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A Descriptive Study of the Pattern of Refractive Errors, Amblyopia Burden, and Effective Refractive Error Coverage
Malaravan Muthusamy1, Thurga Jeyaratnam2, Kumanan Thirunavukarasu3
1Department of Ophthalmology, Teaching Hospital Jaffna, Jaffna, LKA.
Insights
Refractive errors like astigmatism are common in Sri Lankan children, leading to high rates of amblyopia. Many children don't use prescribed spectacles due to lack of information and cost, highlighting a need for better eye care access.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Public Health
Background:
- Visual impairment (VI) significantly impacts children's development and quality of life.
- Refractive errors (REs) are the most common cause of VI in children, potentially leading to amblyopia if uncorrected.
- Understanding RE patterns and associated factors in children is crucial for timely intervention.
Purpose of the Study:
- To describe RE patterns in schoolchildren aged 6-18 years.
- To examine demographic and behavioral factors associated with REs.
- To assess amblyopia burden and effective RE coverage among these children.
Main Methods:
- A prospective, hospital-based cross-sectional study was conducted at Teaching Hospital Jaffna, Sri Lanka.
- 253 schoolchildren with REs were recruited using systematic random sampling.
- Data collected via questionnaires and medical records included demographics, family history, lifestyle, and visual assessments.
Main Results:
- Astigmatism (46.6%) was the most prevalent RE, followed by myopic astigmatism (26.1%) and myopia (22.9%).
- A significant burden of amblyopia (60.1%) was observed.
- Effective RE coverage was low (18.6%), with lack of information and affordability as primary barriers to spectacle use.
Conclusions:
- Astigmatism is the leading RE among children in this Sri Lankan cohort, with high rates of amblyopia.
- Inadequate spectacle compliance due to information gaps and cost necessitates improved eye care services.
- Strengthening early vision screening and ensuring affordable, accessible eye care are vital for reducing childhood VI.
Background:
Visual impairment affects children's learning, development, and quality of life. Refractive errors (REs) are the most prevalent form of VI among ocular conditions, especially in children. They often begin in childhood and can progress significantly if left uncorrected, leading to complications such as amblyopia or long-term visual disability. Thus, this study was conducted to describe the patterns of REs, examine demographic and behavioral characteristics, and assess the burden of amblyopia and effective RE coverage among schoolchildren with REs attending the Ophthalmology Unit of Teaching Hospital Jaffna, Sri Lanka.
Methodology:
This hospital-based prospective cross-sectional study was conducted at the Ophthalmology Unit of Teaching Hospital Jaffna. Data were collected over two months among schoolchildren aged 6-18 years with REs. A total of 253 participants were recruited using systematic random sampling. Data on demographic factors, family history, outdoor activities, screen exposure, spectacle use, visual acuity, and RE patterns were collected using an interviewer-administered questionnaire and medical records from routine eye examinations. Visual assessments and refraction were performed according to standard ophthalmic procedures. Data were analyzed using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA) with descriptive statistics.
Results:
A total of 253 schoolchildren with REs were included, with a mean age of 11.7±3.6 years; 138 (54.5%) were female. Astigmatism was the most common RE (118, 46.6%), followed by myopic astigmatism (66, 26.1%) and myopia (58, 22.9%). A family history of RE was present in 33.2% (n=84) of participants. The effective RE coverage was 18.6%. Among children previously prescribed spectacles, only 47 (33.3%) were current users, with lack of information (58, 61.7%) and affordability (20, 21.3%) being the main barriers to spectacle use. Amblyopia was present in 152 (60.1%) participants and was most common among children with hyperopic astigmatism (5, 100%) and hyperopia (5, 83.3%).
Discussion:
Astigmatism was the most common RE among children attending a tertiary eye care center in Northern Sri Lanka, followed by myopic astigmatism and myopia. A high burden of amblyopia and very low effective RE coverage were observed, indicating inadequate utilization of refractive services despite spectacle prescriptions; the high amblyopia burden likely reflects the tertiary referral-based study population rather than the general community. Lack of information and affordability were the main barriers to spectacle use. These findings highlight the need to strengthen early vision screening, improve awareness of spectacle compliance, and enhance access to affordable eye care services for children in Northern Sri Lanka.
Conclusion:
As the first hospital-based evidence of its kind from Northern Sri Lanka, these findings provide a starting point for local eye care planning while highlighting the broader need for community-based research to establish the true population burden. Strengthening screening pathways, support for spectacle compliance, and the affordability of eye care should be prioritized as immediate steps toward reducing preventable childhood VI in this region.
