ORIGINAL ARTICLE
Open Access

Refractive Errors and Amblyopia among School-Age Children in South Pakistan: A Population-Based Study

Ayesha Siddiqui ORCID1, Muhammad Imran Khan 2, Samina Gul ORCID3

¹ Department of Ophthalmology, Liaquat University of Medical and Health Sciences, Pakistan
² School Eye Health Program, Civil Hospital Karachi, Sindh, Pakistan.
³ Department of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan.

DOI: https://doi.org/10.18081/ajbm/2025.2/131Crossmark logo

Received 07 April 2025, Revised 30 April 2025, Accepted 29 May 2025, Available online 15 June 2025
© 2025 Siddiqui, et al. This is an open-access article under a Creative Commons license (CC BY 4.0).
CC BY 4.0

ABSTRACT

Background: Uncorrected refractive errors and amblyopia remain leading causes of avoidable visual impairment in children worldwide, particularly in low- and middle-income countries. Early detection and correction are crucial for preventing long-term visual disability and improving educational outcomes. However, epidemiological data from southern Pakistan remain limited. This population-based study aimed to determine the prevalence, distribution, and determinants of refractive errors and amblyopia among school-aged children in southern Pakistan.

Methods: A cross-sectional study was conducted between January and October 2024 across public and private schools in the Sindh and Balochistan provinces. Using a multistage cluster random sampling method, 1,350 children aged 5–15 years were selected. Visual acuity was measured using an illuminated Snellen E chart at 6 meters. Children with uncorrected visual acuity worse than 6/9 underwent objective and subjective refraction. Amblyopia was diagnosed when best-corrected visual acuity (BCVA) was ≤6/12 with no structural abnormality and at least a two-line difference between eyes. Data were analyzed using SPSS version 26.0, with significance set at p < 0.05.

Results: Of 1,350 enrolled children, 1,306 (96.7%) completed examination (51.8% male; mean age 10.4 ± 2.7 years). Refractive errors were detected in 257 children (19.7%; 95% CI 16.9–22.5). Myopia was the most common type (11.6%), followed by astigmatism (5.5%) and hyperopia (2.5%). The prevalence of refractive errors increased significantly with age (p < 0.001) and was higher in females (22.4%) and private school students (24.9%). Amblyopia was diagnosed in 43 children (3.3%), predominantly anisometropic (58.1%). Spectacle coverage was low (38.7%), with an unmet visual correction need of 61.3%. Logistic regression identified older age, female gender, and private school attendance as independent predictors of refractive error.

Conclusion: Refractive errors and amblyopia are common, correctable causes of visual impairment among school-aged children in southern Pakistan. Myopia predominates and increases with age, reflecting changing lifestyle and educational demands. The high unmet need for spectacle correction highlights the urgent necessity for nationwide school vision screening programs, public awareness initiatives, and affordable optical services—particularly in underserved rural districts—to prevent avoidable childhood visual disability.

Keywords: Refractive errors; Myopia; Amblyopia; School-age children; Vision screening; Public health ophthalmology

Cite this article

Siddiqui A, Khan AI, Gul S. Refractive errors and amblyopia among school-age children in South Pakistan: a population-based study. Advanced Journal of Biomedicine & Medicine. 2025;13(2):131-141. doi:10.18081/ajbm/2025.2/131

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2025 Vol 13, Issue 2 Pages 131-144

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Ayesha Siddiqui, Muhammad Imran Khan, Samina Gul (2025). Refractive Errors and Amblyopia among School-Age Children in south Pakistan: A Population-Based Study. Advanced Journal of Biomedicine & Medicine, 13(2), 131-144. https://doi.org/ 10. 10.18081/ajbm/2025.2/131
Ayesha Siddiqui, Muhammad Imran Khan, Samina Gul. "Refractive Errors and Amblyopia among School-Age Children in south Pakistan: A Population-Based Study." Advanced Journal of Biomedicine & Medicine, vol. 13, no. 2, 2025, pp. 131-144. DOI: 10. 10.18081/ajbm/2025.2/131.
Ayesha Siddiqui, Muhammad Imran Khan, Samina Gul. Refractive Errors and Amblyopia among School-Age Children in south Pakistan: A Population-Based Study. AJBM. 2025;13(2):131-144. DOI: 10. 10.18081/ajbm/2025.2/131. PMID: .
Ayesha Siddiqui, Muhammad Imran Khan, Samina Gul 2025, "Refractive Errors and Amblyopia among School-Age Children in south Pakistan: A Population-Based Study", Advanced Journal of Biomedicine & Medicine, vol. 13, no. 2, pp. 131-144.
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%0 Journal Article %A Ayesha Siddiqui, Muhammad Imran Khan, Samina Gul %T Refractive Errors and Amblyopia among School-Age Children in south Pakistan: A Population-Based Study %J American Journal of Biomedicine %V 13 %N 2 %P 131-144 %D 2025 %R 10. 10.18081/ajbm/2025.2/131 %M
Ayesha Siddiqui, Muhammad Imran Khan, Samina Gul (2025). Refractive Errors and Amblyopia among School-Age Children in south Pakistan: A Population-Based Study. Advanced Journal of Biomedicine & Medicine, 13(2), 131-144. https://doi.org/ 10. 10.18081/ajbm/2025.2/131

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