Refractive Errors and Their Associated Factors in Schoolchildren: A Structural Equation Modeling

ABSTRACT

Purpose

To determine the prevalence of myopia and hyperopia in Shahroud schoolchildren and their risk factors

Methods

Optometric examinations including the measurement of uncorrected and corrected visual acuity as well as non-cycloplegic and cycloplegic refraction using retinoscopy were done for students. Generalized Structural Equation Modeling (GSEM) was used to determine direct and indirect effects of independent variables on myopia and hyperopia.

Results

The data of 5581 students with a mean age of 9.24 ± 1.7 years were used in this study. The prevalence of myopia was 5.0% (95%CI: 4.3–5.7) and the prevalence of hyperopia was 4.8% (95%CI: 4.0 − 5.5) in all schoolchildren. According to the GSEM results, the odds of myopia in rural areas were 0.55 compared to urban areas. A one-unit increase in the ocular AL increased the odds of myopia by 4.91 times. The interaction of sex and age on myopia was significant such that in girls, the odds of myopia increased by 20% for every one-year increase in age while no significant change was seen in boys. A one-unit increase in the ocular AL decreased the odds of hyperopia by 0.49 times. Moreover, the interaction of outdoor activity hours and sex on the prevalence of hyperopia was significant such that increased outdoor activity reduced the odds of hyperopia in girls while no significant correlation was found in boys.

Conclusion

Myopia and hyperopia had moderate prevalence. Axial Length had the largest direct association on myopia and hyperopia. Age and outdoor activity had weak associations on refractive errors.

KEYWORDS:

• Refractive errors
• myopia
• hyperopia
• risk factors
• Iran

Data Availability

The data that support the findings of this study are available from the corresponding author, [MHE], upon reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

Shahroud School Children Eye Cohort Study is funded by the Noor Ophthalmology Research Center and Shahroud University of Medical Sciences [Grant Numbers: 9329-960351]