Prevalence of refractive errors, uncorrected refractive error, and presbyopia in adults in India: A systematic review

• Published in: Indian journal of ophthalmology Vol. 67; no. 5; pp. 583 - 592
• Main Authors: Sheeladevi, Sethu, Seelam, Bharani, Nukella, Phanindra B, Borah, Rishi R, Ali, Rahul, Keay, Lisa
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-05-2019; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Acuity; Adult; Adults; Age groups; Analysis; Astigmatism; Epidemiology; Estimates; Gender; Health aspects; Humans; Hyperopia; India - epidemiology; Keywords; Methods; myopia; Ophthalmology; Original; Population; Presbyopia; Presbyopia - epidemiology; Presbyopia - physiopathology; Prevalence; Prevalence studies (Epidemiology); Public health; Refraction, Ocular - physiology; Refractive errors; Refractive Errors - epidemiology; Refractive Errors - physiopathology; Studies; Systematic review; Visual impairment; India; myopia; visual impairment; presbyopia; Hyperopia; refractive errors
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_1235_18

The objective of this review is to estimate the prevalence of refractive errors, uncorrected refractive error (URE), and uncorrected presbyopia in adults aged ≥30 years in India.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. A detailed literature search was performed to include all studies published from India from the year 1990 using the Cochrane Library, Medline, and Embase. Refractive error was defined by >0.50 D ametropia. URE was defined by presenting visual acuity (PVA) worse than 6/18 improving with pinhole or spectacle correction, and uncorrected presbyopia by near vision <N8 improving with correction in the absence of distance URE.
Fifteen studies were included from South India, one each from Western and Central India, and one study covered 15 states across India. The prevalence of RE of at least 0.50 D of spherical equivalent ametropia was 53.1% [(95% confidence interval (CI): 37.2-68.5), of which myopia and hyperopia was 27.7% and 22.9%, respectively. The prevalence of URE was 10.2% (95% CI: 6.9-14.8), but heterogeneity in these estimates was very high. The prevalence of uncorrected presbyopia was 33% (95% CI: 19.1-51.0).
This review highlights the magnitude of refractive errors among adults in India. More studies are needed using standard methods in regions where there is a lack of information on UREs. Programs delivering spectacles for adults in India will need to primarily focus on reading glasses to correct presbyopia along with spectacles for hyperopia and myopia.