April 1, 2026
By Mae FA Chong, BOptom, PGDipAdvClinOptom, PGCertOcTher, FACO
Photo Credit: Getty Images
The leading cause of global treatable visual impairment (VI) is uncorrected refractive error (URE). The World Health Organization (WHO) estimates half of the 2.8 million children with VI secondary to URE are in China where myopia is prevalent. This prospective study sought to define prevalence data to inform intervention targets.
This cross sectional study examined data from 9438 school-recruited participants aged 7 to 19 years old. Assessments included uncorrected vision, presenting visual acuity (VA), non-cycloplegic autorefraction and best corrected VA. URE was defined as presenting VA poorer than 6/12, with either eye improving at least one line with appropriate correction. VI was defined as presenting VA poorer than 6/12 (better eye).
The study found URE (prevalence 15.7%) was associated with female sex, spectacle wear, older age, hyperopia, myopia and anisometropia. VI (prevalence 4.9%) was associated with female sex, hyperopia, myopia and rural residence. Refractive error requiring correction prevalence was 55.9%, with older age, female sex, hyperopia, myopia, astigmatism and anisometropia being associated factors.
The study found high prevalence of URE (consequently refractive care needs) although VI due to URE was uncommon in the cohort. Myopia was the most important and anisometropia a significant VI risk factor. Aiming to eliminate preventable VI, the researchers recommended further investigations to refine intervention strategies.
Abstract
Uncorrected Refractive Errors, Visual Impairment and Need for Spectacles Among Children and Adolescents in Eastern, China
Yue Zhou, Qi Cai, Xiaojuan Chen, Xiaobo Huang, Zhimin Sun, Yu Song, Lele Li,Yan Zhu, Wang Yong, Peirong Lu
Background
Uncorrected refractive errors (URE) are the leading preventable cause of visual impairment (VI) in children globally, with China facing a critical dual challenge of high myopia prevalence and insufficient spectacle coverage among youth. Despite eastern China’s rapid development, population-based data on URE, VI, and need for spectacles remain scarce, particularly regarding the understudied role of anisometropia and subtype-specific refractive risks. This study evaluates these unmet needs to inform targeted interventions.
Methods
A cross-sectional school-based study was conducted in Nantong, China, including participants 7–19 years of age. All participants underwent assessments of their uncorrected visual acuity, presenting visual acuity (PVA), and best-corrected visual acuity. URE was defined as PVA worse than 0.3 logMAR (6/12 Snellen) with ≥1 line improvement (≥0.1 logMAR) after correction in either eye.VI was defined as PVA < 6/12 in the better eye. Need for spectacles was defined as the total prevalence of refractive error requiring correction, including unmet, under-met, and met needs. Non-cycloplegic autorefraction was assessed for each participant.
Results
Of the 9,864 participants, 9,438 were included in the analysis. The total prevalence of URE, VI and need for spectacles was 15.7% (95% CI: 15.0–16.5; n = 1,485),4.9% (95% CI: 4.9–5.3; n = 459) and 55.9% (95% CI: 54.9–56.9; n = 5,275), respectively. Multivariate analysis showed that factors such as female sex (aOR: 1.24, 95% CI: 1.09–1.40), wearing spectacles (aOR: 0.16, 95% CI: 0.14–0.19), older age groups (e.g., aOR: 3.92 for 13–14 years), hyperopia (aOR: 13.08, 95% CI: 7.67–22.31), myopia (aOR: 18.65, 95% CI: 12.54–27.77), and anisometropia (aOR: 1.87, 95% CI: 1.64–2.12) were associated with URE. For VI, significant associations included female sex (aOR: 1.20, 95% CI: 0.98–1.47), hyperopia (aOR: 7.23, 95% CI: 1.60–32.61), myopia (aOR: 53.04, 95% CI: 19.68–142.95), and rural residence (aOR: 1.53, 95% CI: 1.25–1.87). Factors such as older age (highest aOR: 11.77 for 19 years), female sex (aOR: 1.58, 95% CI: 1.42–1.77), hyperopia (aOR: 16.56, 95% CI: 10.97–25.01), myopia (aOR: 28.88, 95% CI: 21.83–38.19), astigmatism (aOR: 2.50, 95% CI: 2.22–2.82), and anisometropia (aOR: 1.37, 95% CI: 1.21–1.55) were associated with need for spectacles.
Conclusion
Although the prevalence of VI among children and adolescents in eastern China was low, the prevalence of URE and the need for spectacles were high. Myopia was the most important risk factor for URE, VI, and need for spectacles, and the impact of anisometropia on URE, VI, and need for spectacles cannot be ignored. Further research on adjusting intervention strategies is needed to eliminate preventable visual impairments.
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Mae Chong is a clinical optometrist with special interest in the fields of low vision, pediatric optometry and ocular diseases. She is an experienced clinical instructor and is actively involved in clinical research. Dr. Chong has presented lectures, workshops and tutorials to many audiences including optometrists, students and allied health professionals. A national level classifier with Paralympics Australia, Dr. Chong is involved in the evaluation of vision impaired athletes and provides classification advice to many sporting bodies including the Australian Football League and Tennis Australia. Currently, Dr. Chong is the General Manager Satellite Clinics at the Australian College of Optometry. |
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