Intended for healthcare professionals


Correcting refractive error in low income countries

BMJ 2011; 343 doi: (Published 09 August 2011) Cite this as: BMJ 2011;343:d4793

This article has a correction. Please see:

  1. Lisa Keay, senior research fellow1,
  2. David S Friedman, professor of ophthalmology and international health2
  1. 1Dana Center for Preventive Ophthalmology, Wilmer Eye Institute and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
  2. 2George Institute for Global Health, University of Sydney, Sydney, NSW 2000, Australia
  1. david.friedman{at}

Self refraction has limitations, but is a viable approach to measuring refractive error

Refractive error affects millions of people worldwide. Although spectacles are an effective way of correcting refractive error, about 153 million people globally are visually impaired (vision <6/18) simply because they do not have spectacles to correct their vision.1 Myopia, the most common form of refractive error, has a prevalence of about 10-30% in most Western countries, but this figure is as high as 80% in parts of Asia.2 Poor vision in children as a result of uncorrected refractive errors is a pressing public health concern in countries like China, where about six million children have such errors.1

This problem could be eliminated with proper service delivery. “Spectacle coverage” is a valuable metric that takes into account the prevalence of refractive error and the proportion of those affected who have spectacles to correct their vision. In the linked study in rural China by Zhang and colleagues (doi:10.1136/bmj.d4767),3 spectacle coverage was estimated at 45% for children aged 5-15 years, far lower than that in urban parts of China (85%).1 Furthermore, myopic refractive error is likely to progress during school years, and maintaining appropriate spectacle correction requires regular services for children in these age groups.

In high income countries, the cost of spectacles varies widely. In the United …

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