                      <jats:italic>=<\/jats:italic>\n                      2.38\u00d710\n                      <jats:sup>\u22127<\/jats:sup>\n                      ). Mean refractive and CA increased by 0.11 D and 0.14 D, respectively. A shift towards moderate and severe astigmatism was observed. CA correlated strongly with K2 (\u03b2=0.891, p&lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The prevalence and severity of astigmatism in adults increased following the COVID-19 pandemic, independent of axial length and spherical equivalent. Findings suggest corneal changes, especially along the steep meridian, may underlie this trend and warrant further investigation into environmental and lifestyle factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2026-329895","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:20:20Z","timestamp":1787937620000},"page":"bjo-2026-329895","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Astigmatism trends in adults of Hong Kong from 2015 to 2024: The Hong Kong Children Eye Study"],"prefix":"10.1136","author":[{"given":"Ka Wai","family":"Kam","sequence":"first","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China"},{"name":"Department of Ophthalmology, Alice Ho Miu Ling Nethersole Hospital 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8515-3388","authenticated-orcid":false,"given":"Yuzhou","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9744-4546","authenticated-orcid":false,"given":"Erica","family":"Shing","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandy P H","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvin L","family":"Young","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China"},{"name":"Department of Ophthalmology, Alice Ho Miu Ling Nethersole Hospital SAR, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4407-6907","authenticated-orcid":false,"given":"Clement C","family":"Tham","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China"},{"name":"Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, Hong Kong"},{"name":"Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, Hong 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