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Updated: Jun 23, 2025

Subjective Refraction Test Using a Smartphone for Vision Screening
Published on: October 18, 2024
Characteristics of refractive development in children aged 4 months to 8 years in urban China: A retrospective
Yarong Yan1,2, Xuewen Xia3, Qinghui Zhang3
1Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China.
Insights
Refractive errors and amblyopia risk factors are common in young children, especially under one year old. Myopia prevalence increased in older children, with significant changes observed in those aged 5-8 years.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Public Health
Background:
- Refractive errors are a significant global health concern in children.
- Early detection and intervention are crucial for preventing vision impairment.
Purpose of the Study:
- To analyze refractive error screening data in young children.
- To identify trends in refractive error and amblyopia risk factors.
Main Methods:
- Retrospective study of 14,987 children (4 months to 8 years) in Beijing.
- Cross-sectional and longitudinal analyses of refractive error without cycloplegia.
- Assessment of spherical equivalent, cylinder, axial length, and amblyopia risk factors.
Main Results:
- Higher prevalence of refractive errors and amblyopia risk factors in children under 1 year.
- Boys had longer axial length than girls from 4 years old.
- Increased myopia prevalence in 5-8 year olds between 2018-2019 and 2020-2021.
- Annual myopic shift observed in children aged 5-8 years.
Conclusions:
- Significant variation in refractive error exists in early childhood.
- A trend towards myopia in older children (5-8 years) warrants attention.
- Myopia prevalence increased, particularly in recent years, highlighting the need for ongoing screening.
Purpose:
To conduct a large retrospective study of screening refractive error in young children.
Methods:
This retrospective study included children aged from 4 months to 8 years in Daxing District, Beijing, who underwent refractive examinations without cycloplegia. It included a cross-sectional assessment of refractive error screening for all children, and a longitudinal component for a subgroup with data available for two to five visits.
Results:
A total of 14,987 children were included in the cross-sectional study. In the group <1 year of age, the percentage of children with a spherical equivalent (SE) >+2.00 D or with cylinder <-1.50 D was 15.25% and 33.24%, respectively. These were significantly higher than for the 1- to 4-year-old group (SE 8.1% higher, cylinder 13.2% higher) (χ2 = 53.57, p < 0.001; χ2 = 790.39, p < 0.001). Furthermore, 34.83% of children in the 0-year-old group had amblyopia risk factors (ARFs). In the 4-year-old group, boys had a significantly longer axial length (AL) than girls (differences in the right and left eyes were 0.53 and 0.56 mm, respectively; z = 5.48 p < 0.001, z = 5.80, p < 0.001). AL increased with age, while the AL difference between boys and girls remained stable at 4-8 years of age. The percentage of children aged 5-8 years with myopia in 2020-2021 was significantly higher than that in 2018-2019 (H = 12.44, p = 0.006). In the longitudinal study of 4406 children (up to 12-month follow-up), annual changes in SE were -0.27, -0.06, 0.19 and 0.13 D between 0 and 3 years, and -0.38, -0.58, -0.70 and -0.75 D between 5 and 8 years.
Conclusions:
Children's refractive error varied significantly from ages 4 months to 1 year, with a high proportion having ARFs. Children aged 5-8 years showed a trend towards myopia. The prevalence of myopia in the cross-sectional analysis in 2020-2021 was greater than in 2018-2019. Screening refraction changed minimally over a 12-month period for children aged 1-3 years, but became more myopic for children aged 5-8 years.
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