{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T13:33:01Z","timestamp":1793280781351,"version":"4.5.0"},"reference-count":72,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009246","name":"Technological University Dublin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009246","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Optometry Ireland"},{"name":"Thea Pharmaceuticals"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This meta-analysis estimated clinically significant refractive error prevalence in European children and examined variations based on cycloplegic versus non-cycloplegic refraction, age and sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review (PubMed, Cochrane Library, EMBASE, PROSPERO ID: CRD42022322608) identified studies (January 2000 \u2013 June 2024) reporting myopia (\u2264\u22120.50D), hyperopia (\u2265+2.00D) and astigmatism (\u22651.00 DC) prevalence in children aged 4\u201317 years in Europe. Twenty-six studies from 14 countries (n\u2009=\u200937,282) were included. Pooled prevalence estimates (EPP) were calculated using a random-effects model with Freeman-Tukey double-arcsine transformation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Estimated pooled prevalences were refractive error: 17.90% (95% CI: 13.67\u201322.56), myopia: 14.31% (95% CI: 8.89\u201320.74; 24 studies), hyperopia: 10.20% (95% CI: 6.51\u201314.59; 11 studies), and astigmatism: 10.26% (95% CI: 5.83\u201315.74, eight studies). Cycloplegic and non-cycloplegic prevalence did not differ significantly (myopia: \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.08, p\u2009=\u20090.78; hyperopia: \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.29, p\u2009=\u20090.59). Myopia prevalence increased with age (6.17% at 4\u20139 years, 16.66% at 14\u2009+\u2009years), while hyperopia declined (14.27% at 4\u20139 years, 7.04% at 10\u201313 years). Astigmatism remained stable; however, studies did not report its co-occurrence with myopia or hyperopia, limiting insights into its combined burden. No significant sex differences were observed. Data from 27 European countries were unavailable, limiting regional comparisons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately 18% of European children have clinically significant refractive error, with myopia increasing with age and hyperopia decreasing. Myopia prevalence was highest in Russia, hyperopia in Denmark, and astigmatism in Northern Ireland. Further studies reporting cycloplegic prevalences with improved geographical representation and more granular reporting \u2013 particularly of astigmatism and its co-occurrence with other refractive errors are needed for better comparability and management of refractive errors in European children.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0335666","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T18:36:13Z","timestamp":1762972573000},"page":"e0335666","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence of clinically significant refractive error in children in Europe: Systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0024-8922","authenticated-orcid":true,"given":"Megan","family":"Doyle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aoife","family":"O\u2019Donnell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00edofra","family":"Harrington","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"O\u2019Dwyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3919-444X","authenticated-orcid":true,"given":"Michael","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"issue":"5","key":"pone.0335666.ref001","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1136\/bjophthalmol-2011-300539","article-title":"Global estimates of visual impairment: 2010","volume":"96","author":"D Pascolini","year":"2012","journal-title":"Br J Ophthalmol"},{"issue":"3","key":"pone.0335666.ref002","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.18-25957","article-title":"IMI - Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies","volume":"60","author":"DI Flitcroft","year":"2019","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0335666.ref003","doi-asserted-by":"crossref","first-page":"100852","DOI":"10.1016\/j.eclinm.2021.100852","article-title":"Global economic productivity losses from vision impairment and blindness","volume":"35","author":"AP Marques","year":"2021","journal-title":"EClinicalMedicine"},{"issue":"5","key":"pone.0335666.ref004","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":"pone.0335666.ref005","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/1471-2415-14-163","article-title":"Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children","volume":"14","author":"VD Castagno","year":"2014","journal-title":"BMC Ophthalmol"},{"issue":"1","key":"pone.0335666.ref006","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":"6","key":"pone.0335666.ref007","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1111\/aos.12642","article-title":"Cycloplegic refraction is the gold standard for epidemiological studies","volume":"93","author":"IG Morgan","year":"2015","journal-title":"Acta Ophthalmol"},{"issue":"1","key":"pone.0335666.ref008","first-page":"888","article-title":"Diagnosis and treatment of accommodative spasm with cycloplegics","volume":"16","author":"N Yasin","year":"2022","journal-title":"PJMHS"},{"key":"pone.0335666.ref009","unstructured":"ECOO. 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Standard country or area codes for statistical use (M49). United Nations Statistics Division Methodology. https:\/\/unstats.un.org\/unsd\/methodology\/m49\/. 2025. Accessed 2025 May 2."},{"issue":"8","key":"pone.0335666.ref066","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1111\/j.1755-3768.2009.01800.x","article-title":"Is emmetropia the natural endpoint for human refractive development? 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In: Introduction to Meta-Analysis","author":"M Borenstein","year":"2009"},{"issue":"11","key":"pone.0335666.ref071","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1136\/jech-2013-203104","article-title":"Meta-analysis of prevalence","volume":"67","author":"JJ Barendregt","year":"2013","journal-title":"J Epidemiol Community Health"},{"key":"pone.0335666.ref072","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/B978-0-12-809324-5.23564-5","article-title":"Developmental research methods with infants & young children.","volume-title":"Encyclopedia of infant and early childhood development","author":"TL Olson","year":"2020"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335666","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T18:36:30Z","timestamp":1762972590000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335666"}},"subtitle":[],"editor":[{"given":"Neelam","family":"Pawar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,12]]},"references-count":72,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0335666","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,12]]}}}