This study investigates the association between green space morphology and myopia prevalence in primary school students in Shenzhen, China. Using high-resolution satellite images, the researchers calculated eight landscape metrics to measure the area, aggregation, and shape of green spaces. The study followed 138,735 students from grades 1 to 4 over a two-year period, assessing their myopia prevalence at baseline and follow-up. Key findings include: - Higher proportions, better aggregation, and improved connectivity of green spaces were associated with slower increases in myopia prevalence. - A 1-unit increase in the myopia-related green space morphology index (the first principal component) was negatively associated with a 1.7% decrease in myopia prevalence change at the school level (P = .002). - At the individual level, a 1-unit increase in the myopia-related green space morphology index was associated with a 9.8% reduction in the risk of incident myopia (P < .001), even after adjusting for outdoor time, screen time, reading time, and parental myopia. The study suggests that the structure of green spaces, characterized by larger areas, better connectivity, and more aggregated patches, may protect against myopia development. These findings provide guidance for urban planning and school design to reduce myopia prevalence. However, further interventional studies are needed to confirm these associations and explore the effectiveness of manipulating green space morphology as a population strategy for myopia prevention.This study investigates the association between green space morphology and myopia prevalence in primary school students in Shenzhen, China. Using high-resolution satellite images, the researchers calculated eight landscape metrics to measure the area, aggregation, and shape of green spaces. The study followed 138,735 students from grades 1 to 4 over a two-year period, assessing their myopia prevalence at baseline and follow-up. Key findings include: - Higher proportions, better aggregation, and improved connectivity of green spaces were associated with slower increases in myopia prevalence. - A 1-unit increase in the myopia-related green space morphology index (the first principal component) was negatively associated with a 1.7% decrease in myopia prevalence change at the school level (P = .002). - At the individual level, a 1-unit increase in the myopia-related green space morphology index was associated with a 9.8% reduction in the risk of incident myopia (P < .001), even after adjusting for outdoor time, screen time, reading time, and parental myopia. The study suggests that the structure of green spaces, characterized by larger areas, better connectivity, and more aggregated patches, may protect against myopia development. These findings provide guidance for urban planning and school design to reduce myopia prevalence. However, further interventional studies are needed to confirm these associations and explore the effectiveness of manipulating green space morphology as a population strategy for myopia prevention.