{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:09:02Z","timestamp":1785431342441,"version":"3.56.0"},"reference-count":46,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"InnoHK initiative of the Innovation and Technology Commission of the Hong Kong Special Administrative Region Government"},{"name":"Johnson & Johnson Vision"},{"DOI":"10.13039\/100020485","name":"CooperVision Inc","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100020485","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Hoya Vision Care Canada"},{"name":"EssilorLuxottica Canada"},{"DOI":"10.13039\/501100002791","name":"Canadian Optometric Education Trust Fund","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002791","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/01t1a2303","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Given the growing prevalence of myopia worldwide, prevention and proactive management of at-risk children becomes increasingly important. This study sought to evaluate trends in myopia development in pediatric pre-myopic patients and determine how optometrists in Canada manage pre-myopia. Methods: In this retrospective chart review, records for children aged 6\u201310 years who had an eye exam between 2017 and 2021 were reviewed. Pre-myopic children were included if the presenting refraction at the first visit was between +0.75D and \u22120.25D (inclusive). Up to five unique patients were selected for each age (6, 7, 8, 9, and 10) and initial visit year (2017 to 2021) at each clinical site. Demographic information, refractive status and recommended interventions were recorded. Results: A total of 1740 pre-myopic patients were included across 15 practices in Ontario, of which 184 patients developed myopia (10.6%) during the years studied. Cohort year groups did not differ in baseline age (mean \u00b1 SD 8.39 \u00b1 1.43 years) or baseline refractive error (+0.13 \u00b1 0.27 DS). At initial encounters, most clinicians monitored without intervention (mean across cohort years 91.9%), with some recommending lifestyle changes (3.5%) and SV spectacles\/CL (3.0%). This pattern remained stable over the years studied. Pre-myopic children developed myopia at a similar age over the study period (mean \u00b1 SE: 9.66 \u00b1 0.16 years) and experienced a faster rate of loss of hyperopic reserve (loss of \u22120.26 \u00b1 0.07 D\/year in the 2017 cohort vs. \u22120.73 \u00b1 0.18 D\/year in the 2020 cohort and \u22120.71 \u00b1 0.10 D\/year in the 2021 cohort) regardless of patient age. Conclusions: Pre-myopic children in the 2020 and 2021 cohort years experienced an accelerated loss of hyperopic reserve compared to those in the 2017 cohort. Despite this, very few pre-myopic children were recommended lifestyle changes, which were known to be effective for delaying myopia onset. Since delaying myopia onset may be more impactful than subsequent myopia treatment, additional research should focus on effective interventions for the pre-myopic population.<\/jats:p>","DOI":"10.3390\/jcm15072748","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T02:06:21Z","timestamp":1775441181000},"page":"2748","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pre-Myopic Children: Trends in Myopia Development and Management in Canada"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3832-6762","authenticated-orcid":false,"given":"Amy H. Y.","family":"Chow","sequence":"first","affiliation":[{"name":"School of Optometry and Vision Science, University of Waterloo, 200 Columbia Street West, Waterloo, ON N2L 3G1, Canada"},{"name":"Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Caffery","sequence":"additional","affiliation":[{"name":"Toronto Eye Care, Toronto, ON M4W 1A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Di Marco","sequence":"additional","affiliation":[{"name":"Toronto Eye Care, Toronto, ON M4W 1A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7282-3848","authenticated-orcid":false,"given":"Sarah","family":"Guthrie","sequence":"additional","affiliation":[{"name":"School of Optometry and Vision Science, University of Waterloo, 200 Columbia Street West, Waterloo, ON N2L 3G1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Acs","sequence":"additional","affiliation":[{"name":"Toronto Eye Care, Toronto, ON M4W 1A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Fromstein","sequence":"additional","affiliation":[{"name":"Dr. Shalu Pal & Associates\u2014Yorkville Eye Institute, Toronto, ON M5S 2V1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalu","family":"Pal","sequence":"additional","affiliation":[{"name":"Dr. Shalu Pal & Associates\u2014Yorkville Eye Institute, Toronto, ON M5S 2V1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Ramdass","sequence":"additional","affiliation":[{"name":"Eyeacademy.ca, 800 Southdown Rd Unit A2, Mississauga, ON L5J 2Y4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishakha","family":"Thakrar","sequence":"additional","affiliation":[{"name":"Vaughan Vision Centre, Toronto, ON L4K 0H2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Zeidenberg","sequence":"additional","affiliation":[{"name":"School of Optometry and Vision Science, University of Waterloo, 200 Columbia Street West, Waterloo, ON N2L 3G1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah A.","family":"Jones","sequence":"additional","affiliation":[{"name":"School of Optometry and Vision Science, University of Waterloo, 200 Columbia Street West, Waterloo, ON N2L 3G1, Canada"},{"name":"Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"Mi","DOI":"10.1167\/iovs.18-25983","article-title":"Myopia\u2014A 21st Century Public Health Issue","volume":"60","author":"Resnikoff","year":"2019","journal-title":"Investig. 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