Prevalence of refractive errors, uncorrected refractive error, and presbyopia in adults in India: A systematic review

Abstract

Purpose: The objective of this review is to estimate the prevalence of refractive errors, uncorrected refractive error (URE), and uncorrected presbyopia in adults aged ≥30 years in India. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. A detailed literature search was performed to include all studies published from India from the year 1990 using the Cochrane Library, Medline, and Embase. Refractive error was defined by >0.50 D ametropia. URE was defined by presenting visual acuity (PVA) worse than 6/18 improving with pinhole or spectacle correction, and uncorrected presbyopia by near vision <N8 improving with correction in the absence of distance URE. Results: Fifteen studies were included from South India, one each from Western and Central India, and one study covered 15 states across India. The prevalence of RE of at least 0.50 D of spherical equivalent ametropia was 53.1% [(95% confidence interval (CI): 37.2–68.5), of which myopia and hyperopia was 27.7% and 22.9%, respectively. The prevalence of URE was 10.2% (95% CI: 6.9–14.8), but heterogeneity in these estimates was very high. The prevalence of uncorrected presbyopia was 33% (95% CI: 19.1–51.0). Conclusion: This review highlights the magnitude of refractive errors among adults in India. More studies are needed using standard methods in regions where there is a lack of information on UREs. Programs delivering spectacles for adults in India will need to primarily focus on reading glasses to correct presbyopia along with spectacles for hyperopia and myopia.

Recent Epidemiology Study Data of Myopia

“…In India, the prevalence of myopia is similar to that of the nearby Tibetan province of China where the prevalence is nearly the lowest in all of China. A meta-analysis concluded that only 5.3% of children younger than 16 years of age are myopic in India [ 47 ]. The prevalence of myopia in Europe and North America ranges from 6.2% to 26.2% ( Table 1 ).…”

“…In one study in India on children younger than 16 years old, girls living in urban areas were significantly more likely to have myopia than boys [ 47 ], whereas Reed et al found the opposite to be true [ 39 ]. In the same report from Indian, the prevalence of myopia was shown to be higher in urban areas compared to rural areas (OR 2.12) [ 47 ], supporting the idea that severe air pollution in cities may accelerate myopia progression [ 83 ]. However, Morris et al did not find strong evidence associating urban or rural status with the incidence of myopia in a United Kingdom cohort of 3,512 children.…”

Temporal trends in the prevalence of spectacle use and spectacle coverage in India

“…In India, the prevalence of uncorrected refractive error among its population is estimated to be 10.2 per cent. 4 Since the inception of VISION 2020: The Right to Sight initiative, the last two decades has seen significant improvements in terms of eye-care service delivery. This is evident from the decline in the global prevalence of vision impairment.…”

The burden of uncorrected refractive error

“…[134] A systematic review published in this issue of Indian Journal of Ophthalmology estimates 53% prevalence of at least 0.50 D of spherical equivalent ametropia (myopia 27.7%, hyperopia 22.9%) in India. [5] The estimated prevalence of uncorrected refractive errors was 10.2% [95% confidence interval (CI): 6.9–14.8] and the prevalence of uncorrected presbyopia was 33% (95% CI: 19.1–51.0). In absolute numbers, the estimated prevalence of uncorrected refractive error was 54.5 million and presbyopia was 177 million – a staggering problem.…”