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. 2022 Jul 1;17(7):e0268800.
doi: 10.1371/journal.pone.0268800. eCollection 2022.

The prevalence and causes of pediatric uncorrected refractive error: Pooled data from population studies for Global Burden of Disease (GBD) sub-regions

He Cao  1 , Xiang Cao  2 , Zhi Cao  3 , Lu Zhang  4 , Yue Han  5 , Changchun Guo  6
Affiliations

The prevalence and causes of pediatric uncorrected refractive error: Pooled data from population studies for Global Burden of Disease (GBD) sub-regions

He Cao et al. PLoS One. .

Abstract

Background: There are limited systematic reviews on the prevalence of uncorrected refractive errors in children. We aimed to summarize the prevalence and causes of pediatric uncorrected refractive error (URE) from studies in the Global Burden of Disease (GBD) sub-regions.

Methods: The pooled analysis used the individual participant data (ages less than 20 years old) from population-based studies around the world by regions. URE was defined as presenting VA < 6/18 and improving to ≥ 6/18 or ≥1 line on using a pinhole in either eye, with main causes of myopia, hyperopia or astigmatism. Each study provided data on any URE, myopia, hyperopia or astigmatism by age, gender, and ethnicity. Prevalence rates were directly age and gender standardized to the 2020 world population with all age groups. Estimates were calculated by study and sub-regions after pooling. Summary estimates included studies in which URE was assessed from a pinhole-corrected refraction in the better eye.

Results: The combined pooled data contained 302,513,219 patients including 8 963 URE cases individuals from 57 studies. Prevalence varied by age and GBD sub-regions and differed by gender. The age- and region-standardized prevalence of URE was 3.41 per 1000 (CI, 1.53~7.62) in Western Pacific region (12 studies), 2.26 per 1000 (CI, 0.85~6.01) in South-East Asia region (14 studies), 5.85 per 1000 (CI, 3.75~9.13) in Americans (11 studies) and 4.40 per 1000 (CI, 3.0~6.45) in Eastern Mediterranean region (13 studies). On the basis of these data, myopia was the first-leading cause in female children with 12~17 age group, with the prevalence rate 18.2 per 1000 (CI, 11.52~23.61). Astigmatism was detected in 27.2 per 1000 male children with 6~11 age group (CI: 19.12-30.68).

Conclusions: Prevalence of URE available data within these sub-regions are widely disparate. Myopia and astigmatism in young age children continue as the leading cause of URE worldwide. Providing appropriate refractive correction to those individuals whose vision can be improved is an important public health endeavor with implications for safety and quality of life.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram showing the selection process for inclusion of studies in the meta-analysis.
CI = confidence interval; URE = uncorrected refractive error.
Fig 2
Fig 2. Gender-standardized prevalence of URE by GBD sub-regions.
Prevalence rates shown are per 1000 children and include data from only those studies that assessed both eyes for each subject. Prevalence rates have been directly age- and gender-standardized to the 2020 world population with all ages groups Children (< 20 years) (population data extracted from Ref. 15); URE = uncorrected refractive error.
Fig 3
Fig 3. Prevalence of URE by GBD sub-regions from 2000 to 2021 (per/1000).
Fig 4
Fig 4. Crude prevalence of myopia, hyperopia and astigmatism by age in gender.
The broken line are informative data points from included studies that reported the prevalence of URE.
Fig 5
Fig 5. Forest plot showing prevalence of refractive errors among children aged < 20 years in Western Pacific region.
Fig 6
Fig 6. Forest plot showing prevalence of URE among children aged < 20 years in American region.
Fig 7
Fig 7. Forest plot showing prevalence of refractive errors among children aged < 20 years in Eastern Mediterranean region.
Fig 8
Fig 8. Forest plot showing prevalence of refractive errors among children aged < 20 years in South-East Asia region.
See this image and copyright information in PMC

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