The Association Between Refractive Errors and Breastfeeding in Pakistani Children: A Case-Control Study

Objective The aim of this study was to determine the association between breastfeeding and the occurrence of refractive errors (REs) among children. Methodology This was a (retrospective) case-control study carried out between December 1, 2021, and March 30, 2022, at the Basheeran Umar Eye Hospital in Islamabad, Pakistan, and Sheikh Khalifa bin Zayed Al Nayhan Combined Military Hospital in Rawalakot in Kashmir, Pakistan. A total of 200 participants between the ages of five and 16 years (106 cases with REs and 94 controls without REs) were included in this study. After obtaining informed consent from the parent accompanying the participant, the parent was further interviewed to extract information regarding biodata, breastfeeding, and other parameters including parental myopia, the number of hours spent on outdoor activities, on gadgets, and doing near work; this data was entered into a questionnaire. The participant's visual acuity was then checked using the Snellen chart. Data were analyzed using SPSS Statistics version 20.0 (IBM Corp., Armonk, NY) and statistical tests such as multivariate regression analysis and chi-square were carried out and odds ratios (OR) were calculated. Results There were 74 (37%) females and 126 (63%) males, with 67.5% residing in urban localities and only 32.5% hailing from rural areas. Testing revealed no significant association between REs and area of residence (p=0.97) or the gender of the participant (p=0.74). Hypermetropia was the most common RE among our participants (59.4%). Breastfeeding was significantly associated with errors of refraction (OR: 27.852, 95% CI: 3.686-210.45, χ²=21.680, p<0.001, degrees of freedom: 1), and we observed a lower risk of REs in children who had been breastfed. There was no association between REs and the number of hours spent outdoors per week or the number of hours spent using gadgets per week. However, there was a significant association between the development of REs and the duration of breastfeeding and the number of hours spent on near work. Conclusion This study demonstrates that breastfeeding plays a protective role in the prevention of REs. The type of breastfeeding also had a significant effect on the development of REs, i.e., children exclusively breastfed (regardless of the duration of breastfeeding) were less likely to develop errors of refraction in the future.