Astigmatism among schoolchildren in Mumbai, India: a large, population-based study

Background: Astigmatism is a common refractive error. If left untreated, it may result in blurred or distorted vision. We determined the prevalence of astigmatism in schoolchildren aged 6–16 years in Mumbai, India. Methods: A cross-sectional study was conducted using a stratified cluster random sampling method. We included primary and secondary schoolchildren aged 6–16 years. All children underwent a comprehensive eye examination. Astigmatism was characterized as having a diopter cylinder (DC) power of 0.50 or more in at least one eye, and for prevalence estimation, we reported the number of children with astigmatism. Astigmatism severity was defined as mild (less than or equal to - 1.50 DC), moderate (- 1.50 DC to - 2.50 DC), and severe (> - 2.50 DC). Based on the axis orientation, astigmatism was categorized as with-the-rule, against-the-rule, and oblique. Results: A total of 3151 schoolchildren with a mean (standard deviation) age of 12.1 (2.9) years were screened; boys and girls accounted for 49.22% and 50.78%, respectively. Age groups of 6–9, 10–13, and 14–16 years accounted for 51.35%, 28.53%, and 20.12%, respectively. The overall prevalence of astigmatism was 11.46%, with no significant difference between sexes (P > 0.05). The prevalences of astigmatism in the groups aged 6–9-, 10–13-, and 14–16 years were 5.24%, 3.49%, and 2.73%, respectively. Prevalence differed significantly among age groups (P < 0.05), with a trend of decreasing prevalence with increasing age. No significant association was found between age and severity of astigmatism (P > 0.05). The prevalences of mild, moderate, and severe astigmatism were 6.51%, 3.11%, and 1.84%, respectively. Mild astigmatism was significantly more prevalent than moderate (P < 0.05) or severe astigmatism (P < 0.05). The prevalence of astigmatism differed significantly among the three orientations of axis (P < 0.001). The prevalences were 9.20%, 1.68%, and 0.57% for with-the-rule, against-the-rule, and oblique astigmatism, respectively. We found a statistically significant difference in the prevalences of astigmatism based on the axis orientation between boys and girls (P < 0.05) and between age groups (P < 0.001), with a decreasing trend observed with increasing age. Conclusions: We found a prevalence of 11.46% for astigmatism among schoolchildren aged 6–16 years in Mumbai, India. There was a decreasing trend in prevalence with increasing age, with no difference between sexes. The prevalence was the highest for mild astigmatism, followed by moderate and severe astigmatism. Prevalence differed significantly based on the axis orientation among the three subtypes, age groups, and between the two sexes, with a decreasing trend with increasing age. With-the-rule astigmatism was the most common, followed by against-the-rule astigmatism; oblique astigmatism was the least common.