Causes of Decreased Visual Acuity in Primary Schools’ Students in a Sample of Iraqi Schools

Abstract

Aim: The goal is to evaluate pupils in elementary schools for visual acuity (VA) to determine factors that contribute to a decline in VA.

Methods: During a 12-month follow-up period between June 2024 and June 2025, a sample of Iraqi primary school students participated in this cross-sectional study. One thousand eight hundred eighty-five pupils were randomly chosen from five elementary schools in Iraq—two in Baqubah (an urban region), three in Kana'an City (a rural location), and five in Diayala. Every student had completed a thorough eye exam at school, which included cover/uncover and alternate cover tests, visual acuity, and ocular motility. Children with cycloplegia, along with subnormal visual acuity (<6\6), were taken to a primary eye care unit for a follow-up examination using an autorefractometer (Huvits HRK-7000) and a posterior and anterior segment examination using a slit lamp and a condensing lens with a diopter of +90. Children having a history of trauma, strabismus, or prior eye surgery were not allowed to participate in the research.

Findings: This study involved 3770 eyeballs from 1885 elementary school pupils. There were 43.4% female participants and 56.6% male participants, with a mean age of 9 years (range: 6–12). One thousand four hundred ninety-seven eyes (39.7%) had aberrant VA when the VA was checked. They were referred to a primary care facility for cycloplegic refraction, and two days later, their VA was checked again. There were 1007 (26.7%) fewer eyes with abnormal VA. It was discovered that the most prevalent cause of decreased vision (98.2%) was refractive errors, with hypermetropia having the greatest occurrence, afterwards astigmatism and myopia.

Conclusion: According to the current study, uncorrected refractive error is the most prevalent cause of decreased visual acuity in school-age children, and the majority of these defects (87.1%) go untreated. The most prevalent mistake was hypermetropia, which was followed by astigmatism along with myopia.