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Globally, at least 450 million children have a sight condition that needs treatment, with 90 million children living with some form of sight loss.
  • 448 million children and adolescents have refractive errors1,2
  • 90 million children and adolescents live with sight loss3
    • 2 million are living with blindness
    • 30 million have moderate to severe sight loss
    • 58 million have mild sight loss
  • The prevalence of vision loss in children varies considerably within, and between countries and regions.
  • However, if refractive error is excluded, the number of children who are blind from eye conditions is falling in all regions,4 due to the reduction of corneal blindness due to vitamin A deficiency and measles.
  • Malik et al.5 reported that children who are blind are more likely to die in childhood than a child with good vision, especially in low-income countries6
  • It is estimated that  40% of children are blind from eye conditions that could be managed if the child had access to eye care services or could be prevented7
  • The Lancet Commission7 reported that vision impairment in children is associated with lower academic outcomes,8–13 and children in LMICs are up to five times less likely to be in formal education14
  • School-based eye health programmes are cost-efficient and effective12

Early detection and treatment of eye conditions is critical, as there is an increased risk of morbidity and mortality in children due to several conditions that cause blindness, including vitamin A deficiency, metabolic syndromes and retinoblastoma.14–19   

Vision impairment in children can severely impact educational outcomes,6–10 contribute to low self-esteem,20 and future socio-economic potential.21 

The prevalence of vision impairment and blindness varies considerably within, and between countries. Refractive error is the leading cause of vision impairment (MSVI) in school-aged children.22 Other common causes of vision impairment and blindness include cataract, retinopathy of prematurity, congenital ocular anomalies, corneal scarring, and cerebral visual impairment.5,23 The most prevalent avoidable causes of blindness are corneal scarring, cataract, and retinopathy of prematurity.23 

The trends on the causes of childhood blindness have changed over the last 30 years. There has been a substantial shift in the leading causes of blindness in children in low-income countries due to the reduction of corneal blindness due to vitamin A deficiency and measles, and cataract is now the principal cause of avoidable blindness.18,24 In children, the leading causes of unavoidable blindness include genetic retinal conditions and congenital eye anomalies.4   

In 2012, Naidoo et al.33 reported that in school-based surveys, refractive error is the leading cause of vision impairment in children,. With a prevalence ranging between 55-93%, 55% of children aged 5-15 years in Chile (Hyperopia the leading cause), and 93% of children in China aged 5-15 years (myopia the leading cause).30

The Lancet Commission4 reported the provision of spectacles to be one of the most effective health interventions for children, reducing the odds of failing a class by 44%, with an effect size greater than or equal to other health interventions.6–10 

The cost-effectiveness of screening and correcting refractive errors in schoolchildren has been demonstrated in a variety of settings.34,35 

The prevalence of myopia in children is rapidly increasing in many parts of the world.28

  • East Asian countries have the highest prevalence of myopia, with reports that the prevalence of myopia is as high as 97% in 19-year-old males in Seoul.29
  • In China, the prevalence of myopia increased from 56% to 66% in 14 to 16-year-olds between 2006 and 2015.30 Similarly, this rapid increase was reported in a recent systematic review, where prior to 2000 to 2015, the prevalence of children with myopia increased from 26% to 46%.30
  • The rapid increase in the prevalence of myopia is observed in other regions, such as Northern Ireland, where the prevalence increased from 18% to 23% between 2007 and 2017.31,32

There are a number of eye conditions in children that have associated morbidity that do not cause vision impairment. Common non-vision impairing eye conditions in children include conjunctivitis (allergic and infectious), blepharitis and chalazion, which can require ongoing care and affect the quality of life of both the child and the parents.27 

To address the eye health conditions in children, school-based eye health programmes have been adopted as they offer an effective,35–37 cost-effective model to deliver eye care to schoolchildren,35,39 and are efficient in respect to time and resources.12 School-based refraction and dispensing services increase access to spectacles.39 However, UNICEF reports gender parity is achieved in only 42% and 24% of lower secondary and upper secondary schools, respectively.44 As reported in the recent Lancet Commission5 It is also known that children who have vision impairment are less likely to attend school, and have poorer educational outcomes. It has been demonstrated that the provision of spectacles improves educational performance.6–10 While school-based services provide care to school-going children, this benefit is not realised by all children, particularly girls who are disproportionately represented in the out-of-school population. 


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  2. Castagno VD, Fassa AG, Carret MLV, et al. Hyperopia: A meta-analysis of prevalence and a review of associated factors among school-aged children. BMC Ophthalmology 2014;14. doi:10.1186/1471-2415-14-163
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