A Descriptive Study of the Pattern of Refractive Errors, Amblyopia Burden, and Effective Refractive Error Coverage Among Children Attending a Tertiary Hospital in Northern Sri Lanka

Abstract

Background: Visual impairment affects children's learning, development, and quality of life. Refractive errors (REs) are the most prevalent form of VI among ocular conditions, especially in children. They often begin in childhood and can progress significantly if left uncorrected, leading to complications such as amblyopia or long-term visual disability. Thus, this study was conducted to describe the patterns of REs, examine demographic and behavioral characteristics, and assess the burden of amblyopia and effective RE coverage among schoolchildren with REs attending the Ophthalmology Unit of Teaching Hospital Jaffna, Sri Lanka. Methodology: This hospital-based prospective cross-sectional study was conducted at the Ophthalmology Unit of Teaching Hospital Jaffna. Data were collected over two months among schoolchildren aged 6-18 years with REs. A total of 253 participants were recruited using systematic random sampling. Data on demographic factors, family history, outdoor activities, screen exposure, spectacle use, visual acuity, and RE patterns were collected using an interviewer-administered questionnaire and medical records from routine eye examinations. Visual assessments and refraction were performed according to standard ophthalmic procedures. Data were analyzed using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA) with descriptive statistics. Results: A total of 253 schoolchildren with REs were included, with a mean age of 11.7±3.6 years; 138 (54.5%) were female. Astigmatism was the most common RE (118, 46.6%), followed by myopic astigmatism (66, 26.1%) and myopia (58, 22.9%). A family history of RE was present in 33.2% (n=84) of participants. The effective RE coverage was 18.6%. Among children previously prescribed spectacles, only 47 (33.3%) were current users, with lack of information (58, 61.7%) and affordability (20, 21.3%) being the main barriers to spectacle use. Amblyopia was present in 152 (60.1%) participants and was most common among children with hyperopic astigmatism (5, 100%) and hyperopia (5, 83.3%). Discussion: Astigmatism was the most common RE among children attending a tertiary eye care center in Northern Sri Lanka, followed by myopic astigmatism and myopia. A high burden of amblyopia and very low effective RE coverage were observed, indicating inadequate utilization of refractive services despite spectacle prescriptions; the high amblyopia burden likely reflects the tertiary referral-based study population rather than the general community. Lack of information and affordability were the main barriers to spectacle use. These findings highlight the need to strengthen early vision screening, improve awareness of spectacle compliance, and enhance access to affordable eye care services for children in Northern Sri Lanka. Conclusion: As the first hospital-based evidence of its kind from Northern Sri Lanka, these findings provide a starting point for local eye care planning while highlighting the broader need for community-based research to establish the true population burden. Strengthening screening pathways, support for spectacle compliance, and the affordability of eye care should be prioritized as immediate steps toward reducing preventable childhood VI in this region.