Prevalence of refractive error among urban and rural middle school children in Tindivanam Taluk, Tamil Nadu – a cross-sectional study

P. M. Dikshapriya; J. Arun Daniel; S. Bhuvaneswary; S. Andrew John Silvester

doi:10.18203/2394-6040.ijcmph20260731

Authors

P. M. Dikshapriya School of Allied Health Sciences, Vinayaka Mission’s Puducherry Campus, Puducherry, India
J. Arun Daniel Department of Community Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
S. Bhuvaneswary Department of Community Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
S. Andrew John Silvester School of Allied Health Sciences, Vinayaka Mission’s Puducherry Campus, Puducherry, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20260731

Keywords:

School children, Refractive error, Prevalence

Abstract

Background: Refractive errors are one of the major public health issues of school children and remain the important causes of preventable visual impairment. When left unnoticed, these vision problems can have a negative effect on a child's learning, social relationships and general wellbeing. Objectives were to find the prevalence of refractive error among urban and rural middle school children.

Methods: This cross-sectional study involved 456 school-going children aged 11–13 years who were sampled in a selected group of government schools. The approach used in the selection of participants was cluster sampling. Data were gathered with a pretested semi-structured questionnaire on socio-demographic information, ocular history and eye care practices. Visual acuity evaluation was done using the application World Health Organization (WHO) eyes, followed by basic ocular examination. Data was described with descriptive and inferential statistics.

Results: The prevalence rate of refractive error was 13.8% with the most common type of refractive error being myopia (10.8%), astigmatism (2.2%) and hypermetropia (0.9%). Ocular complaints were reported by 32.7% of the students, and they were mostly blurring of vision (13.8%). Most children had normal unaided visual acuity (86.2%). Refractive errors were significantly linked with ocular complaints, spectacle use, past ocular morbidity, previous eye treatment.

Conclusions: Refractive errors particularly myopia are common in school aged children, therefore the need for regular school-based vision screening, early detection and correction is essential in order to prevent long term visual problems.

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References

He M, Zeng J, Liu Y, Xu J, Pokharel G, Ellwein L. Refractive error and visual impairment in urban children in Southern China. Invest Ophthalmol Vis Sci. 2004;45(3):793. DOI: https://doi.org/10.1167/iovs.03-1051

Naidoo K, Raghunandan A, Mashige K, Govender-Poonsamy P, Holden B, Pokharel G, et al. Refractive error and visual impairment in African children in South Africa. Invest Ophthalmol Vis Sci. 2003;44(9):3764. DOI: https://doi.org/10.1167/iovs.03-0283

Agarwal T, Saxena R, Gupta V, Kalaivani M, Dhiman R, Bhardawaj A, et al. Prevalence of myopia in Indian school children: Meta-analysis of last four decades. PLoS One. 2020;15(10):e0240750. DOI: https://doi.org/10.1371/journal.pone.0240750

Joseph E, CK M, Kumar R, Sebastian M, Suttle C, Congdon N, et al. Prevalence of refractive errors among school-going children in a multistate study in India. Br J Ophthalmol. 2022;108(1):143-51. DOI: https://doi.org/10.1136/bjo-2022-322123

Gopalakrishnan A, Hussaindeen J, Sivaraman V, Swaminathan M, Wong Y, Armitage J, et al. Prevalence of myopia among urban and suburban school children in Tamil Nadu, South India: Findings from the STEM study. Ophthalmic Physiol Opt. 2022;42(2):345-57. DOI: https://doi.org/10.1111/opo.12943

Resnikoff S. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ. 2008;86(1):63-70. DOI: https://doi.org/10.2471/BLT.07.041210

Srivastava T, Kumar A, Shukla E, Singh V, Anuranjani L. Prevalence of refractive errors among school-going children in urban versus rural areas. Cureus. 2024;16(4):e59197. DOI: https://doi.org/10.7759/cureus.59197

Adhikari P, Chudal G, Karn R, Thakur S, Sitoula R, Singh S. Prevalence of refractive error in school-going children of Sunsari District and Biratnagar, Nepal. J Chitwan Med Coll. 2023;13(1):39-43. DOI: https://doi.org/10.54530/jcmc.1231

Pan CW, Ramamurthy D, Saw SM. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt. 2011;32(1):3-16. DOI: https://doi.org/10.1111/j.1475-1313.2011.00884.x

Foster PJ, Jiang Y. Epidemiology of myopia. Eye. 2014;28(2):202-8. DOI: https://doi.org/10.1038/eye.2013.280

Paudel P, Ramson P, Naduvilath T, Wilson D, Phuong HT, Ho SM, et al. Prevalence of vision impairment and refractive error in school children in Vietnam. Clin Exp Ophthalmol. 2014;42(3):217-26. DOI: https://doi.org/10.1111/ceo.12273

You QS, Wu LJ, Li YB, Luo YX, Liu LJ, Li X, et al. Prevalence of myopia in school children in greater Beijing. Acta Ophthalmol. 2013;92(5). DOI: https://doi.org/10.1111/aos.12299

Nguyen T, Shock L, Missoi T, Muzaffar A. Incidence of amblyopia and its risk factors in children. Cleft Palate Craniofac J. 2016;53(1):14-7. DOI: https://doi.org/10.1597/14-212

Kumar N, Jangra B, Jangra MS, Pawar N. Risk factors associated with refractive error among medical students. Int J Community Med Public Health. 2018;5(2):634-8. DOI: https://doi.org/10.18203/2394-6040.ijcmph20170241

Vashist P, Senjam SS, Gupta V, Manna S, Gupta N, Shamanna BR, et al. Prevalence of visual impairment and causes of vision loss in school-aged children in North India: A population-based study. Indian J Ophthalmol. 2021;69(2):351-7.

Mukazhanova A, Zhumadilova A, Tulegenova A, Tursynbekova A. Prevalence and risk factors of myopia among school children in Central Asia. BMC Ophthalmology. 2022;22:112.

Sharma A, Saxena R, Vashist P. Childhood myopia: Epidemiology, risk factors, and prevention. Indian J Ophthalmol. 2020;68(2):227-34.

Sharma P, Gupta R, Mehta D. Visual acuity status and refractive errors among school children in urban slum areas. J School Health. 2025;95(1):45-52.

Joseph S, Thomas A, George R. Familial aggregation and environmental determinants of refractive errors in children. Ophthalmic Epidemiol. 2022;29(4):367-74.

Falkenberg HK, Langaas T, Svarverud E. Vision problems and academic performance in school children. Acta Ophthalmologica. 2019;97(3):247-52.

Li SM, Li H, Li SY, Liu LR, Kang MT, Wang YP, Anyang Childhood Eye Study Group. Visual impairment and academic performance in school-aged children. Ophthalmology. 2020;127(6):750-8.

Bhartiya S, Gupta N, Tandon R. Ocular morbidity patterns among school children: Evidence from community-based screening. Indian J Public Health. 2024;68(1):45-51.

Mohammadi SF, Ashrafi E, Hashemi H. Association between refractive errors and ocular symptoms in school-aged children. J Pediatr Ophthalmol Strabismus. 2022;59(5):332-8.

Németh J, Tapasztó B, Tóth G. Environmental risk factors of myopia in children: The role of screen exposure and outdoor activity. Surv Ophthalmol. 2022;67(4):1012-20.

Ismail M, Sukumaran KD. Urban–rural differences in refractive errors among Indian school children. J Clin Diagn Res. 2022;16(6):NC01-5.

Dikshit A, Verma S, Agarwal M. Effectiveness of school-based vision screening programs in early detection of refractive errors. Int J Community Med Public Health. 2024;11(2):812-8.

Mansoori N, Khan A, Siddiqui Z. Role of educational institutions in prevention of childhood visual impairment. J Family Med Prim Care. 2025;14(1):89-95.