Prevalence, Distribution, and Predictors of Refractive Errors among School-Going Children in Surat District, Gujarat: A Large-Scale School-Based Screening Study

Background: Uncorrected refractive errors are a leading cause of preventable visual impairment among school-aged children, affecting learning and overall development. Large-scale school screening programs play a critical role in early detection and timely correction. Objective: To estimate the prevalence, pattern, and predictors of refractive errors among school-going children aged 5–16 years in Surat district, Gujarat, through school-based screening under the National Programme for Control of Blindness and Visual Impairment (NPCB&VI) and the Rashtriya Bal Swasthya Karyakram (RBSK). Methods: A cross-sectional, community-based study was conducted between March 2024 and April 2025. Using a stratified cluster random sampling approach, 500,000 children from government and private schools were screened for visual acuity (Snellen and LogMAR charts), anterior segment abnormalities, and refractive status using objective and subjective refraction. Data were analyzed with SPSS 26.0 using χ², ANOVA, Pearson correlation, and logistic regression tests. Results: Of the 497,200 children screened, 5,364 (1.07%; 95% CI 1.04–1.10) had refractive errors. Myopia was the most common subtype (60.0%), followed by astigmatism (27.5%) and hypermetropia (12.5%). The prevalence of myopia increased markedly after age 10 years and was significantly associated with urban residence and private-school attendance (p < 0.001). After spectacle correction, mean visual acuity improved from 0.52 ± 0.18 logMAR to 0.00 ± 0.04 logMAR (p < 0.001), with 93% attaining 6/6 vision. Spectacle compliance at 3-month follow-up was 78.5%. Conclusion: Myopia emerged as the predominant refractive error among schoolchildren in Surat, with age, urbanization, and schooling type as key predictors. Strengthening periodic school-based screening, visual-hygiene education, and follow-up counseling is vital to mitigate preventable childhood visual impairment.