Prevalence of Refractive Errors Among School-Age Children and Adolescents in Saudi Arabia: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Abdulmajeed Al Khathami,1,&ast; Mohamed Baklola,2,&ast; Anwar Ali Alshehri,3 Lujain Hussain Alnasser,4 Razan Saleh Alshehri,5 Mohammed A Salawi,6 Rahaf Hussain Alwadai,7 Mohammed Al Ghazwi,8 Amira Ahmed Qadim Alanazi,9 Asayel Mojidea Alshammari,10 Naji Al-bawah,11,&ast; Mayas Hafez,12 Abdullah Abu Melha1 1Department of Ophthalmology, King Fahad Hospital, Al Baha Health Cluster, Al Baha, Saudi Arabia; 2Faculty of Medicine, Mansour University, Mansoura, Egypt; 3College of Medicine, University of Bisha, Bisha, Saudi Arabia; 4College of Medicine, University of Hail, Hail, Saudi Arabia; 5Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia; 6College of Medicine, Taif University, Taif, Saudi Arabia; 7College of Medicine, Najran University, Najran, Saudi Arabia; 8Batterjee Medicine college, Jeddah, Saudi Arabia; 9College of Medicine, Northern Border University, Arar, Saudi Arabia; 10College of Medicine, Aljouf University, Aljouf, Saudi Arabia; 11Faculty of Medicine, Sana’a University, Sana’a, Yemen; 12Qatif Central Hospital, Al Qatif, 32654, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Naji Al-bawah, Email Najialbawah@gmail.com Mohamed Baklola, Email Mohamedbaklola2000@gmail.comBackground: Refractive errors, including myopia, hyperopia, and astigmatism, are a leading cause of visual impairment among children worldwide. In Saudi Arabia, the prevalence of these conditions among school-age children and adolescents remains poorly understood, with significant variations reported across studies. This systematic review and meta-analysis aimed to provide a comprehensive estimate of the pooled prevalence of refractive errors in this population and explored factors influencing their distribution.Methods: A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect was conducted in accordance with PRISMA 2020 guidelines. Observational studies reporting the prevalence of refractive errors among Saudi school-aged children and adolescents were included. Data extraction and quality assessment were conducted using the Newcastle-Ottawa Scale. Pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using a random-effects model, and heterogeneity was assessed with the I² statistic.Results: Nine studies including over 15,000 participants were analyzed. The pooled prevalence of myopia was 6.7% (95% CI: 3.0% to 14.2%), hyperopia was 3.6% (95% CI: 1.3% to 9.8%), and astigmatism was 7.7% (95% CI: 2.5% to 20.9%). Subgroup analysis revealed regional disparities, with the highest myopia prevalence reported in Taif (33.3%) and Bisha (22.5%), and the lowest in Medina (1.6%). Studies conducted after 2018 showed a significantly higher pooled myopia prevalence (16.4%, 95% CI: 8% to 30.5%) compared to those published before 2018 (3.3%, 95% CI: 1.4% to 7.5%) (p < 0.001). While studies using cycloplegic refraction reported a slightly higher myopia prevalence (7.2%, 95% CI: 4.7% to 11%) than those using non-cycloplegic methods (6.7%, 95% CI: 2.4% to 17.5%), the difference was not statistically significant (p = 0.9). No significant difference was observed between studies with smaller or larger sample sizes, although high heterogeneity persisted across all subgroups.Conclusion: Refractive errors, particularly astigmatism, represent a significant and growing public health issue among Saudi school-aged children and adolescents. The findings underscore the urgent need for standardized diagnostic protocols, including the use of cycloplegic refraction, and the implementation of school-based vision screening programs.Keywords: myopia, hyperopia, astigmatism, refractive errors, children
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".