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Prevalence of myopia and its risk factors in rural school children in North India: the North India myopia rural study (NIM-R Study)



To assess the prevalence of myopia and its risk factors in rural school children.


Children in classes 4–7 of eight randomly selected schools (five government and three private) in rural Haryana, with unaided vision <6/9.5 were screened, their cycloplegic refraction is done, myopes were identified. A questionnaire-based assessment of risk factors was done for myopes and compared with 10% of randomly selected children with normal vision (controls). The prevalence of myopia and its association with risk factors were assessed.


Children screened were 1486 (89.5% coverage). The mean age of children was 11.2 ± 1.5 years with 861 (57.9%) boys. Prevalence of myopia was 6.4% (95% Confidence intervals [CI]: 5.2%, 7.8%). Prevalence was higher among private schools (10.1%) compared to government schools (1.4%) (p < 0.001), and among girls 7.2% (45/625) compared to boys 5.8% (50/861) (p = 0.2786). The mean spherical equivalent refractive error was −1.61D ± 1.32D. The prevalence of high myopia was 1.1% (1/95). There was a 75% unmet need for spectacles. Studying in private school was positively associated with myopia as per our multivariate analysis (p = 0.016). An inverse association was found for time spent outdoors (p = 0.009). Watching television, indoor time, screen time, age, or gender were not found to be statistically significant as risk factors.


The prevalence of myopia is increasing among children of rural areas, especially those in private schools with a strong inverse association with time spent outdoors. Regular screening, lifestyle modification and awareness about modifiable risk factors are essential.

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  1. Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ. 2008;86:63–70.

    Article  Google Scholar 

  2. Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012;379:1739–48.

    Article  Google Scholar 

  3. Pan CW, Ramamurthy D, Saw SM. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt. 2012;32:3–16.

    Article  Google Scholar 

  4. Vitale S, Sperduto RD, Ferris FL. Increased prevalence of myopia in the United States between 1971-2 and 1999–2004. Arch Ophthalmol. 2009;127:1632–39.

    Article  Google Scholar 

  5. Dandona R, Dandona L, Srinivas M, Sahare P, Narsaiah S, Muñoz SR, et al. Refractive error in children in a rural population in India. Invest Ophthalmol Vis Sci. 2002;43:615–22.

    PubMed  Google Scholar 

  6. Murthy GV, Gupta SK, Ellwein LB, Muñoz SR, Pokharel GP, Sanga L, et al. Refractive error in children in an urban population in New Delhi. Invest Ophthalmol Vis Sci. 2002;43:623–31.

    CAS  PubMed  Google Scholar 

  7. Ghosh S, Mukhopadhyay U, Maji D, Bhaduri G. Visual impairment in urban school children of low-income families in Kolkata, India. Indian J Public Health. 2012;56:163–67.

    Article  Google Scholar 

  8. Saxena R, Vashist P, Menon V. Is myopia a public health problem in India? Indian J Community Med. 2013;38:83–5.

    Article  Google Scholar 

  9. Sheeladevi S, Seelam B, Nukella PB, Modi A, Ali R, Keay L. Prevalence of refractive errors in children in India: a systematic review. Clin Exp Optom. 2018;101:495–503.

    Article  Google Scholar 

  10. Agarwal D, Saxena R, Gupta V, Mani K, Dhiman R, Bhardawaj A, et al. Prevalence of myopia in Indian school children: meta-analysis of last four decades. PLoS ONE. 2020;15:e0240750.

    CAS  Article  Google Scholar 

  11. Congdon N, Burnett A, Frick K. The impact of uncorrected myopia on individuals and society. Community Eye Health J. 2019;32:7–8.

    Google Scholar 

  12. Pratt C, Bryant P. Young children understanding that looking leads to knowing (so long as they are looking into a single barrel). Child Dev. 1990;61:973–82.

    CAS  Article  Google Scholar 

  13. Packwood EA, Cruz OA, Rychwalski PJ, Keech RV. The psychosocial effects of amblyopia study. J AAPOS. 1999;3:15–17.

    CAS  Article  Google Scholar 

  14. Agrawal D, Sahu A, Agrawal D. Prevalence of ocular morbidities among school children in Raipur district, India. Indian J Ophthalmol. 2020;68:340–4.

    Article  Google Scholar 

  15. Pokharel GP, Negrel AD, Munoz SR, Ellwein LB. Refractive error study in children: results from Mechi Zone, Nepal. Am J Ophthalmol. 2000;129:436–44.

    CAS  Article  Google Scholar 

  16. Saxena R, Vashist P, Tandon R, Pandey RM, Bhardawaj A, Gupta V, et al. Incidence and progression of myopia and associated factors in urban school children in Delhi: the North India myopia study (NIM Study). PLoS ONE 2017;12:e0189774.

    Article  Google Scholar 

  17. Saxena R, Vashist P, Tandon R, Pandey RM, Bhardawaj A, Menon V, et al. Prevalence of myopia and its risk factors in urban school children in Delhi: the North India myopia study (NIM Study). PLoS ONE. 2015;10:e0117349.

    Article  Google Scholar 

  18. Matsumura H, Hirai H. Prevalence of myopia and refractive changes in students from 3 to 17 years of age. Surv Ophthalmol. 1999;44:S109–S115. PMID: 10548123

    Article  Google Scholar 

  19. Yoon KC, Mun GH, Kim SD, Kim SH, Kim CY, Park KH, et al. Prevalence of eye diseases in South Korea: data from the Korea National Health and Nutrition Examination Survey 2008-9. Korean J Ophthalmol. 2011;25:421–33.

    Article  Google Scholar 

  20. Lim HT, Yoon JS, Hwang SS, Lee SY. Prevalence and associated sociodemographic factors of myopia in Korean children: the 2005 third Korea National Health and Nutrition Examination Survey (KNHANES III).Jpn J Ophthalmol. 2012;56:76–81.

    Article  Google Scholar 

  21. Saw SM, Zhang MZ, Hong RZ, Fu ZF, Pang MH, Tan DT. Near-work activity, night-lights, and myopia in the Singapore-China study. Arch Ophthalmol. 2002;120:620–7.

    Article  Google Scholar 

  22. Lin LL, Shih YF, Hsiao CK, Chen CJ. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singap. 2004;33:27–33.

    CAS  PubMed  Google Scholar 

  23. Lin LL, Shih YF, Hsiao CK, Chen CJ, Lee LA, Hung PT. Epidemiologic study of the prevalence and severity of myopia among schoolchildren in Taiwan in 2000. J Formos Med Assoc. 2001;100:684–91.

    CAS  PubMed  Google Scholar 

  24. Fan DS, Lam DS, Lam RF, Lau JT, Chong KS, Cheung EY, et al. Prevalence, incidence, and progression of myopia of school children in Hong Kong. Invest Ophthalmol Vis Sci. 2004;45:1071–5.

    Article  Google Scholar 

  25. Lam CS, Lam CH, Cheng SC, Chan LY. Prevalence of myopia among Hong Kong Chinese schoolchildren: changes over two decades. Ophthalmic Physiol Opt. 2012;32:17–24.

    Article  Google Scholar 

  26. He M, Zeng J, Liu Y, Xu J, Pokharel GP, Ellwein LB. Refractive error and visual impairment in urban children in southern China. Invest Ophthalmol Vis Sci. 2004;45:793–99.

    Article  Google Scholar 

  27. Qian YS, Chu RY, He JC, Sun XH, Zhou XT, Zhao NQ, et al. Incidence of myopia in high school students with and without red-green color vision deficiency. Invest Ophthalmol Vis Sci. 2009;50:1598–605.

    Article  Google Scholar 

  28. You QS, Wu LJ, Duan JL, Luo YX, Liu LJ, Li X, et al. Prevalence of myopia in school children in great- er Beijing: the Beijing Childhood Eye Study. Acta Ophthalmol. 2014;92:e398–406.

    Article  Google Scholar 

  29. Rustagi N, Uppal Y, Taneja DK. Screening for visual impairment: outcome among schoolchildren in a rural area of Delhi. Indian J Ophthalmol. 2012;60:203–06.

    Article  Google Scholar 

  30. Gogate P, Mukhopadhyaya D, Mahadik A, Naduvilath TJ, Sane S, Shinde A, et al. Spectacle compliance amongst rural secondary school children in Pune district, India. Indian J Ophthalmol. 2013;61:8–12.

    Article  Google Scholar 

  31. Gupta V, Saxena R, Vashist P, Bhardwaj A, Pandey RM, Tandon R, et al. Spectacle coverage among urban schoolchildren with refractive error provided subsidized spectacles in North India. Optom Vis Sci. 2019;96:301–08.

    Article  Google Scholar 

  32. Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental history of myopia, sports and outdoor activities, and future myopia. Invest Ophthalmol Vis Sci. 2007;48:3524–32.

    Article  Google Scholar 

  33. Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmol. 2008;115:1279–85.

    Article  Google Scholar 

  34. Ashby R, Ohlendorf A, Schaeffel F. The effect of ambient illuminance on the development of deprivation myopia in chicks. Invest Ophthalmol Vis Sci. 2009;50:5348–54.

    Article  Google Scholar 

  35. Saw SM, Cheng A, Fong A, Gazzard G, Tan DT, Morgan I. School grades and myopia. Ophthalmic Physiol Opt. 2007;27:126–29.

    Article  Google Scholar 

  36. Morgan IG, Rose KA. Myopia and international educational performance. Ophthalmic Physiol Opt. 2013;33:329–38.

    Article  Google Scholar 

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The authors would like to acknowledge the assistance of all school principals and teachers for their support. We also acknowledge the contribution of Mr. Deepak towards data analysis.


The study was funded through Grant number E-1475/390/2015 of the Department of Science and Technology, Government of India. The funds were for school visits, data collection and analysis. None of the authors are employed by the funding agency ( The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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R.S.—Concept and editing of the manuscript. V.G.—conduction of the study and data collection. P.P.—preparation of manuscript A.B.—data analysis. P.V.—conduction of the study and data collection.

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Correspondence to Rohit Saxena.

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Saxena, R., Gupta, V., Prasad, P. et al. Prevalence of myopia and its risk factors in rural school children in North India: the North India myopia rural study (NIM-R Study). Eye (2021).

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