{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:30:05Z","timestamp":1792805405077,"version":"4.5.0"},"reference-count":34,"publisher":"Association for Research in Vision and Ophthalmology (ARVO)","issue":"13","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Invest. Ophthalmol. Vis. Sci."],"DOI":"10.1167\/iovs.66.13.33","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T13:30:38Z","timestamp":1761053438000},"page":"33","source":"Crossref","is-referenced-by-count":13,"title":["Acceleration of Myopic Shifts in Refraction and Axial Elongation Begins in the Premyopia Stage"],"prefix":"10.1167","volume":"66","author":[{"given":"Wenjia","family":"Cai","sequence":"first","affiliation":[{"name":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Hu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian G","family":"Morgan","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China"},{"name":"Research School of Biology, College of Medicine, Biology and Environment, Australia National University, Canberra, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingguang","family":"He","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China"},{"name":"School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China"},{"name":"Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong, China"},{"name":"Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, China"}],"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, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"27","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"bib1","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.1016\/S0140-6736(12)60272-4","article-title":"Myopia","volume":"379","author":"Morgan","year":"2012","journal-title":"Lancet"},{"key":"bib2","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1038\/519276a","article-title":"The myopia boom","volume":"519","author":"Dolgin","year":"2015","journal-title":"Nature"},{"key":"bib3","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.preteyeres.2017.09.004","article-title":"The epidemics of myopia: aetiology and prevention","volume":"62","author":"Morgan","year":"2018","journal-title":"Prog Retin Eye Res"},{"key":"bib4","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1097\/IAE.0000000000001272","article-title":"Epidemic of pathologic myopia: what can laboratory studies and epidemiology tell us?","volume":"37","author":"Morgan","year":"2017","journal-title":"Retina"},{"key":"bib5","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1167\/tvst.13.10.11","article-title":"Is the change in prevalence of high myopia compared to that of myopia really disproportionate?","volume":"13","author":"Brennan","year":"2024","journal-title":"Transl Vis Sci Technol"},{"key":"bib6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.preteyeres.2004.06.004","article-title":"How genetic is school myopia?","volume":"24","author":"Morgan","year":"2005","journal-title":"Prog Retin Eye Res"},{"key":"bib7","doi-asserted-by":"publisher","first-page":"e1003442","DOI":"10.1371\/journal.pgen.1003442","article-title":"Focusing in on the complex genetics of myopia","volume":"9","author":"Wojciechowski","year":"2013","journal-title":"PLoS Genet"},{"key":"bib8","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1167\/iovs.66.7.4","article-title":"Perspectives on genetic and environmental factors in myopia, its prediction, and the future direction of research","volume":"66","author":"Williams","year":"2025","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib9","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1111\/opo.13464","article-title":"Myopia is predominantly genetic or predominantly environmental?","volume":"45","author":"Verhoeven","year":"2025","journal-title":"Ophthalmic Physiol Opt"},{"key":"bib10","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1167\/iovs.64.4.25","article-title":"The causal effect of education on myopia: evidence that more exposure to schooling, rather than increased age, causes the onset of myopia","volume":"64","author":"Ding","year":"2023","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib11","doi-asserted-by":"crossref","first-page":"k2022","DOI":"10.1136\/bmj.k2022","article-title":"Education and myopia: assessing the direction of causality by mendelian randomisation","volume":"361","author":"Mountjoy","year":"2018","journal-title":"BMJ"},{"key":"bib12","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1167\/iovs.63.3.15","article-title":"Exposure to the life of a school child rather than age determines myopic shifts in refraction in school children","volume":"63","author":"Ding","year":"2022","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib13","doi-asserted-by":"publisher","first-page":"3524","DOI":"10.1167\/iovs.06-1118","article-title":"Parental history of myopia, sports and outdoor activities, and future myopia","volume":"48","author":"Jones","year":"2007","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib14","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1016\/j.ophtha.2007.12.019","article-title":"Outdoor activity reduces the prevalence of myopia in children","volume":"115","author":"Rose","year":"2008","journal-title":"Ophthalmology"},{"key":"bib15","doi-asserted-by":"publisher","first-page":"1462","DOI":"10.1016\/j.ophtha.2020.01.054","article-title":"Increased time outdoors is followed by reversal of the long-term trend to reduced visual acuity in Taiwan primary school students","volume":"127","author":"Wu","year":"2020","journal-title":"Ophthalmology"},{"key":"bib16","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1001\/jama.2015.10803","article-title":"Effect of time spent outdoors at school on the development of myopia among children in China: a randomized clinical trial","volume":"314","author":"He","year":"2015","journal-title":"JAMA"},{"key":"bib17","doi-asserted-by":"publisher","first-page":"7871","DOI":"10.1167\/iovs.13-12403","article-title":"Myopia stabilization and associated factors among participants in the Correction of Myopia Evaluation Trial (COMET)","volume":"54","author":"COMET Group","year":"2013","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib18","doi-asserted-by":"publisher","first-page":"2510","DOI":"10.1167\/iovs.06-0562","article-title":"Refractive error, axial length, and relative peripheral refractive error before and after the onset of myopia","volume":"48","author":"Mutti","year":"2007","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib19","doi-asserted-by":"publisher","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":"bib20","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1167\/iovs.09-3431","article-title":"Ocular component growth curves among Singaporean children with different refractive error status","volume":"51","author":"Wong","year":"2010","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib21","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1016\/j.ophtha.2012.01.017","article-title":"Annual changes in refractive errors and ocular components before and after the onset of myopia in Chinese children","volume":"119","author":"Xiang","year":"2012","journal-title":"Ophthalmology"},{"key":"bib22","doi-asserted-by":"publisher","first-page":"M20","DOI":"10.1167\/iovs.18-25957","article-title":"IMI - defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies","volume":"60","author":"Flitcroft","year":"2019","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib23","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1001\/jamaophthalmol.2015.0471","article-title":"Prediction of juvenile-onset myopia","volume":"133","author":"Zadnik","year":"2015","journal-title":"JAMA Ophthalmol"},{"key":"bib24","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1136\/bjo-2025-327401","article-title":"Intergenerational change in China's epidemic of myopia: the impact of the social environment","volume":"109","author":"Chen","year":"2025","journal-title":"Br J Ophthalmol"},{"key":"bib25","first-page":"1","article-title":"The Guangzhou Twin Eye Study: what we learn in the context of myopia control","volume":"1","author":"Chen","year":"2024","journal-title":"Eye Science"},{"key":"bib26","doi-asserted-by":"publisher","first-page":"21704","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":"bib27","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s00417-022-05842-z","article-title":"Imposed positive defocus changes choroidal blood flow in young human subjects","volume":"261","author":"Swiatczak","year":"2023","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"bib28","doi-asserted-by":"publisher","first-page":"108402","DOI":"10.1016\/j.visres.2024.108402","article-title":"Mechanisms of emmetropization and what might go wrong in myopia","volume":"220","author":"Schaeffel","year":"2024","journal-title":"Vision Res"},{"key":"bib29","doi-asserted-by":"publisher","first-page":"4399","DOI":"10.1167\/iovs.16-21279","article-title":"Subclinical decrease in central inner retinal activity is associated with myopia development in children","volume":"58","author":"Li","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib30","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/S0002-9394(99)00452-3","article-title":"Refractive error study in children: results from Shunyi District, China","volume":"129","author":"Zhao","year":"2000","journal-title":"Am J Ophthalmol"},{"key":"bib31","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.ophtha.2006.08.020","article-title":"Refractive error and visual impairment in school children in rural southern China","volume":"114","author":"He","year":"2007","journal-title":"Ophthalmology"},{"key":"bib32","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1167\/iovs.03-1051","article-title":"Refractive error and visual impairment in urban children in southern China","volume":"45","author":"He","year":"2004","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"bib33","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1375\/twin.12.1.86","article-title":"Comparisons of refractive errors between twins and singletons in Chinese school-age samples","volume":"12","author":"Hur","year":"2009","journal-title":"Twin Res Hum Genet"},{"key":"bib34","doi-asserted-by":"publisher","first-page":"5565","DOI":"10.1167\/iovs.11-7258","article-title":"Ophthalmic phenotypes and the representativeness of twin data for the general population","volume":"52","author":"Sanfilippo","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"}],"container-title":["Investigative Ophthalmology &amp; Visual Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/iovs.arvojournals.org\/article.aspx?articleid=2810979","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:32:03Z","timestamp":1791927123000},"score":1,"resource":{"primary":{"URL":"https:\/\/iovs.arvojournals.org\/article.aspx?articleid=2810979"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":34,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.1167\/iovs.66.13.33","relation":{},"ISSN":["1552-5783"],"issn-type":[{"value":"1552-5783","type":"print"}],"subject":[],"published":{"date-parts":[[2025,10,21]]}}}