What is the prevalence and burden of myopia (nearsightedness) in India?

Prevalence and Burden of Myopia in India

Myopia is a major public health problem in India with an overall prevalence of 7.5% (95% CI, 6.5-8.5%) in children aged 5-15 years over the last four decades, showing a concerning upward trend especially in urban adolescents where prevalence has reached 15.0% in the last decade. 1

Current Prevalence Statistics

• Urban vs. Rural Distribution:

  • Urban prevalence: 8.5% (95% CI, 7.1-9.9%) 1
  • Rural prevalence: 6.1% (95% CI, 4.5-7.7%) 1
  • Significant rural increase noted in the last decade from 4.6% to 6.8%, indicating changing environmental factors 1

• Age-Related Trends:

  • Higher prevalence (27%) among older children (9-12 years) 2
  • Highest prevalence in urban 11-15 year age group at 15.0% in the last decade 1

• Regional Variations:

  • South India (Tamil Nadu): 17.5% (95% CI: 14.7-20.5%) prevalence reported in children aged 5-16 years 3
  • North India (Gurugram): 21.1% prevalence in schoolchildren aged 5-15 years 2

Burden and Impact

Myopia represents a significant public health burden in India for several reasons:

1. Population Scale: With 41% of India's population (492 million) under 18 years of age, the absolute number of affected children is substantial 1

2. Clinical Impact:

   • Mean myopic spherical error: -1.94 ± 0.92 D in North Indian schoolchildren 2
   • High myopia (≤ -6.00 D) prevalence: 0.5% (95% CI: 0.3-0.9%) in South Indian children 3

3. Socioeconomic Burden:

   • The clinical and socioeconomic impact is expected to rise with increasing prevalence 4
   • Represents an avoidable cause of visual impairment affecting children across India 5

Risk Factors

Several modifiable risk factors have been identified:

• Study habits: Children studying more than 4 hours per day show positive association with myopia (P < .008) 2
• Screen time: Playing computer/video/mobile games more than 2 hours per day increases risk (P < .001) 2
• Outdoor activity: Time spent outdoors (>1.5 hours/day) shows protective effect (OR, 0.01 [0.00 to 0.06]) 2
• Urban environment: Urban school location has higher odds for myopia prevalence 3
• Gender differences:
  • School-based studies show higher prevalence among girls than boys (OR: 1.2 [CI: 1.1-1.3]) 5
  • However, some studies show higher prevalence in boys (25%) compared to girls 2

Trends and Concerns

The data reveals several concerning trends:

1. Increasing Prevalence: Multiple studies confirm that myopia prevalence is rising rapidly among Indian schoolchildren 4, 2, 3

2. Urban-Rural Gap Narrowing: While urban prevalence remains higher, the rural prevalence is increasing, suggesting environmental changes affecting rural communities 1

3. Age-Related Progression: Prevalence increases significantly with age, with adolescents showing much higher rates 1, 2, 3

Clinical Implications

The rising prevalence necessitates:

• Development of standardized national guidelines for myopia management in Indian children 4
• Implementation of cost-effective screening and intervention strategies 2, 5
• Focus on prevention of incidence and progression rather than just correction 4
• Concerted efforts from healthcare providers, education professionals, and parents 5

The burden of myopia in India represents a significant public health challenge requiring urgent attention, particularly as prevalence continues to increase in both urban and rural settings.