Refractive error and visual impairment in school children in urban children in Nepal

Despite considerable efforts in many developing countries, through national blindness prevention programs, the global number of blind and visually disabled seems to be growing. 80% of Blindness is avoidable (preventable or curable). The study was conducted by random selection of school going children of age group 5 to 15 years of age from 26 schools from November 2009 to July 2010 in Kathmandu valley, Nepal. The examination included visual acuity measurements, ocular motility examination, retinoscopy, autorefraction under cycloplegia and examination of external eye. A total of 1026 children were included. The prevalence of uncorrected, baseline, and best corrected visual acuity 20/40 or worse in better eye was 18.1%, 14% and 9.80%. Refractive error was the cause in 91% of eyes with vision impairment, amblyopia in 4.5%, retinal disorders in 1.3% and unexplained causes in remaining. There was an age-related shift in refractive error from hyperopia in younger children (17.8% in 5 years old) towards myopia in older children (11% in 15 years old). Reduced vision because of uncorrected refractive error is a major public health problem in urban school-aged children in Nepal. Cost effective strategies and visual screening programs should be regularly conducted in every schools to reduce morbidity due to impaired vision. Effective strategies are needed to eliminate this easily treated cause of significant visual impairment.