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Background  To evaluate the impact of parental myopia and outdoor time on myopia among students in Wenzhou.    Methods  We examined 1388 primary students from first grade to third grade in Wenzhou from September 2012 to March 2015. We performed noncycloplegic refractometry on each student every six months and axial length (AL) measurements every year. At the commencement of our study, children were asked to complete a questionnaire regarding near work activity and outdoor activity, whereas parents were asked to complete a self-administered questionnaire regarding their background circumstances and their history of myopia.    Results  A total of 1294 students (93.2%) returned for follow-up examinations. Children with initial and final no myopia spent more time on outdoor activities than those with new onset myopia (1.92 vs. 1.81 h/d,  p  = 0.022), and elongation of AL in children with a high level (> 2.5 h/day) of outdoor time (0.22 ± 0.13 mm/Y) was less than those with a low level (≤ 1.5 h/day) of outdoor time (0.24 ± 0.14 mm/Y,  p  = 0.045). The proportion of rapid myopia progression (≤-0.5D/Y) was 16.7%, 20.2% and 31.5% among the children with no myopic parent, one myopic parent and two myopic parents, respectively (X 2  = 28.076,  p  < 0.001), and the elongation of AL in children among different numbers of myopic parents was significantly different ( p  < 0.001). A high level of outdoor time was a protective factor for children with one myopic parent (HR 0.49, 95% CI 0.27–0.88;  p  = 0.018).    Conclusions  In this sample, parental myopia and outdoor time were associated with myopia in children. A high level of outdoor time was a protective factor for children with one myopic parent.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12886-020-01763-9.

Longitudinal association between myopia and parental myopia and outdoor time among students in Wenzhou: a 2.5-year longitudinal cohort study