{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T03:16:07Z","timestamp":1777086967648,"version":"3.51.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>School myopia screening commonly employs non-cycloplegic spherical equivalent refraction (SER \u2264 \u22120. 50 D) for its practicality. However, this SER-only approach likely overestimates the prevalence of visually significant myopia, as it cannot distinguish true myopia from accommodative pseudomyopia, especially in younger children. We quantified the disparity between this SER-only criterion and a combined criterion integrating uncorrected visual acuity (UCVA), the SER + UCVA criterion, and examined its variation across age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This serial cross-sectional study (2018\u20132021) included 20,750 students aged 5\u201318 years from Southern China. Myopia was defined using two criteria based on non-cycloplegic measurements in at least one eye: (1) SER-only: SER \u2264 \u22120.50 D; and (2) SER + UCVA: SER \u2264 \u22120.50 D plus age-impaired UCVA (&amp;gt;0.20 logMAR at age 5; &amp;gt;0.00 logMAR at ages \u22656) in the same eye. Age-stratified prevalence estimates were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The SER + UCVA criterion yielded consistently lower prevalence estimates than the SER-only criterion (e.g., 48.89% vs. 59.48% in 2021), corresponding to a 15\u201321% annual relative overestimation. Crucially, this overestimation demonstrated a strong age gradient. It was most severe in young children, with the SER-only myopia prevalence nearly double the SER + UCVA myopia prevalence at ages 5\u20136 years (relative difference &amp;gt;50%), and progressively narrowed to approximately 10\u201315% in adolescents (14\u201318 years). Notably, a significant acceleration in SER + UCVA myopia prevalence was observed in children aged 7\u201310 years between 2019 and 2020. Furthermore, from age 10 onwards, SER + UCVA myopia prevalence was significantly higher in females than males (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sole reliance on non-cycloplegic SER substantially overestimates the burden of visually significant myopia, especially in younger children. Incorporating UCVA provides a more accurate and functionally relevant metric for public health screening. We advocate for adopting age-specific SER + UCVA criteria in school-based screenings to optimize referral efficiency, with the greatest benefit expected for younger populations where specificity gains are maximal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1776604","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:22:48Z","timestamp":1773897768000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Combining visual acuity with refraction reduces overestimation of myopia prevalence in school screenings: an age-stratified analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ningfeng","family":"Li","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology","place":["Guangzhou, China"]},{"name":"Department of Ophthalmology, Guangzhou First 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