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Updated: Aug 16, 2025
Subjective Refraction Test Using a Smartphone for Vision Screening
Published on: October 18, 2024
Prevalence of refractive errors among school-going children in a multistate study in India
Elizabeth Joseph1, Meena Ck1, Rahul Kumar2
1Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India.
Insights
Childhood refractive errors, particularly myopia, are prevalent in India, increasing with age. Higher literacy rates in certain states may drive myopia prevalence, suggesting a potential rise with increasing education.
Area of Science:
- Ophthalmology and Public Health
Background:
- Existing data on childhood refractive error prevalence in India are limited and often outdated, stemming from localized studies.
- A comprehensive, multistate assessment is needed to understand the current prevalence, severity, and contributing factors of refractive errors in Indian school children.
Purpose of the Study:
- To estimate the prevalence and severity of refractive errors among school-going children across multiple Indian states.
- To identify determinants associated with refractive errors, particularly myopia, in this population.
Main Methods:
- A cross-sectional study involving vision screening of 2,240,804 children aged 5-18 years across five Indian states.
- Refractive errors were assessed using retinoscopy and subjective refraction, defined by spherical equivalent (SE) and spherical ametropia.
- Myopia was defined as SE ≤-0.5 diopters (D) or spherical ametropia, and hyperopia as SE ≥+1.0 D or spherical ametropia; astigmatism was >0.5 D.
Main Results:
- The prevalence of SE myopia increased with age, from 1.57% (5-9 years) to 4.8% (15-18 years).
- Myopia prevalence, defined by spherical ametropia, was 0.84% (5-9 years) to 4.24% (15-18 years).
- Myopia was significantly associated with older age, female gender, private school attendance, urban location, and state literacy rates.
Conclusions:
- Refractive errors, especially myopia, are a significant public health concern among Indian school children.
- State-level differences in myopia prevalence appear linked to literacy rates, indicating a potential for increased myopia burden with rising educational attainment.
Aim:
Much existing data on childhood refractive error prevalence in India were gathered in local studies, many now dated. The aim of this study was to estimate the prevalence, severity and determinants of refractive errors among school-going children participating in a multistate vision screening programme across India.
Methods:
In this cross-sectional study, vision screening was conducted in children aged 5-18 years at schools in five states using a pocket vision screener. Refractive error was measured using retinoscopy, and subjective refraction and was defined both by spherical equivalent (SE) and spherical ametropia, as myopia ≤-0.5 diopters (D), hyperopia ≥+1.0 D and/or astigmatism as >0.5 D. Data from the eye with less refractive error were used to determine prevalence.
Results:
Among 2 240 804 children (50.9% boys, mean age 11.5 years, SD ±3.3), the prevalence of SE myopia was 1.57% (95% CI 1.54% to 1.60%) at 5-9 years, 3.13% (95% CI 3.09% to 3.16%) at 10-14 years and 4.8% (95% CI 4.73% to 4.86%) at 15-18 years. Hyperopia prevalence was 0.59% (95% CI 0.57% to 0.61%), 0.54% (95% CI 0.53% to 0.56%) and 0.39% (95% CI 0.37% to 0.41%), respectively. When defined by spherical ametropia, these values for myopia were 0.84%, 2.50% and 4.24%, and those for hyperopia were 2.11%, 2.41% and 2.07%, respectively.Myopia was associated with older age, female gender, private school attendance, urban location and state. The latter appeared to be driven by higher literacy rates.
Conclusions:
Refractive error, especially myopia, is common in India. Differences in prevalence between states appear to be driven by literacy rates, suggesting that the burden of myopia may rise as literacy increases.
