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To study the prevalence of and changes in astigmatism from the onset of myopia at school age.Two hundred and forty myopic schoolchildren (mean age 10.9 years), with no previous spectacles, were recruited during 1983–1984 to a randomized 3-year clinical trial of bifocal treatment of myopia. Three annual examinations with subjective cycloplegic refraction were performed for 237–238 subjects. Subsequent examinations were performed at the mean ages of 23.2 and 33.9 years for 178 and 163 subjects, and the last examination, including data from prescriptions of different ophthalmologists, for 32 subjects. Corneal topography was studied at baseline, at the 3-year follow-up and at the two adulthood follow-ups. Prevalence and changes in refractive astigmatism (RA), in its polar valuesJ0 andJ45, and corneal astigmatism (CA) were studied.Mean RA of the right eye increased during follow-up from 0.26 D (SD) ± 0.30 to 0.79 D ± 0.74. Mean CA was 1.07 D ± 0.74 at study end. The prevalence of RA ≥0.25 or ≥1.00 D increased from 54.9 and 3.8% to 83.4 and 34.4%, respectively. The main direction of the axis of RA and its polar valueJ0 and CA changed mainly through sphericity, from against the rule (ATR) to with the rule during the follow-up. There was a negative correlation between RA and spherical refraction in the ATR group at end of follow-up. Changes in RA were associated with increase in myopia and with changes in CA.The prevalence and mean amount of RA associated with CA increased, and the axis of astigmatism changed among myopics during the 23-year follow-up.