Refractive error, amblyopia and ocular alignment among schoolchildren in Saudi Arabia

Normal visual development starts early in childhood, and achieving optimal corrected visual acuity, binocular function and ocular alignment is key to healthy visual maturation.

To assess the prevalence of refractive error, amblyopia and ocular alignment among school children in Qassim Region, Saudi Arabia.

Using a modified refractive error study in school-aged children protocol, we collected data from 850 children aged 6-17 years from 6 randomly selected schools in Qassim, Saudi Arabia, between March and May 2024. We assessed refractive error with a noncycloplegic autorefractometer, ocular alignment with the alternate cover test and prism bar, and anterior/posterior segments using a slit-lamp and ophthalmoscopy. We analysed the data using SPSS version 25 and further analysed the prevalence of refractive error amblyopia and ocular misalignment using MedCalc for Windows. P < 0.05 was regarded as statistical significance.

The overall prevalence of refractive error was 61.1%, including hyperopia (30.5%), myopia (19.3%) and astigmatism (11.3%). M ost children (68.0%) had o rthophoria at near fixation. Phoria was found in 25.5% of children, predominantly exophoria (19.8%), while strabismus was present in 6.5%, mainly esotropia (4.8%). Ocular alignment status was significantly associated with age and gender (P < 0.001). Amblyopia affected 8.4% of the children, with higher prevalence in males (P = 0.034) but there was no significant association with age (P = 0.094). Children without previous eye examinations were at higher risk for developing amblyopia (odds ratio = 3.58, P < 0.001).

The high prevalence of refractive error, amblyopia and strabismus in this study indicates an increased risk of visual disorder among the children. There is therefore a need for routine vision screening and improved access to paediatric eye care.