The prevalence of refractive error in schoolchildren

Clinical relevance: Information on the refractive error prevalence in school-aged children will result in delivering the optimal eye health service to this group. Background: Understanding the prevalence of refractive error in school-aged children is crucial to reduce the consequences of uncorrected refractive error. This study aims to investigate the prevalence of refractive error among school-aged children in Shiraz, Iran. Methods: In this cross-sectional population-based study, 2001 schoolchildren aged 6–12 years participated. All participants underwent cycloplegic refraction. Spherical equivalent (SE) of −0.50 dioptre or more was considered as myopia, SE of +2.00 dioptre or more as hyperopia, and astigmatism as cylinder power of 0.75 dioptre or more. The difference of 1.00 dioptre or more between two eyes defined as anisometropia. Results: The prevalence of myopia was 11.6% (95% confidence interval [CI]: 10.2–13.1%), hyperopia 6.7% (95%CI: 5.6–7.9%), and astigmatism 28.9% (95%CI: 26.9–31.0%), out of which 82.1% had with the rule astigmatism. Anisometropia was detected in 4.0% (95%CI: 3.2–5.0%) of children. Astigmatism and anisometropia were significantly higher in boys (p < 0.001, p = 0.03 respectively). The SE decreased significantly with increasing age (p < 0.001) indicating an increase in myopia with age. In addition, the rate of myopic astigmatism increased with age (p < 0.001). Among studied schoolchildren 97.0% could achieve the best-corrected visual acuity of 6/6 and 3.0% could not in the better eye. Conclusion: Astigmatism was the most common refractive error among primary school children. The prevalence of myopia was relatively higher than other studies conducted in Iran, and it increased with age. These results may highlight the role of lifestyle changes and increased near work activities on the myopic shift in school-aged children. The findings provide information for screening programmes in school-aged children.