Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Effective refractive error coverage and spectacle coverage among school children in Telangana, South India

Eye volume 38, pages 2143–2149 (2024)Cite this article

Subjects

Abstract

Background

Uncorrected refractive error (URE) is one of the leading causes of childhood vision impairment. Increasing effective refractive error coverage (e-REC) is one of the main indicators of WHO’s 2030 global eye health targets. The aim of this study is to estimate the e-REC and spectacle coverage among school children in Telangana, South India.

Methods

School children aged 4–15 years in the study locations underwent vision screening using 6/12 tumbling E optotype by trained community eye health workers in the schools. Those failing the initial vision screening and/or found to be having eye conditions were referred to a nearby referral centre appropriately, where they underwent detailed eye examination.

Results

A total of 774,184 children were screened in schools of which 51.49% were boys. The mean age was 9.40 ± 3.27 years. The prevalence of URE was 1.44% (95%CI:1.41–1.46) of which myopia was 1.38% (95%CI: 1.35–1.41). In multivariate analysis, the risk of myopia was higher among older children (Adj.OR: 17.04; 95%CI: 14.64–19.85), those residing in urban areas (Adj.OR:3.05, 95%CI:2.60–3.57), those with disabilities (Adj.OR:2.61, 95%CI:2.00–3.39) and among girls (Adj.OR:1.30, 95%CI:1.25–1.35) (P < 0.001). The overall e-REC was 56.97% and the spectacle coverage was 62.83%.

Conclusion

The need for interventions to improve e-REC to achieve 2030 global eye health target is eminent among children in this region. Improving refractive services through school eye health programs could aid in accelerating this process to achieve the target. Myopia being the most common type of RE, the risk factors included increasing age, urban location, and presence of disability.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The dataset can be made available on request.

References

  1. International Agency for Prevention of Blindness—A situational analysis of child eye health Available from: [https://www.iapb.org/learn/resources/a-situational-analysis-of-child-eye-health-a-review/] (Accesses 15 May 2023).

  2. 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  PubMed  PubMed Central  Google Scholar 

  3. Fricke TR, Jong M, Naidoo KS, Sankaridurg P, Naduvilath TJ, Ho SM, et al. Global prevalence of visual impairment associated with myopic macular degeneration and temporal trends from 2000 through 2050: systematic review, meta-analysis and modelling. Br J Ophthalmol. 2018;102:855–62. https://doi.org/10.1136/bjophthalmol-2017-311266. 2018, 102(7):855-862.

    Article  PubMed  Google Scholar 

  4. 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  PubMed  Google Scholar 

  5. 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  PubMed  PubMed Central  Google Scholar 

  6. Narayanan A, Krishnamurthy SS, Kumar RK. Status of eye health among school children in South India - Sankara Nethralaya School Children Eye Examination Study (SN-SEES). Ophthalmic Epidemiol. 2021;28:349–58.

    Article  PubMed  Google Scholar 

  7. Prakash WD, Marmamula S, Mettla AL, Keeffe J, Khanna RC. Visual impairment and refractive errors in school children in Andhra Pradesh, India. Indian j ophthalmol. 2022;70:2131–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. World Health Organisation. World report on vision. Geneva; 2019. Available from https://www.who.int/publications-detail/world-report-on-vision In.(Accessed 16 May 2023).

  9. Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive error study in children: sampling and measurement methods for a multi-country survey. Am J Ophthal. 2000;129:421–6.

    Article  CAS  PubMed  Google Scholar 

  10. Flitcroft DI, He M, Jonas JB, Jong M, Naidoo K, Ohno-Matsui K, et al. IMI—Defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Invest Ophthalmol Vis Sci. 2019;60:M20–M30. https://doi.org/10.1167/iovs.18-25957.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Maul E, Barroso S, Munoz SR, Sperduto RD, Ellwein LB. Refractive error study in children: results from La Florida, Chile. Am J Ophthalmol. 2000;129:445–54.

    Article  CAS  PubMed  Google Scholar 

  12. Murthy GVS, 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 

  13. Zhao J, Pan X, Sui R, Munoz SR, Sperduto RD, Ellwein LB. Refractive error study in children: results from Shunyi District, China. Am J Ophthalmol. 2000;129:427–35.

    Article  CAS  PubMed  Google Scholar 

  14. WHO - ICD -11 Vision Impairment classification. Available from [https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment] (Accessed 16 May 2023).

  15. McCormick I, Mactaggart I, Bastawrous A, Burton M, Ramke J. Effective refractive error coverage: an eye health indicator to measure progress towards universal health coverage. Ophthalmic Physiol Opt. 2020;40:1–5.

    Article  PubMed  Google Scholar 

  16. Jose R, Sachdeva S. School eye screening and the national program for control of blindness. Indian Pediatr. 2009;46:205–8.

    CAS  PubMed  Google Scholar 

  17. Gao Z, Meng N, Muecke J, Chan W, Piseth H, Kong A, et al. Refractive error in school children in an urban and rural setting in Cambodia. Ophthalmic Epidemiol. 2012;19:16–22.

    Article  PubMed  Google Scholar 

  18. Joseph E, Ck M, Kumar R, Sebastian M, Suttle CM, Congdon N, et al. Prevalence of refractive errors among school-going children in a multistate study in India. Br J Ophthalmol. 2024;108:143–151.

  19. Chandrasekar A, Rangavittal S, Krishnamurthy S, Narayanan A. Profile of ocular conditions from school eye screening in Southern India. Indian j ophthalmol. 2022;70:1755–60.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Grzybowski A, Kanclerz P, Tsubota K, Lanca C, Saw S-M. A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmol. 2020;20:27.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rudnicka AR, Kapetanakis VV, Wathern AK, Logan NS, Gilmartin B, Whincup PH, et al. Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention. Br J Ophthalmol. 2016;100:882–90. https://doi.org/10.1136/bjophthalmol-2015-307724.

    Article  PubMed  Google Scholar 

  23. Priscilla JJ, Verkicharla PK. Time trends on the prevalence of myopia in India - A prediction model for 2050. Ophthalmic Physiol Opt. 2021;41:466–74.

    Article  PubMed  Google Scholar 

  24. Philip K, Sankaridurg P, Naduvilath T, Konda N, Bandamwar K, Kanduri S, et al. Prevalence and Patterns of Refractive Errors in Children and Young Adults in an Urban Region in South India: the Hyderabad Eye Study. Ophthalmic Epidemiol. 2023;30:27–37.

  25. Gopalakrishnan A, Hussaindeen JR, Sivaraman V, Swaminathan M, Wong YL, Armitage JA, et al. Prevalence of myopia among urban and suburban school children in Tamil Nadu, South India: findings from the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study. Ophthalmic Physiol Opt. 2022;42:345–57.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Saxena R, Gupta V, Prasad P, Bhardwaj A, Vashist P. Prevalence of myopia and its risk factors in rural school children in North India: the North India myopia rural study (NIM-R Study). Eye (Lond). 2022;36:2000–5. https://doi.org/10.1038/s41433-021-01797-3.

    Article  PubMed  Google Scholar 

  27. Tsao WS, Hsieh HP, Chuang YT, Sheu MM. Ophthalmologic abnormalities among students with cognitive impairment in eastern Taiwan: The special group with undetected visual impairment. J Formos Med Assoc. 2017;116:345–50.

    Article  PubMed  Google Scholar 

  28. 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 https://doi.org/10.1371/journal.pone.0189774.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. 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;96:301–8.

    Article  PubMed  Google Scholar 

  30. He M, Xu J, Yin Q, Ellwein LB. Need and challenges of refractive correction in urban Chinese School Children. Optom Vis Sci. 2005;82:229–34.

    Article  PubMed  Google Scholar 

  31. Chin MP, Siong KH, Chan KH, Do CW, Chan HH, Cheong AM. Prevalence of visual impairment and refractive errors among different ethnic groups in schoolchildren in Turpan, China. Ophthalmic Physiol Opt. 2015;35:263–70. https://doi.org/10.1111/opo.12193.

    Article  PubMed  Google Scholar 

  32. Barria F, Conte F, Muñoz S, Leasher JL, Silva JC. Prevalence of refractive error and spectacle coverage in schoolchildren in two urban areas of Chile. Rev Panam Salud Publica. 2018;42:e61 https://doi.org/10.26633/RPSP.2018.61.

    Article  PubMed  PubMed Central  Google Scholar 

  33. National Institute of Educational Planning and Administration, New Delhi. Available from: [https://www.education.gov.in/sites/upload_files/mhrd/files/statistics-new/ESAG-2018.pdf] (Accessed 24 May 2023).

Download references

Acknowledgements

We thank all the children who were enroled in the study. We are also grateful to all the paediatric ophthalmologists, Vision technicians the Community eye health workers and, administrators who were involved in this study. We also thank Ms. Asha Latha Mettla for all the administrative and logistical support throughout this project.

Funding

This study was funded by Lavelle Fund for the Blind, USA, Sun Pharma Corporate Social Responsibility grant and Hyderabad Eye Research Foundation, India.

Author information

Authors and Affiliations

  1. Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, Telangana, India

    Winston D Prakash, Srinivas Marmamula, Jill Keeffe & Rohit C. Khanna

  2. Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, Telangana, India

    Winston D Prakash & Srinivas Marmamula

  3. J V Ramanamma Children Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India

    Winston D Prakash

  4. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India

    Srinivas Marmamula & Rohit C. Khanna

  5. School of Optometry and Vision Science, University of New South Wales, Sydney, Australia

    Rohit C. Khanna

  6. University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA

    Rohit C. Khanna

Authors
  1. Winston D Prakash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Srinivas Marmamula
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jill Keeffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rohit C. Khanna
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

First author: Winston D Prakash. Data cleaning and analysis, interpretation, and manuscript writing. Second Author: Srinivas Marmamula: Study design, data collection and manuscript review. Third author: Jill Keeffe: Study design and manuscript review. Fourth & corresponding author: Rohit Khanna: Study concept, design, data interpretation and manuscript review.

Corresponding author

Correspondence to Rohit C. Khanna.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

This study was approved by Institutional Review Board of Hyderabad Eye Research Foundation prior to the screening. Ethics reference number: LEC 01-15-011.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Prakash, W.D., Marmamula, S., Keeffe, J. et al. Effective refractive error coverage and spectacle coverage among school children in Telangana, South India. Eye 38, 2143–2149 (2024). https://doi.org/10.1038/s41433-024-02986-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-024-02986-6

Search

Advanced search

Quick links