Prevalence of refractive errors in children in India: a systematic review

Abstract

Uncorrected refractive error is an avoidable cause of visual impairment which affects children in India. The objective of this review is to estimate the prevalence of refractive errors in children ≤ 15 years of age. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in this review. A detailed literature search was performed to include all population and school-based studies published from India between January 1990 and January 2017, using the Cochrane Library, Medline and Embase. The quality of the included studies was assessed based on a critical appraisal tool developed for systematic reviews of prevalence studies. Four population-based studies and eight school-based studies were included. The overall prevalence of refractive error per 100 children was 8.0 (CI: 7.4-8.1) and in schools it was 10.8 (CI: 10.5-11.2). The population-based prevalence of myopia, hyperopia (≥ +2.00 D) and astigmatism was 5.3 per cent, 4.0 per cent and 5.4 per cent, respectively. Combined refractive error and myopia alone were higher in urban areas compared to rural areas (odds ratio [OR]: 2.27 [CI: 2.09-2.45]) and (OR: 2.12 [CI: 1.79-2.50]), respectively. The prevalence of combined refractive errors and myopia alone in schools was higher among girls than boys (OR: 1.2 [CI: 1.1-1.3] and OR: 1.1 [CI: 1.1-1.2]), respectively. However, hyperopia was more prevalent among boys than girls in schools (OR: 2.1 [CI: 1.8-2.4]). Refractive error in children in India is a major public health problem and requires concerted efforts from various stakeholders including the health care workforce, education professionals and parents, to manage this issue.

Changing trend in prevalence of refractive errors: a hospital-based study

“…Authors referred to the cut off points as recommended by Sheeladevi et al to consider a refractive error significant (myopia of ≥-0.75D, hypermetropia of more than +2D, astigmatism cylindrical error of more than 0.75D). 11 In thin study, 503 (53.2%) children were males and 443 (46.8%) were females. The prevalence of refractive errors was found to be slightly higher in males, though the difference was not statistically significant.…”

“…Being a hospital-based study, this study had a greater number of children with refractive errors within the given study period (i.e, 946 as compared to 898 highest among the population-based studies and 582 highest among the school-based studies). 11 Dandona et al screened 1726 patients but they had included patients till 99 years of age in their study and Saxena et al included 1,297 patients but their aim was to find the prevalence of myopia in a group of population. 8,9 Authors used a logMAR digital vision chart to assess the vision and every child in this study underwent dilated retinoscopy to confirm the refractive error.…”

“…Significant refractive error was considered to be myopia of ≥-0.75D, hypermetropia of more than +2D, astigmatism cylindrical error of more than 0.75D. 11 Amblyopia was defined as unilateral or bilateral subnormal vision, at least two lines less than normal or two lines less than the fellow eye in unilateral cases. 12 The degree of subnormal vision was categorized as mild (6/9-12) moderate (6/15-6/36) and severe (worse than 6/36).…”

A cross sectional study on defective vision among secondary school going children in Vijayawada city, Andhra Pradesh

“…10 In a study conducted by Sheeladevi et al, the prevalence of defective vision was higher among girls than boys. 18 In a study conducted by Shrestha, the association between ocular morbidity, age and sex. 8 P value was considered significant at 0.05 for 95% confidence interval.…”

An observational study to evaluate the prevalence and pattern of refractive errors in children aged 3-17 years in Mumbai, India

“…According to a 31% 46% 23% 3 to 8 years 9 to 12 years 13 to 17 years systematic review conducted on the studies in India on refractive errors in children, the overall prevalence was found to be 8%. 10 The present study is hospital-based study, hence the likelihood of patients having refractive error is high as they are already screened and referred from schools or are having ocular complains.…”