Prevalence of clinically significant refractive error in children in Europe: Systematic review and meta-analysis
Abstract
Purpose: This meta-analysis estimated clinically significant refractive error prevalence in European children and examined variations based on cycloplegic versus non-cycloplegic refraction, age and sex.
Methods: A systematic review (PubMed, Cochrane Library, EMBASE, PROSPERO ID: CRD42022322608) identified studies (January 2000 - June 2024) reporting myopia (≤-0.50D), hyperopia (≥+2.00D) and astigmatism (≥1.00 DC) prevalence in children aged 4-17 years in Europe. Twenty-six studies from 14 countries (n = 37,282) were included. Pooled prevalence estimates (EPP) were calculated using a random-effects model with Freeman-Tukey double-arcsine transformation.
Results: Estimated pooled prevalences were refractive error: 17.90% (95% CI: 13.67-22.56), myopia: 14.31% (95% CI: 8.89-20.74; 24 studies), hyperopia: 10.20% (95% CI: 6.51-14.59; 11 studies), and astigmatism: 10.26% (95% CI: 5.83-15.74, eight studies). Cycloplegic and non-cycloplegic prevalence did not differ significantly (myopia: χ2 = 0.08, p = 0.78; hyperopia: χ2 = 0.29, p = 0.59). Myopia prevalence increased with age (6.17% at 4-9 years, 16.66% at 14 + years), while hyperopia declined (14.27% at 4-9 years, 7.04% at 10-13 years). Astigmatism remained stable; however, studies did not report its co-occurrence with myopia or hyperopia, limiting insights into its combined burden. No significant sex differences were observed. Data from 27 European countries were unavailable, limiting regional comparisons.
Conclusions:…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 37,282 participants or records.
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