Current status of vision and refractive errors among children and adolescents in northeast Sichuan, China: a school-based cross-sectional study

Purpose To investigate the status of visual acuity and refractive errors among children and adolescents in northeastern Sichuan, providing a basis for targeted myopia prevention and control. Methods In 2024, a school-based vision screening program using a stratified cluster sampling framework was conducted among students from participating schools in 3 districts and 6 counties of Nanchong City. Visual acuity screening and non-cycloplegic autorefraction were performed using an electronic intelligent screening system with real-time data collection and strict quality control. Of the 61,012 students initially screened, 59,319 students with complete and analyzable data were included in the final analysis, corresponding to an effective screening rate of 97.23%. Detection rates and distribution characteristics of poor visual acuity and suspected myopia were analyzed, along with associated risk factors. Results The prevalence of poor visual acuity and suspected myopia increased markedly with educational stage, reaching 90.81% and nearly 90%, respectively, in general senior high school students, accompanied by a parallel increase in myopia severity and high myopia proportion. Suspected myopia was more common among female students. Substantial regional disparities were observed, with the highest prevalence in Nanbu County (80.49%) and the lowest in Langzhong City (46.41%). Urban students had significantly higher myopia prevalence than township students. In addition, during the general senior high stage, students in ordinary schools showed significantly higher myopia prevalence than those in key schools. Regarding vision correction, eyeglasses were the predominant method. The rate of spectacle use increased with education level, though proper correction remained suboptimal. Additionally, astigmatism and anisometropia were prevalent among myopic students and increased with school grade. Hyperopia reserve declined progressively in lower-grade students. Multivariable logistic regression analysis showed that school grade, gender, regional type, and school level were independently associated with myopia. Conclusions This study reveals the epidemiological characteristics and influencing factors of visual acuity and refractive errors among children and adolescents in northeastern Sichuan, providing essential data and scientific evidence for the development of targeted myopia prevention strategies in the region.