Evolving patterns of childhood myopia in Taiwan: Effects of urbanization, digitalization, and outdoor activity policies

PURPOSE: To investigate temporal and spatial trends in childhood myopia in Taiwan and to evaluate the roles of urbanization, digitalization, and outdoor activity policies by comparing three population-based cohorts. MATERIALS AND METHODS: Grade 2 students from three cross-sectional groups were included: Taipei 2013 ( n = 11,590), Taipei 2023 ( n = 6,350), and Yilan 2023 ( n = 804). Cycloplegic autorefraction was used to assess refractive status. Parents completed questionnaires on sociodemographic and behavioral factors. RESULTS: The prevalence of myopia increased from 36.36% in 2013 to 39.39% in 2023 in Taipei, while remaining lower in Yilan (24.00%). Over the past decade, digital device use increased (86.76% vs. 92.83%; P < 0.001) and outdoor activity time also improved (≥1 h/day on weekdays: 15.81% vs. 33.13%, P < 0.001; ≥2 h/day on weekends: 27.14% vs. 31.36%, P = 0.374). Children in more urbanized areas had significantly more myopic spherical equivalence values (0.09 ± 1.22 D in rural area, −0.17 ± 1.43 D in suburban area, and −0.28 ± 1.24 D in urban area, P < 0.001). Multivariate analysis confirmed significant risk factors including greater magnitude of astigmatism (odds ratio [OR] 1.85), living in Taipei (OR 1.82), having myopic parents (1 parent OR 1.30, 2 parents OR 2.35), and reduced weekend outdoor time (OR 1.28). CONCLUSION: The prevalence of childhood myopia in Taiwan continues to rise, although the rate of increase has slowed compared with historical trends. Educational and environmental factors remain important. Urbanization continues to be a key determinant. Increased outdoor exposure over the past decade remains fundamental to myopia prevention strategies in addressing the childhood myopia burden in Taiwan.