Refractive error and visual impairment in school children in rural southern China

Purpose: To assess the prevalence of refractive error and visual impairment in schoolchildren in a rural area of southern China. Design: Prospective cross-sectional survey. Participants: Two thousand four hundred children from junior high schools in Yangxi County. Methods: Random selection of classes from the 3 junior high school grade levels was used to identify the study sample. Children from 36 classes in 13 schools were examined in April 2005. The examination included visual acuity (VA) testing; ocular motility evaluation; cycloplegic autorefraction; and examination of the external eye, anterior segment, media, and fundus. Main Outcome Measures: Distance VA and cycloplegic refraction. Results: Among 2515 enumerated children, 2454 (97.6%) were examined. The study population consisted of the 2400 children between 13 and 17 years old. Prevalences of uncorrected, presenting, and best-corrected VA <= 20/40 in the better eye were 27.0%, 16.6%, and 0.46%, respectively. Sixty percent of those who could achieve acuity >= 20/32 in at least one eye with best correction were without the necessary spectacles. Refractive error was the cause in 97.1% of eyes with reduced vision; amblyopia, 0.81%; other causes, 0.67%; and unexplained causes, 1.4%. Myopia (spherical equivalent, -0.50 diopters [D] or more in either eye) affected 36.8% of 13-year-olds, increasing to 53.9% of 17-year-olds. Myopia was associated with higher grade level, female gender, schooling in the county urban center, and higher parental education. Hyperopia (+2.00 D or more) affected approximately 1.0% in all age groups. Astigmatism ( >= 0.75 D) was present in 25.3% of all children. Conclusions: Reduced vision because of uncorrected myopia is a public health problem among school-age children in rural China. Effective VA screening strategies are needed to eliminate this easily treated cause of visual impairment.