The Prevalence of Refractive Errors in Indian School Children: A Systematic Review and Meta-Analysis

Refractive errors (REs) are a significant cause of vision impairment and the second leading cause of blindness worldwide. Myopia, hyperopia, and astigmatism are the most prevalent forms. In developing regions, including India, the prevalence and impact of REs, particularly among school-aged children, is profound, affecting their academic performance and overall quality of life. This review aimed to consolidate data from studies published post-2018 to provide updated prevalence estimates of REs among Indian school children. Following the PRISMA guidelines, a comprehensive literature search was conducted in May 2024 across four databases: Web of Science, PubMed, Scopus, and Embase. Inclusion criteria focused on cross-sectional studies from India, reporting the prevalence of REs among school-aged children. Out of 1434 studies, 43 met the inclusion criteria. The overall pooled prevalence of REs was 11% (95% CI: 0.08-0.15). The subgroup analysis showed a slight decline in prevalence post-COVID-19, from 12% to 11%. Prevalence was higher in cycloplegic studies at 12%, compared to 10% in non-cycloplegic. Myopia was the most prevalent RE at 8%, with astigmatism at 3% and hyperopia at 1%. No significant gender differences were found. The meta-regression does not indicate a statistically significant relation between the year of publication and the prevalence of RE. REs, particularly myopia, pose a significant burden among Indian schoolchildren. Despite the COVID-19 pandemic, the overall prevalence of REs has remained stable. These findings emphasize the need for continued vision screening programs and targeted interventions to reduce the prevalence of uncorrected refractive errors.