ImportanceMyopia in school-aged children is a public health issue worldwide; consequently, effective interventions to prevent onset and progression are required.ObjectiveTo investigate whether SMS text messages to parents increase light exposure and time outdoors in school-aged children and provide effective myopia control.Design, Setting, and ParticipantsThis randomized clinical trial was conducted in China from May 2017 to May 2018, with participants observed for 3 years. Of 528 965 primary school–aged children from Anyang, 3113 were randomly selected. Of these, 268 grade 2 schoolchildren were selected and randomly assigned to SMS and control groups. Data were analyzed from June to December 2021.InterventionsParents of children in the SMS group were sent text messages twice daily for 1 year to take their children outdoors. All children wore portable light meters to record light exposure on 3 randomly selected days (2 weekdays and 1 weekend day) before and after the intervention.Main Outcomes and MeasuresThe co–primary outcomes were change in axial length (axial elongation) and change in spherical equivalent refraction (myopic shift) from baseline as measured at the end of the intervention and 3 years later. A secondary outcome was myopia prevalence.ResultsOf 268 grade 2 schoolchildren, 121 (45.1%) were girls, and the mean (SD) age was 8.4 (0.3) years. Compared with the control group, the SMS intervention group demonstrated greater light exposure and higher time outdoors during weekends, and the intervention had significant effect on axial elongation (coefficient, 0.09; 95% CI, 0.02-0.17; P = .01). Axial elongation was lower in the SMS group than in the control group during the intervention (0.27 mm [95% CI, 0.24-0.30] vs 0.31 mm [95% CI, 0.29-0.34]; P = .03) and at year 2 (0.39 mm [95% CI, 0.35-0.42] vs 0.46 mm [95% CI, 0.42-0.50]; P = .009) and year 3 (0.30 mm [95% CI, 0.27-0.33] vs 0.35 mm [95% CI, 0.33-0.37]; P = .005) after the intervention. Myopic shift was lower in the SMS group than in the control group at year 2 (−0.69 diopters [D] [95% CI, −0.78 to −0.60] vs −0.82 D [95% CI, −0.91 to −0.73]; P = .04) and year 3 (−0.47 D [95% CI, −0.54 to −0.39] vs −0.60 D [95% CI, −0.67 to −0.53]; P = .01) after the intervention, as was myopia prevalence (year 2: 38.3% [51 of 133] vs 51.1% [68 of 133]; year 3: 46.6% [62 of 133] vs 65.4% [87 of 133]).Conclusions and RelevanceIn this randomized clinical trial, SMS text messages to parents resulted in lower axial elongation and myopia progression in schoolchildren over 3 years, possibly through increased outdoor time and light exposure, showing promise for reducing myopia prevalence.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR-IOC-17010525

Prevalence of RA in the Chinese 12-year-old children was relatively high compared with other studies. RA and CA had mainly 'WTR' astigmatism, while IA was mainly ATR and partially compensated for CA. Girls had greater means and prevalences of CA and IA than did boys. Both RA and CA, but not IA, increased with refractive errors away from emmetropia.

Purpose The purpose of the study was to evaluate myopia progression and axial elongation after stopping 0.01% atropine eye drops through a 2‐year cross‐over study. Methods This study was a randomized, double‐masked, placebo‐controlled, cross‐over trial in mainland China. 220 children aged 6–12 years with spherical equivalent range of −1.00 D to −6.00 D in both eyes were enrolled in Phase 1 for 1 year. Children who had completed the first year's follow‐up continued in the second phase. In Phase 2, the placebo group was crossed over to the 0.01% atropine group (referred to as the ‘placebo‐atropine group’), and the 0.01% atropine group was crossed over to the placebo group (referred to as the ‘atropine‐placebo group’). All children underwent the examination of cycloplegic refraction and axial length at a 6‐month interval. Only data from right eyes were included in analysis. Results One hundred thirty‐three subjects completed 2 years of follow‐up. In the first year, the mean myopia progression in atropine‐placebo group was 0.21 ± 0.08 D slower than that in placebo‐atropine group. After cross‐over treatment, the mean myopia progression in atropine‐placebo group was 0.22 ± 0.07D faster than that in placebo‐atropine group in the second year. Over 2 years, the mean myopia progression was −1.26 ± 0.66D and −1.25 ± 0.70D in the atropine‐placebo and placebo‐atropine groups (p = 0.954). Conclusions The difference in myopia progression between atropine‐placebo group and placebo‐atropine group in Phase 1 was similar to Phase 2 during the cross‐over treatment. Through our cross‐over trial, the results suggest that there is no rebound effect after using 0.01% atropine eye drops to prevent progression of myopia.