Objective To investigate the association between piano playing and myopia prevalence, and to analyze the interactive effect of piano playing and outdoor activity time or out-of-class study time on myopia among primary and secondary school students in Shanghai.

Methods Visual acuity tests and a self-administered anonymous questionnaire survey were conducted among 26 522 students recruited using multistage cluster sampling in 7 primary and secondary schools in 7 districts of Shanghai municipality from September to November 2021. An unconditional binary logistic regression model was used to analyze the association between piano playing and myopia prevalence among students.

Results Of the students surveyed, 3 778 (14.2%) reported playing the piano. The myopia detection rate was 77.7% in students who reported playing the piano and significantly different from that 76.1% in those who did not (χ² = 4.368, P < 0.05). After controlling for gender and parental myopia, no statistically significant association was found between piano playing and myopia prevalence. Compared to students who did not play piano and spent 2 hours or more per day in outdoor activities, students who did not play piano and spent less than 2 hours per day in outdoor activities had an increased risk of myopia (odds ratio OR = 1.153, 95% confidence interval 95%CI: 1.073 – 1.239), and students who played piano and spent less than 2 hours per day in outdoor activities also had an increased risk of myopia (OR = 1.165, 95%CI: 1.038 – 1.308). Compared to the students who did not play piano and spent less than 2 hours per day studying outside the classroom, the students who did not play piano and spent 2 hours and more per day studying outside the classroom had an increased risk of myopia (OR = 1.212, 95%CI: 1.119 – 1.312) and the students who played piano and spent 2 hours and more per day studying outside the classroom also had an increased risk of myopia (OR = 1.203, 95%CI: 1.027 – 1.411).

Conclusion This study did not find a statistically significant association between piano playing and myopia prevalence in primary and secondary school students in Shanghai, and further prospective studies may investigate the association between piano playing and myopia in students.