| Purpose: To access the prevalence of refractive error and visual impairment in school-age children in one of the most impoverished counties of southern China.
Design: Prospective cross-section survey
Methods: Students from the only high school in the region and the only primary school which provides 6 years of primary education were enumerated and examined in April 2011. The examination included visual acuity (VA) measurements; ocular motility evaluation; cycloplegic autorefraction; and examination of the external eye, anterior segment, and fundus.
Results: A total of 1221 children between 6-18 years old studying in the 2 identified schools were examined. The prevalence of uncorrected visual acuity ≤ 20/40 in the better eye was 8.3%. Refractive error was the cause in 94.74% of the 228 eyes with reduced vision (VA ≤ 20/40), amblyopia accounted for 4.82%. Myopia (spherical equivalent of at least -0.50D in either eye) affected no children in 6 years old, 1.09% in 9-year-old, 11.81% in 12-year-olds, 17.17% in 15-year-olds, and increasing to 23.77% in 18-year-olds. Hyperopia (+2.00D or more) was present in 4.17% of 6-year-olds, 1.09% of 9-year-olds, below 1% of 12 and 15-year-olds respectively, and affecting no children in 18-year-olds. Astigmatism (cylinder of ≥ 0.75D) was present in 8.32% of all children. 75.9% of the children who could achieve visual acuity ≥ 20/32 in at least one eye under best correction did not have the necessary spectacles.
Conclusions: The prevalence of different types of refractive error was relatively low in school-age children in Shapingzhen, compared to findings in urban cities of China. But still there are more than two third of children do not have the necessary spectacles for refractive error correction. Cost-effective strategies should be applied to eliminate this easily treated cause of visual impairment. | 
