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Long-term astigmatism progression and its interaction with spherical equivalent in Chinese school-age children: A

Zhuoer Qin1, Qiaolan Zheng1, Yuanyuan Liu1

  • 1National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China.

Journal of Optometry
|January 24, 2026
PubMed

Insights

Astigmatism progression in Chinese children depends on initial severity. Higher myopia accelerated astigmatism, while higher astigmatism slightly protected against myopia progression.

Area of Science:

  • Ophthalmology
  • Pediatric Optometry
  • Refractive Error Research

Background:

  • Astigmatism and spherical equivalent (SE) changes are common in school-age children.
  • Understanding the interplay between astigmatism and SE progression is crucial for myopia management.
  • Longitudinal data on these refractive interactions in diverse populations are limited.

Purpose of the Study:

  • To analyze longitudinal changes in astigmatism and its relationship with spherical equivalent (SE) progression.
  • To investigate how baseline astigmatism severity influences its progression.
  • To examine the interaction between astigmatism and SE changes in Chinese school-age children.

Main Methods:

  • Retrospective analysis of medical records from 2946 Chinese children (aged 6-10 at baseline).
  • Follow-up data collected between 2008 and 2022, with a minimum age of 16 at the last assessment.
  • Astigmatism analyzed using clinical and vector notation (J0, J45); factors influencing annual changes in astigmatism and SE were assessed.

Main Results:

  • Astigmatism cylinder power increased in low astigmatism (≤1.50 D) but decreased in high astigmatism (≥3.00 D).
  • Oblique astigmatism (J45) increased, while with-the-rule astigmatism (J0) decreased over time.
  • More negative baseline SE correlated with greater astigmatism increase; higher baseline astigmatism correlated with less SE progression.

Conclusions:

  • Astigmatism progression in children is dependent on initial refractive error.
  • Myopia is linked to accelerated astigmatism progression.
  • Higher astigmatism offers a slight protective effect against myopic shift, though clinical significance is limited by small effect sizes.
Abstract

Keywords:
AstigmatismInteractionSchool-age childrenSpherical equivalent

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