Prevalence of Refractive Errors in School-Aged Children: A Vision Screening and Community Medicine Approach
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/055Keywords:
Refractive Errors, Myopia, Astigmatism, Vision Screening, HyperopiaAbstract
Background: In low-resource areas, where frequent eye checks are not common like in other parts of the world, refractive errors rank among the most prevalent causes of avoidable childhood visual impairment. Vision screening programs in schools suggest a fundamental platform of early detection and correction. The purpose of this study was to evaluate the distribution and spectrum of refractive errors in schoolchildren and to highlight the significance of ophthalmic screening conducted in the community in primary preventive health care.
Methods: The descriptive cross-sectional study was conducted between March and July 2024 in coordination with local government schools and the Department of Community Medicine. Stratified random sampling was used to select 1200 children aged 6-16 years in urban and rural schools. Visual acuity was performed by trained optometrists on the Snellen chart, with retinoscopy, and subjective refraction in patients with VA of less than 6/9. SPSS version 26.0 was used to analyze data. The chi-square and ANOVA tests were used to determine associations between refractive errors and demographic variables.
Results: Among 1200 children, 186 (15.5%) had refractive errors. Most prevalent refractive error types were myopia (110 (59.1%)), astigmatism (45 (24.2%)), and hyperopia (31 (16.7%)). The prevalence was higher in urban children (p = 0.003) and in children aged 13-16 years (p = 0.001).
Conclusion: The prevalence of uncorrected refractive errors among school-going children is significant and mostly undiagnosed. Primary healthcare strategies that incorporate regular screening at schools should be implemented to prevent unnecessary visual disability and improve educational outcomes.
References
1. Kumar V, Soni M, Rajagopal V, Behera A, Gandhi A, Shamim MA, et al. The Prevalence of Refractive Errors in Indian School Children: A Systematic Review and Meta-Analysis. Ophthalmic Epidemiol. 2025 Feb 25:1-10. doi: 10.1080/09286586.2025.2450346.
2. Salari N, Molaeefar S, Abdolmaleki A, Beiromvand M, Bagheri M, Rasoulpoor S, et al. Global prevalence of myopia in children using digital devices: a systematic review and meta-analysis. BMC Pediatr. 2025 Apr 24;25(1):325. doi: 10.1186/s12887-025-05684-8.
3. Yasir Z, Khandekar R, Balous MA, Banaeem AS, Al-Shangiti AK, Basakran FA, et al. Prevalence and determinants of refractive status and related ocular morbidity among Indian school children in Riyadh, Saudi Arabia. Saudi J Ophthalmol. 2022 Feb 18;35(2):97-101. doi: 10.4103/1319-4534.337848.
4. Habani S, Belgacem S, Chiali S, Mahmoudi K, Nadjet LD, Kail F. The Impact of Excessive Digital Screen use on Refractive Error Progression Over 1 Year Among Schoolchildren in Northwest Algeria. Beyoglu Eye J. 2024 Dec 11;9(4):190-201. doi: 10.14744/bej.2024.68094.
5. Khalaf AM, Alhazimi AY, Almaymuni KK, Alsubaie NA. Prevalence of Myopia Among Schoolchildren and the Impact of Increased Screen Time: A Systematic Review. Cureus. 2024 Aug 13;16(8):e66815. doi: 10.7759/cureus.66815.
6. Wang X, Zeng L, Xian Y, Xin M, Shan Q, Li W, et al. Prevalence of myopia and refractive parameters among children and adolescents in Hi-tech District of Chengdu City. Front Pediatr. 2025 Feb 3;12:1502660. doi: 10.3389/fped.2024.1502660.
7. Enthoven CA, Polling JR, Verzijden T, Tideman JWL, Al-Jaffar N, Jansen PW, et al. Smartphone Use Associated with Refractive Error in Teenagers: The Myopia App Study. Ophthalmology. 2021 Dec;128(12):1681-1688. doi: 10.1016/j.ophtha.2021.06.016.
8. Ha A, Lee YJ, Lee M, Shim SR, Kim YK. Digital Screen Time and Myopia: A Systematic Review and Dose-Response Meta-Analysis. JAMA Netw Open. 2025 Feb 3;8(2):e2460026. doi: 10.1001/jamanetworkopen.2024.60026.
9. Chu GCH, Chan LYL, Do CW, Tse ACY, Cheung T, Szeto GPY, et al. Association between time spent on smartphones and digital eye strain: A 1-year prospective observational study among Hong Kong children and adolescents. Environ Sci Pollut Res Int. 2023 Apr;30(20):58428-58435. doi: 10.1007/s11356-023-26258-0.
10. Little JA, Chan VF, Saw SM, Tham YC, Chew L, Foo LL, et al. Current status of school vision screening-rationale, models, impact and challenges: a review. Br J Ophthalmol. 2025 Jul 3:bjo-2024-326726. doi: 10.1136/bjo-2024-326726.
11. Bhardwaj R, Agrawal U, Vashist P, Manna S. Determination of sample size for various study designs in medical research: A practical primer. J Family Med Prim Care. 2024 Jul;13(7):2555-2561. doi: 10.4103/jfmpc.jfmpc_1675_23.
12. Seguí-Crespo M, Cantó-Sancho N, Sánchez-Brau M, Ronda-Pérez E. CVS-Q teen: an adapted, reliable and validated tool to assess computer vision syndrome in adolescents. Sci Rep. 2024 Sep 16;14(1):21576. doi: 10.1038/s41598-024-70821-9. Erratum in: Sci Rep. 2024 Dec 17;14(1):30534. doi: 10.1038/s41598-024-81622-5.
13. Li X, Li L, Qin W, Cao Q, Mu X, Liu T, Li Z, et al. Urban Living Environment and Myopia in Children. JAMA Netw Open. 2023 Dec 1;6(12):e2346999. doi: 10.1001/jamanetworkopen.2023.46999.
14. Foreman J, Salim AT, Praveen A, Fonseka D, Ting DSW, Guang He M, et al. Association between digital smart device use and myopia: a systematic review and meta-analysis. Lancet Digit Health. 2021 Dec;3(12):e806-e818. doi: 10.1016/S2589-7500(21)00135-7.
15. Fan Y, Liao J, Liu S, Cai X, Lv S, Yang Q, et al. Effect of Time Outdoors and Near-viewing Time on Myopia Progression in 9- to 11-year-old Children in Chongqing. Optom Vis Sci. 2022 Jun 1;99(6):489-495. doi: 10.1097/OPX.0000000000001898.
16. Li M, Lanca C, Tan CS, Foo LL, Sun CH, Yap F, et al. Association of time outdoors and patterns of light exposure with myopia in children. Br J Ophthalmol. 2023 Jan;107(1):133-139. doi: 10.1136/bjophthalmol-2021-318918.
17. Fan Q, Wang H, Kong W, Zhang W, Li Z, Wang Y. Online Learning-Related Visual Function Impairment During and After the COVID-19 Pandemic. Front Public Health. 2021 Nov 29;9:645971. doi: 10.3389/fpubh.2021.645971.
18. Althnayan YI, Almotairi NM, Alharbi MM, Alamer HB, Alqahtani HB, Alfreihi S. Myopia Progression Among School-Aged Children in the COVID-19 Distance-Learning Era. Clin Ophthalmol. 2023 Jan 20;17:283-290. doi: 10.2147/OPTH.S381061.
19. Thakur S, Verkicharla PK. Greater axial elongation associated with low accommodative lag: new insights on accommodative lag theory for myopia. Ophthalmic Physiol Opt. 2021 Nov;41(6):1355-1362. doi: 10.1111/opo.12893.
20. Enthoven CA, Polling JR, Verzijden T, Tideman JWL, Al-Jaffar N, Jansen PW, et al. Smartphone Use Associated with Refractive Error in Teenagers: The Myopia App Study. Ophthalmology. 2021 Dec;128(12):1681-1688. doi: 10.1016/j.ophtha.2021.06.016.
21. Masarwa D, Niazov Y, Ben Natan M, Mostovoy D. The role of parental health beliefs in seeking an eye examination for their child. BMC Ophthalmol. 2023 Jun 13;23(1):269. doi: 10.1186/s12886-023-02994-2.
22. Li Q, Guo L, Zhang J, Zhao F, Hu Y, Guo Y, et al. Effect of School-Based Family Health Education via Social Media on Children's Myopia and Parents' Awareness: A Randomized Clinical Trial. JAMA Ophthalmol. 2021 Nov 1;139(11):1165-1172. doi: 10.1001/jamaophthalmol.2021.3695.
23. Sano K, Fukai K, Terauchi R, Furuya Y, Nakazawa S, Kojimahara N, et al. Association between ocular diseases and screen time and sedentary time derived from job-exposure matrices. Sci Rep. 2024 Nov 7;14(1):27042. doi: 10.1038/s41598-024-74854-y.
24. Israr M, Hareem T, Rahim MU, Zia Q, Tahir M, Qureshi FM, et al. VISUAL SCREEN TIME EXPOSURE AND ITS ASSOCIATION WITH REFRACTIVE ERRORS IN SCHOOL-AGED CHILDREN. IJLSS. 2025 Jun 18;3(3 (Social)):198-204. doi: 10.71000/fm2d6x77.
25. Zong Z, Zhang Y, Qiao J, Tian Y, Xu S. The association between screen time exposure and myopia in children and adolescents: a meta-analysis. BMC Public Health. 2024 Jun 18;24(1):1625. doi: 10.1186/s12889-024-19113-5.
26. Alrasheed SH, Alghamdi W. Systematic review and meta-analysis of the prevalence of myopia among school-age children in the Eastern Mediterranean Region. East Mediterr Health J. 2024 May 14;30(4):312-322. doi: 10.26719/2024.30.4.312.
27. Guo X, Nguyen AM, Vongsachang H, Kretz AM, Mukherjee MR, Neitzel AJ, et al. Refractive Error Findings in Students Who Failed School-based Vision Screening. Ophthalmic Epidemiol. 2022 Aug;29(4):426-434. doi: 10.1080/09286586.2021.1954664.
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