Abstract: Objective  To investigate parents' awareness of the potential risks of myopia and their understanding of prevention and control strategies, and to explore the relationship between parents' awareness and the progression rate of myopia in children, providing a basis for conducting precise myopia health education. Design Prospective cohort study. Participants 383 primary school students from grades 4 to 6 at Peixin Primary School in Dongcheng District and their parents, Beijing in 2024. Methods  The subjects underwent vision screening, including visual acuity, intraocular pressure, non-cycloplegic and cycloplegic computerized refraction, and ocular biometry in 2023 and 2024. Calculate the axial length growth and equivalent spherical lens growth of primary school students from 2023 to 2024. Online questionnaires were distributed to the guardians to understand the students' eye usage behaviors and their parents' awareness of the potential risks of myopia and its prevention and control strategies in 2024. Main Outcome Measures  Parents' cognitive level of myopia prevention and control, subjects' axial length growth and spherical equivalent growth in one year. Results  Among the 383 primary school students, 126 wore corrective glasses for myopia, 96 were screened for myopia but did not wear corrective glasses, and 137 were screened for myopia. 6.8% of primary school students spend more than 2 hours outdoors every day. The axial length increase within one year of children with myopia who were not wearing glasses [0.35 (0.25, 0.47) mm] was significantly higher (P<0.001) than that of children wearing glasses [0.23 (0.13, 0.34) mm]; the increase in equivalent spherical lens within one year of children with myopia who were not wearing glasses [0.50 (0.25, 1.00) D] was significantly higher (P=0.027) than that of children wearing glasses [0.50 (0.00, 0.75) D]. 70.1% of the parents expressed moderate or higher levels of concern about their children's myopia. The two main reasons for parents' concerns were the impact on appearance and sports due to wearing glasses (70.1%) and eye complications (58.2%). Parents of children with myopia who were not wearing glasses had the highest proportion of concerns about the impact on appearance and sports (79.2%), which was significantly higher (P<0.05) than that of parents of non-myopic children (65.7%), and higher than that of parents of children wearing glasses (70.6%), but without statistical significance (P>0.05). The faster axial length growth of children was significantly correlated with parents' concerns about ocular complications (P=0.007) and concerns about the impact of wearing glasses on appearance and movement (P=0.047). The awareness level of basic myopia intervention measures among parents of primary school students in Beijing was generally low. Only 33.7% of the parents knew that children should have at least 2 h of outdoor activities every day. Parents who expressed concern regarding potential eye complications associated with myopia demonstrated significantly higher scores (P=0.016) in the assessment of cognition related to myopia prevention and control, compared to those who did not express such concern. 79.6% of the parents believed that it was "very necessary" or "relatively necessary" to conduct myopia science popularization education. Medical institutions, schools, and online platforms were the preferred channels for parents to obtain myopia prevention and control knowledge. Conclusions  The awareness of myopia among parents of primary school students in Beijing needs to be improved urgently. Parents' correct understanding of the potential risks of myopia is conducive to enhance their awareness of myopia prevention and control; conversely, incorrect understanding may delay the intervention and treatment of myopia, leading to rapid progression of myopia. The collaboration between medical institutions and schools, using online platforms to enhance parents' awareness of myopia prevention and treatment through family health education, will be an effective approach to controlling myopia in children. 

Key words: Myopia prevention and control, Parent cognition, Health education