Objective: To understand the referral rate in children with abnormal refractive error in screening programs and associated factors, aiming to provide evidence for improving the rate and myopia prevention and control in the future. Methods: Using cluster sampling, three primary schools and three junior middle schools in Huangpu District, Shanghai were selected. All students were archived for refractive development, including examinations such as visual acuity, non cycloplegic autorefraction and axial length. The follow up visit and related factor information were collected through questionnaire, and the influencing factors of referral rate were analyzed by multivariate Logistic regression. Results: A total of 2 104 high risk children and adolescents with suspected refractive abnormalities were suggested follow up visit, and the actual referral rate was estimated to be 60.4%; the rate of referral to designated hospitals was estimated to be 58.8%. Nonconditional Logistic regression analysis showed that myopic status before the screening( OR=1.37, 95%CI =1.08-1.72), wearing spectacles or ortho contact lens( OR=2.05, 95%CI =1.62-2.59), myopic degree ( OR below -0.5 D =2.08, 95% CI =1.48-2.92, OR -3.0~-0.5 D =1.86, 95% CI =1.47-2.36), parents familiarity with screening results( OR=2.92, 95%CI =1.89-4.50), parents satisfaction with suggestions after screening ( OR=3.54, 95%CI =1.16-10.79) were significant factors associated with the referral rate( P <0.05). Conclusion The actual referral rate among children and adolescents needs to be improved. It is necessary to further optimize the informatization of refractive archives, strengthen popular science education for key population, standardize the professional interpretation of preliminary screening refractive examination results, improve parents awareness, participation and satisfaction through health education, and achieve the whole process management of refractive archives.