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1 From the Public Health Ophthalmology Service, L. V. Prasad Eye Institute, Hyderabad, India; and the 2 Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, Australia.
PURPOSE. To assess the prevalence, distribution, and demographic associations of refractive error in an urban population in southern India.
METHODS. Two thousand five hundred twenty-two subjects of all ages,
representative of the Hyderabad population, were examined in the
population-based Andhra Pradesh Eye Disease Study. Objective and
subjective refraction was attempted on subjects >15 years of age with
presenting distance and/or near visual acuity worse than 20/20 in
either eye. Refraction under cycloplegia was attempted on all subjects
15 years of age. Spherical equivalent >0.50 D in the worse eye was
considered as refractive error. Data on objective refraction under
cycloplegia were analyzed for subjects 15 years and on subjective
refraction were analyzed for subjects >15 years of age.
RESULTS. Data on refractive error were available for 2,321 (92.0%) subjects. In
subjects 15 years of age, age-gender–adjusted prevalence of myopia
was 4.44% (95% confidence interval [CI], 2.14%–6.75%), which was
higher in those 10 to 15 years of age (odds ratio, 2.75; 95% CI,
1.25–6.02), of hyperopia 59.37% (95% CI, 44.65%–74.09%), and of
astigmatism 6.93% (95% CI, 4.90%–8.97%). In subjects >15 years of
age, age-gender–adjusted prevalence of myopia was 19.39% (95% CI,
16.54%–22.24%), of hyperopia 9.83% (95% CI, 6.21%–13.45%), and
of astigmatism 12.94% (95% CI, 10.80%–15.07%). With multivariate
analysis, myopia was significantly higher in subjects with Lens Opacity
Classification System III nuclear cataract grade 
3.5 (odds ratio,
9.10; 95% CI, 5.15–16.09), and in subjects with education of
class 11 or higher (odds ratio, 1.80; 95% CI, 1.18–2.74); hyperopia
was significantly higher in subjects 30 years of age compared with
those 16 to 29 years of age (odds ratio, 37.26; 95% CI,
11.84–117.19), in females (odds ratio, 1.86; 95% CI, 1.33–2.61), and
in subjects belonging to middle and upper socioeconomic strata (odds
ratio, 2.10; 95% CI, 1.09–4.03); and astigmatism was significantly
higher in subjects 40 years of age (odds ratio, 3.00; 95% CI,
2.23–4.03) and in those with education of college level or higher
(odds ratio, 1.73; 95% CI, 1.07–2.81).
CONCLUSIONS. These population-based data on distribution and demographic associations of refractive error could enable planning of eye-care services to reduce visual impairment caused by refractive error. If these data are extrapolated to the 255 million urban population of India, among those >15 years of age an estimated 30 million people would have myopia, 15.2 million hyperopia, and 4.1 million astigmatism not concurrent with myopia or hyperopia; in addition, based on refraction under cycloplegia, 4.4 million children would have myopia and 2.5 million astigmatism not concurrent with myopia or hyperopia.
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