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Prevalence of Myopia and Associated Risk Factors in Schoolchildren in North India

Singh, Neeraj Kumar, BSOptom, MPhil1,2,3*; James, Ritika M., BSOptom4; Yadav, Avdhesh, MPH, PhD3; Kumar, Rishikesh, MOptom3; Asthana, Smita, MD2; Labani, Satyanarayana, PhD2

doi: 10.1097/OPX.0000000000001344

SIGNIFICANCE Studies reporting the prevalence and associated risk factors of myopia among schoolchildren in India are limited. Knowledge about the prevalence and the modifiable risk factors associated with myopia development will help in planning cost-effective strategies to prevent its progression in India.

PURPOSE The purpose of this study was to assess the prevalence and associated behavioral risk factors of myopia in schoolchildren in Gurugram, Haryana, in north India.

METHODS This cross-sectional study was conducted on schoolchildren (aged 5 to 15 years) from two private schools in Gurugram. Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study chart. Myopia was defined as the spherical equivalent refractive error of at least −0.50 D in the better eye. Information on the child's habits and lifestyle, study hours, hours of playing video games, and outdoor playtime were obtained using a questionnaire. Association of behavioral risk factors was analyzed for children with and without myopia, and adjusted odds ratio (OR) for each factor was estimated.

RESULTS A total of 1234 children (mean ± SD age, 10.5 ± 3 years; 59% boys) were screened. Myopia prevalence was found to be 21.1% (n = 261; mean ± SD age, 11 ± 2 years; 52% boys). The mean ± SD myopic spherical error was −1.94 ± 0.92 D. The prevalence of myopia was found to be higher (27%; 95% confidence interval, 23 to 30.6; OR, 3.19 [2.13 to 4.76]) among older children (9 to 12 years). Prevalence of myopia was more in boys (25%; 95% confidence interval, 21.1 to 28.8) compared with girls (P < .01). A positive association of presence of myopia was observed with children studying more than 4 hours per day (P < .008) and with children playing computer/video/mobile games more than 2 hours per day (P < .001). A protective effect was observed in children with outdoor activities/play for more than 1.5 hours per day (OR, 0.01 [0.00 to 0.06]).

CONCLUSIONS Myopia is a major public health concern, and its prevalence is increasing rapidly among schoolchildren in India. There is a pressing need to develop cost-effective strategies to prevent this cause of vision impairment, which can be easily treated with optical interventions.

1Borish Center for Ophthalmic Research, School of Optometry, Indiana University, Bloomington, Indiana

2Department of Epidemiology and Biostatistics, Indian Council of Medical Research, National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India

3Centre for Sight Eye Hospital, New Delhi, India

4Association for Social Health in India, New Delhi, India *

Supplemental Digital Content: The Appendix, available at, is the 19-item questionnaire used to collect information on habits, lifestyle, and time spent during outdoor play and near-work in schoolchildren. The parents and children jointly answered the questionnaire. The response of this questionnaire was used to analyze the associated behavioral risk factors in children with and without myopia.

Submitted: January 16, 2018

Accepted: October 25, 2018

Funding/Support: Association for Social Health in India (Young Investigator Award; to NKS).

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Author Contributions and Acknowledgments: Conceptualization: NKS, RMJ, AY, SL; Data Curation: NKS, RMJ; Formal Analysis: NKS, SA, SL; Funding Acquisition: NKS, RMJ; Investigation: NKS, RK; Methodology: NKS, RMJ, AY, SA, SL; Project Administration: RMJ, AY; Software: SL; Supervision: AY, SA, SL; Validation: SA; Visualization: RMJ; Writing – Original Draft: NKS, RK; Writing – Review & Editing: NKS, RMJ, AY, SA, SL.

The authors thank Prof. Arthur Bradley, Indiana University School of Optometry, for suggestions in article revision.

Supplemental Digital Content: Direct URL links are provided within the text.

© 2019 American Academy of Optometry