AIM: To investigate the effects of school-based comprehensive intervention on myopia development in elementary school children. METHODS: As a part of the Wenzhou Epidemiology of Refraction Error Study, there were 1524 participating elementary students (730 girls, 47.9%) in grades 1 to 3 from three campuses of one school, aged 7.3±0.9y, who were examined twice every year for a 2.5y follow up period. Comprehensive intervention and other reminders were given at school every semester for the intervention group. The control group did not receive comprehensive intervention and did not have reminders of it. RESULTS: There were 651 students in the intervention group [mean age 7.3±0.9y; 294 (45.2%) girls] and 737 students in the control group [mean age 7.2±0.9y; 346 (46.9%) girls]. Overall mean myopia progression during the 2.5y follow-up was -0.49±1.04 diopters (D) in the intervention group and -0.65±1.08 D in the control group (P=0.004). The majority that not get myopia at baseline spherical equivalent (SE≤-1.0 D). Their mean myopia progression during the 2.5y follow-up was -0.37±0.89 D in the intervention group and -0.51±0.93 D in the control group (27.5% reduction, P=0.009); Overall, mean axial length elongation was less in the intervention group (0.56±0.32 mm) than in the control group (0.61±0.38 mm, 10.5% reduction, P=0.009). The percentage of close reading distance (<30 cm) in the intervention group was less than in the control group (73.4% vs 76.2%, P<0.001), the percentage of everyday perform eye exercises in the intervention group was more than in the control group (27.8% vs 20.7%, P<0.001) 30mo later. CONCLUSION: The comprehensive intervention program at elementary school has a significant alleviating effect on myopia progression for children during the 2.5y follow-up, especially for those non-myopia at baseline.