Importance Myopia incidence and progression has been described extensively in children. However, few data exist regarding myopia incidence and progression in early adulthood.

Objective To describe the 8-year incidence of myopia and change in ocular biometry in young adults and their association with the known risk factors for childhood myopia.

Design, Setting, and Participants The Raine Study is a prospective single-center cohort study. Baseline and follow-up eye assessments were conducted from January 2010 to August 2012 and from March 2018 to March 2020. The data were analyzed from June to July 2021. A total of 1328 participants attended the baseline assessment, and 813 participants attended the follow-up assessment. Refractive information from both visits was available for 701 participants. Participants with keratoconus, previous corneal surgery, or recent orthokeratology wear were excluded.

Exposures Participants’ eyes were examined at ages 20 years (baseline) and 28 years.

Main Outcomes and Measures Incidence of myopia and high myopia; change in spherical equivalent (SE) and axial length (AL).

Results A total of 516 (261 male [50.6%]) and 698 (349 male [50.0%]) participants without myopia or high myopia at baseline, respectively, were included in the incidences analyses, while 691 participants (339 male [49%]) were included in the progression analysis. The 8-year myopia and high myopia incidence were 14.0% (95% CI, 11.5%-17.4%) and 0.7% (95% CI, 0.3%-1.2%), respectively. A myopic shift (of 0.50 diopters [D] or greater in at least 1 eye) occurred in 261 participants (37.8%). Statistical significance was found in longitudinal changes in SE (−0.04 D per year; P < .001), AL (0.02 mm per year; P <.001), and lens thickness (0.02 mm per year; P < .001). Incident myopia was associated with self-reported East Asian vs White race (odds ratio [OR], 6.13; 95% CI, 1.06-35.25; P = .04), female vs male sex (OR, 1.81; 95% CI, 1.02-3.22; P = .04), smaller conjunctival ultraviolet autofluorescence area (per 10-mm² decrease, indicating less sun exposure; OR, 9.86; 95% CI, 9.76-9.97; P = <.009), and parental myopia (per parent; OR, 1.57; 95% CI, 1.03-2.38; P = <.05). Rates of myopia progression and axial elongation were faster in female participants (estimate: SE, 0.02 D per year; 95 % CI, 0.01-0.02 and AL, 0.007 mm per year, 95 % CI, 0.00.-0.011; P ≤ .001) and those with parental myopia (estimate per parent: SE, 0.01 D per year; 95% CI, 0.00-0.02 and AL, 95% CI, 0.002-0.008; P ≤ .001). Education level was not associated with myopia incidence or progression.

Conclusions and Relevance These findings suggest myopia progression continues for more than one-third of adults during the third decade of life, albeit at lower rates than during childhood. The protective effects of time outdoors against myopia may continue into young adulthood.

重要性 近视的发病率和进展已在儿童中得到广泛描述。然而，关于成年早期近视发病率和进展的数据很少。

目的 描述年轻人近视的 8 年发病率和眼部生物特征的变化及其与已知的儿童近视危险因素的关系。

设计、设置和参与者 Raine 研究是一项前瞻性单中心队列研究。基线和随访眼科评估分别于 2010 年 1 月至 2012 年 8 月和 2018 年 3 月至 2020 年 3 月进行。数据分析时间为 2021 年 6 月至 2021 年 7 月。共有 1328 名参与者参加了基线评估，813 名参与者参加了后续上评价。701 名参与者可获得两次访问的屈光信息。患有圆锥角膜、既往角膜手术或近期佩戴角膜塑形镜的参与者被排除在外。

暴露 参与者的眼睛在 20 岁（基线）和 28 岁时进行了检查。

主要结果和措施 近视和高度近视的发生率；球当量 (SE) 和轴向长度 (AL) 的变化。

结果 共有 516 名（261 名男性 [50.6%]）和 698 名（349 名男性 [50.0%]）参与者在基线时没有近视或高度近视，分别被纳入发病率分析，而 691 名参与者（339 名男性 [49%] ]) 被包括在进展分析中。8年近视和高度近视发生率分别为14.0%（95% CI，11.5%-17.4%）和0.7%（95% CI，0.3%-1.2%）。261 名参与者 (37.8%) 发生近视偏移（至少一只眼睛 0.50 屈光度 [D] 或更大）。SE（每年-0.04 D；P  < .001）、AL（每年0.02 mm；P  <.001）和晶状体厚度（每年0.02 mm ； P ）的纵向变化具有统计学意义 < .001)。近视事件与自我报告的东亚与白人（优势比 [OR]，6.13；95% CI，1.06-35.25；P  = .04）、女性与男性（OR，1.81；95% CI，1.02）相关-3.22；P  = .04），结膜紫外线自发荧光面积更小（每减少 10-mm ²，表明阳光照射减少；OR，9.86；95% CI，9.76-9.97；P  = <.009）和父母近视（每个父母；OR，1.57；95% CI，1.03-2.38；P  = <.05）。女性参与者的近视进展率和眼轴伸长率更快（估计：SE，每年 0.02 D；95 % CI，0.01-0.02 和 AL，每年 0.007 mm，95 % CI，0.00.-0.011；P ≤ .001）和父母近视患者（估计每位父母：SE，每年 0.01 D；95% CI，0.00-0.02 和 AL，95% CI，0.002-0.008；P  ≤ .001）。教育水平与近视发生率或进展无关。

结论和相关性 这些研究结果表明，超过三分之一的成年人在生命的第三个十年中继续发展近视，尽管这一比率低于儿童时期。户外活动对近视的保护作用可能会持续到成年。