Prevalence and Amblyopiogenic Risk Factors of Uncorrected Refractive Errors Among School-Going Children in Bangladesh: A Cross-Sectional Study

Abstract

Background: Amblyopia is a major cause of one-sided vision problems in kids all over the world. Although early refractive correction can largely prevent it, Uncorrected refractive error remains a major public health concern in low- and middle-income countries, and remains a significant problem in developing countries. Bangladesh does not possess comprehensive, population-based data on childhood amblyopia, notwithstanding considerable progress in Vision 2020 initiatives. This study evaluates the prevalence and patterns of amblyopia, as well as its amblyopiogenic risk factors, in school aged children in Bangladesh, contextualizing baseline data from 2014 with regionally reported prevalence trends from published literature (2014–2024), rather than longitudinal follow-up

Methods: A cross-sectional screening was conducted in schools with 3,268 children aged 4 to 10 years in the Dhaka and Narayanganj districts. We used age-appropriate Snellen and Lea symbols charts to test Visual Acuity (VA). We did cycloplegic refraction, cover tests, ophthalmoscopy, and pinhole tests. Amblyopia was diagnosed because the person's vision was insufficient (<6/12) and could not be fully corrected with refraction or because of an eye disease. Descriptive statistics and chi-square tests assessed demographic and etiological distributions.

Result: The total prevalence of amblyopia was 1.74% (95% CI: 1.2–2.3). The causes of amblyopia were meridional (32%), anisometropic (24%), ametropic (16%), and stimulus-deprivation (9%). Hyperopia (54%) constituted the principal refractive anomaly. No significant gender difference was observed (p > 0.05). Comparative literature (2014–2024) reveals a declining prevalence in similar Asian cohorts: India 1.5 – 1.8 %, Malaysia 1.3 %, and China 0.9 %, indicating improved school screening coverage. Among identified amblyopic children, approximately 80% were enrolled in occlusion therapy, with 62% demonstrating visual acuity improvement of two or more lines at 6-month follow-up.

Conclusions: The findings underscore uncorrected refractive error as a major preventable factor leading to amblyopia in children in Bangladesh. To reach the Vision 2030 goals, it is important to include regular school vision tests and low-cost optical correction in national eye health plans.