{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T19:15:44Z","timestamp":1771355744310,"version":"3.50.1"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>This study aimed to determine the prevalence, demographic distribution, and predictors of refractive error (RE) among school children in Bhutan using secondary data from the 2019 Bhutan School Sight Survey (BSSS). It also sought to compare these population-level findings with standardized estimates from the Refractive Error Study in Children (RESC). Secondary data from 586 schools, comprising 164,365 school-enrolled children aged 5\u201318 years (94.3% of the national school-age population), were analyzed. As part of the BSSS, vision screening and cycloplegic refraction were conducted following the RESC protocol. Spectacles were provided at no cost to children requiring correction. Descriptive statistics were used to analyse data on demographic and school-related variables, and logistic regression to identify associated predictors. Findings were compared with previously published RESC data to contextualise observed trends. Visual impairment (VI) affected 12.14% (95% CI: 11.98-12.30) of school-aged children in Bhutan, with higher rates in females (13.16%) than males (11.07%) (p\u2009&lt;\u20090.01). RE was the leading cause, accounting for 11.71% of all cases and 96.1% of VI. Myopia was most common (5.78%), followed by astigmatism (5.26%) and hypermetropia (0.67%). Multivariate analysis showed that female students (AOR\u2009=\u20091.18), those in private schools (AOR\u2009=\u20091.41), and urban schooling (AOR\u2009=\u20091.68) were significant RE predictors (p\u2009&lt;\u20090.01). Of 19,243 students diagnosed with RE, only 11.5% had appropriate spectacles. Among those needing new spectacles (n\u2009=\u200917,021), 96.2% eventually received them within four months, while 3.8% were lost to follow-up. In Bhutan, RE affects over 10% of school children, primarily due to myopia and astigmatism. The higher burden among females, urban students, and private schools highlights persistent inequities. These results are consistent with prior RESC findings and demonstrate that large-scale school screening is both feasible and scalable. Strengthening school-based vision services, timely spectacle delivery, and cross-sectoral coordination are essential to close the gap and address uncorrected RE.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005085","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:30:12Z","timestamp":1771353012000},"page":"e0005085","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refractive error among school-aged children in Bhutan: A secondary analysis of data from nationwide Bhutan School Sight Survey"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8815-794X","authenticated-orcid":true,"given":"Indra Prasad","family":"Sharma","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8261-9779","authenticated-orcid":true,"given":"Kovin Shunmugam","family":"Naidoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8199-0891","authenticated-orcid":true,"given":"Khathutshelo Percy","family":"Mashige","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8034-3860","authenticated-orcid":true,"given":"Nor Tshering","family":"Lepcha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"issue":"5","key":"pgph.0005085.ref001","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050","volume":"123","author":"BA Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"pgph.0005085.ref002","unstructured":"World Health Organization. Blindness and vision impairment [Internet]. 2025 [cited 2025 May 3]. Available from: https:\/\/www.who.int\/en\/news-room\/fact-sheets\/detail\/blindness-and-visual-impairment"},{"issue":"2","key":"pgph.0005085.ref003","doi-asserted-by":"crossref","first-page":"100495","DOI":"10.1016\/j.optom.2023.100495","article-title":"A systematic review of the impact of childhood vision impairment on reading and literacy in education","volume":"17","author":"L Loh","year":"2024","journal-title":"J Optom"},{"issue":"7","key":"pgph.0005085.ref004","article-title":"The prevalence and causes of pediatric uncorrected refractive error: Pooled data from population studies for Global Burden of Disease (GBD) sub-regions","volume":"17","author":"H Cao","year":"2022","journal-title":"PLoS One"},{"issue":"3","key":"pgph.0005085.ref005","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1136\/bjo-2024-325427","article-title":"Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis","volume":"109","author":"J Liang","year":"2025","journal-title":"Br J Ophthalmol"},{"key":"pgph.0005085.ref006","volume-title":"SPECS 2030: A global initiative to increase effective refractive error coverage","author":"World Health Organization","year":"2021"},{"issue":"4","key":"pgph.0005085.ref007","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(20)30488-5","article-title":"The Lancet Global Health Commission on Global Eye Health: vision beyond 2020","volume":"9","author":"MJ Burton","year":"2021","journal-title":"Lancet Glob Health"},{"issue":"113","key":"pgph.0005085.ref008","article-title":"Primary eye care in Bhutan: achievements and challenges","volume":"34","author":"NT Lepcha","year":"2021","journal-title":"Community Eye Health"},{"key":"pgph.0005085.ref009","unstructured":"International Agency for the Prevention of Blindness. The Summary Report of Bhutan School Sight Programme [Internet]. [cited 2025 May 3]. Available from: https:\/\/www.iapb.org\/news\/the-summary-report-of-bhutan-school-sight-programme\/"},{"issue":"9","key":"pgph.0005085.ref010","article-title":"Visual impairment and refractive error in school children in Bhutan: The findings from the Bhutan School Sight Survey (BSSS 2019","volume":"15","author":"IP Sharma","year":"2020","journal-title":"). PLoS One"},{"issue":"1","key":"pgph.0005085.ref011","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.joco.2017.08.009","article-title":"Global and regional estimates of prevalence of refractive errors: Systematic review and meta-analysis","volume":"30","author":"H Hashemi","year":"2017","journal-title":"J Curr Ophthalmol"},{"issue":"2","key":"pgph.0005085.ref012","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/08164622.2022.2153582","article-title":"Prevalence of refractive errors in Nepalese children and adults: a systematic review with meta-analysis","volume":"106","author":"J Bist","year":"2023","journal-title":"Clin Exp Optom"},{"key":"pgph.0005085.ref013","first-page":"101484","article-title":"Prevalence and temporal trends in myopia and high myopia children in China: a systematic review and meta-analysis with projections from 2020 to 2050","volume":"55","author":"W Pan","year":"2025","journal-title":"Lancet Reg Health West Pac"},{"issue":"3","key":"pgph.0005085.ref014","doi-asserted-by":"crossref","first-page":"214","DOI":"10.3341\/kjo.2016.30.3.214","article-title":"Refractive Errors in Koreans: The Korea National Health and Nutrition Examination Survey 2008-2012","volume":"30","author":"TH Rim","year":"2016","journal-title":"Korean J Ophthalmol"},{"issue":"5","key":"pgph.0005085.ref015","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1177\/1524838020916837","article-title":"The Neglect of Left-Behind Children in China: A Meta-Analysis","volume":"22","author":"Y-J Wen","year":"2021","journal-title":"Trauma Violence Abuse"},{"issue":"1","key":"pgph.0005085.ref016","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/s12886-024-03382-0","article-title":"Prevalence and risk factors for astigmatism in 7 to 19-year-old students in Xinjiang, China: a cross-sectional study","volume":"24","author":"Y Wang","year":"2024","journal-title":"BMC Ophthalmol"},{"issue":"6","key":"pgph.0005085.ref017","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1001\/jamaophthalmol.2017.0641","article-title":"Spectacle Wear Among Children in a School-Based Program for Ready-Made vs Custom-Made Spectacles in India: A Randomized Clinical Trial","volume":"135","author":"P Morjaria","year":"2017","journal-title":"JAMA Ophthalmol"},{"issue":"4","key":"pgph.0005085.ref018","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/cxo.12689","article-title":"Prevalence of refractive errors in children in India: a systematic review","volume":"101","author":"S Sheeladevi","year":"2018","journal-title":"Clin Exp Optom"},{"issue":"2","key":"pgph.0005085.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0263335","article-title":"Systematic review and meta-analysis of myopia prevalence in African school children","volume":"17","author":"G Ovenseri-Ogbomo","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0005085.ref020","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1136\/bjo-2022-322123","article-title":"Prevalence of refractive errors among school-going children in a multistate study in India","volume":"108","author":"E Joseph","year":"2023","journal-title":"Br J Ophthalmol"},{"issue":"10","key":"pgph.0005085.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0240750","article-title":"Prevalence of myopia in Indian school children: Meta-analysis of last four decades","volume":"15","author":"D Agarwal","year":"2020","journal-title":"PLoS One"},{"issue":"122","key":"pgph.0005085.ref022","first-page":"6","article-title":"WHO SPECS 2030 - a global initiative to strengthen refractive error care","volume":"37","author":"S Keel","year":"2024","journal-title":"Community Eye Health"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005085","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T18:30:17Z","timestamp":1771353017000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0005085"}},"subtitle":[],"editor":[{"given":"Sheetal Prakash","family":"Silal","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0005085","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]}}}