{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T06:12:38Z","timestamp":1761027158349,"version":"build-2065373602"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"Background<\/jats:title>School-based vision screening plays a vital role in identifying visual problems at an early stage. There is limited evidence on the frequency of visual impairment and its associated risk factors among school-aged children.<\/jats:p><\/jats:sec>Objective<\/jats:title>This research aimed to assess the prevalence of visual impairment and its associated risk factors among school children enrolled in Government Schools of Rawalpindi.<\/jats:p><\/jats:sec>Methodology<\/jats:title>An analytical cross-sectional study was conducted among 320 schoolchildren in the Rawalpindi district of Punjab province from July to December 2024. Presenting visual acuity was assessed using the validated Peek Acuity app on smartphone with the tumbling E optotypes. Visual impairment was defined as presenting visual acuity worse than 6\/12, based on failure to correctly identify at least four out of five optotypes at the 6\/12 level at a testing distance of 3 m. A validated questionnaire was utilized to assess risk factors associated with visual impairment. The prevalence of visual impairment was presented as frequencies and percentages. Binary logistic regression was performed with visual impairment as the dependent variable, considering age, gender, father's educational status, mother's educational status, household income, maternal illness during pregnancy, parent with visual impairment, sibling with visual impairment, birth weight, gestational age, complications at birth, serious infection during childhood, history of head trauma or injury, duration of television exposure, and duration of mobile\/computer exposure as independent variables. Variables with a p<\/jats:italic> &lt; 0.05 and a 95% confidence interval in the multivariate model were considered statistically significant.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 320 study participants were included in this study. Visual impairment was identified in 82 children (25.6%), consisting of 35 males (42.68%) and 47 females (57.3%). It was categorized as mild in 30 (36.58%) and moderate in 52 (63.41%) children. In multivariate analysis, parent with visual impairment [4.201 (2.221\u20137.948)], low birth weight [0.376 (0.189\u20130.749)], small gestational age [0.231 (0.113\u20130.475)] and exposure to mobile and computer devices [2.368 (1.040\u20135.393)] were factors significantly associated with visual impairment.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>This study identified a high burden of visual impairment among schoolchildren, with a greater proportion observed in females and predominantly presenting with moderate severity.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1661710","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T05:36:44Z","timestamp":1761025004000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and associated risk factors of visual impairment in school children: mHealth-based vision screening in government schools of Rawalpindi, Pakistan"],"prefix":"10.3389","volume":"12","author":[{"given":"Ayesha","family":"Javed","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shamaila","family":"Mohsin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramsha","family":"Habib","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uzma Ahsan","family":"Malik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul Momin Rizwan","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"482","DOI":"10.26719\/emhj.23.020","article-title":"Systematic review and meta-analysis of childhood visual impairment in the Eastern Mediterranean Region","volume":"29","author":"Alrasheed","year":"2023","journal-title":"East Mediterr Health J."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e0216492","DOI":"10.1371\/journal.pone.0216492","article-title":"A comprehensive study capturing vision loss burden in Pakistan (1990\u20132025): findings from the Global Burden of Disease (GBD) 2017 study","volume":"14","author":"Hassan","year":"2019","journal-title":"PLoS ONE."},{"key":"B3","doi-asserted-by":"publisher","first-page":"CD006543","DOI":"10.1002\/14651858.CD006543.pub2","article-title":"Low vision rehabilitation for better quality of life in visually impaired adults","volume":"1","author":"Hoeben","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e0268800","DOI":"10.1371\/journal.pone.0268800","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":"Cao","year":"2022","journal-title":"PLoS ONE."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0271313","DOI":"10.1371\/journal.pone.0271313","article-title":"Prevalence of visual impairment due to refractive error among children and adolescents in Ethiopia: a systematic review and meta-analysis","volume":"17","author":"Atlaw","year":"2022","journal-title":"PLoS ONE."},{"key":"B6","doi-asserted-by":"publisher","first-page":"85","DOI":"10.37268\/mjphm\/vol.20\/no.3\/art.656","article-title":"Parents'awareness and perception of children's refractive error. A qualitative study","volume":"20","author":"Al Ghailani","year":"2020","journal-title":"Malays J Public Health Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.ophtha.2015.11.023","article-title":"Uncorrected hyperopia and preschool early literacy: results of the vision in preschoolers\u2013hyperopia in preschoolers (VIP-HIP) study","volume":"123","author":"Kulp","year":"2016","journal-title":"Ophthalmology."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2345","DOI":"10.2147\/OPTH.S298929","article-title":"Refractive error and visual impairment among school children: result of a South-Eastern Nigerian regional survey","volume":"15","author":"Maduka-Okafor","year":"2021","journal-title":"Clini Ophthalmol."},{"key":"B9","doi-asserted-by":"publisher","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":"Loh","year":"2024","journal-title":"J Optom."},{"key":"B10","unstructured":"Blindness and Visual Impairment\n \n 2023"},{"key":"B11","doi-asserted-by":"publisher","first-page":"37","DOI":"10.2188\/jea.JE20110063","article-title":"Prevalence of eye diseases and causes of visual impairment in school aged children in Western China","volume":"22","author":"Pi","year":"2012","journal-title":"J Epidemiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e130","DOI":"10.1016\/S2214-109X(20)30425-3","article-title":"Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study","volume":"9","author":"Bourne","year":"2021","journal-title":"Lancet Glob Health."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e26275","DOI":"10.2196\/26275","article-title":"Use of mobile apps for visual acuity assessment: systematic review and meta-analysis","volume":"10","author":"Suo","year":"2022","journal-title":"JMIR Mhealth Uhealth."},{"key":"B14","first-page":"212","article-title":"The validity of visual acuity assessment using mobile technology devices in the primary care setting","volume":"45","author":"O'Neill","year":"2016","journal-title":"Aust Fam Physician."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2682","DOI":"10.1001\/jama.2015.15855","article-title":"Smartphone-based visual acuity measurement for screening and clinical assessment","volume":"314","author":"Brady","year":"2015","journal-title":"JAMA."},{"key":"B16","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1038\/eye.2015.60","article-title":"The eye phone study: reliability and accuracy of assessing Snellen visual acuity using smartphone technology","volume":"29","author":"Perera","year":"2015","journal-title":"Eye."},{"key":"B17","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1001\/jamaophthalmol.2015.1468","article-title":"Development and validation of a smartphone-based visual acuity test (peek acuity) for clinical practice and community-based fieldwork","volume":"133","author":"Bastawrous","year":"2015","journal-title":"JAMA Ophthalmol."},{"key":"B18","unstructured":"Vision and Eye Screening Implementation Handbook.\n \n 2024"},{"key":"B19","doi-asserted-by":"publisher","first-page":"4749","DOI":"10.1167\/iovs.06-0374","article-title":"Prevalence of blindness and visual impairment in Pakistan: the Pakistan National Blindness and Visual Impairment Survey","volume":"47","author":"Jadoon","year":"2006","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B20","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1167\/tvst.8.4.27","article-title":"Development and validation of a smartphone-based visual acuity test (vision at home)","volume":"8","author":"Han","year":"2019","journal-title":"Transl Vis Sci Technol."},{"key":"B21","unstructured":"ICD-11 for Mortality and Morbidity Statistics (Version: 04\/2019) Vision Impairment Including Blindness.\n \n 2019"},{"key":"B22","doi-asserted-by":"publisher","first-page":"138","DOI":"10.3109\/09286586.2013.767354","article-title":"Risk factors for strabismus and amblyopia in young Singapore Chinese children","volume":"20","author":"Chia","year":"2013","journal-title":"Ophthalmic Epidemiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"558","DOI":"10.4097\/kja.19087","article-title":"Multicollinearity and misleading statistical results","volume":"72","author":"Kim","year":"2019","journal-title":"Korean J Anesthesiol."},{"key":"B24","first-page":"157","article-title":"Prevalence and comparison of undetected refractive errors among children of age b\/w 5\u201310 years in public & private sector schools","volume":"12","author":"Inam","year":"2018","journal-title":"Pak J Med Health Sci."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.12669\/pjms.325.10367","article-title":"Vision screening in children: is 7\u20139 years of age a threshold for visual impairment?","volume":"32","author":"Ertekin","year":"2016","journal-title":"Pak J Med Sci."},{"key":"B26","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1089\/tmj.2018.0213","article-title":"Implementing a school vision screening program in Botswana using smartphone technology","volume":"26","author":"Andersen","year":"2020","journal-title":"Telemed J E-Health."},{"key":"B27","doi-asserted-by":"publisher","first-page":"246","DOI":"10.3109\/09286586.2015.1056811","article-title":"Prevalence of visual impairment and refractive errors in children of South Sinai, Egypt","volume":"22","author":"Yamamah","year":"2015","journal-title":"Ophthalmic Epidemiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"135","DOI":"10.2147\/OPTO.S213047","article-title":"Prevalence and associated factors of visual impairment among school-age children in Bahir Dar City, Northwest Ethiopia","volume":"11","author":"Merrie","year":"2019","journal-title":"Clin Optom."},{"key":"B29","doi-asserted-by":"publisher","first-page":"163","DOI":"10.4103\/0019-557X.99919","article-title":"Visual impairment in urban school children of low-income families in Kolkata, India","volume":"56","author":"Sambuddha Ghosh","year":"2012","journal-title":"Indian J Public Health."},{"key":"B30","doi-asserted-by":"publisher","first-page":"339","DOI":"10.2147\/PHMT.S487164","article-title":"The prevalence and risk factors of abnormal vision among preschool children","volume":"15","author":"Liu","year":"2024","journal-title":"Pediatric Health Med Ther."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.18240\/ijo.2019.06.25","article-title":"Visual problems: a review of prevalence studies on visual impairment in school-age children","volume":"12","author":"Atowa","year":"2019","journal-title":"Int J Ophthalmol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"6062","DOI":"10.3390\/jcm12186062","article-title":"Risk factors for myopia: a review","volume":"12","author":"Mart\u00ednez-Albert","year":"2023","journal-title":"J Clin Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1136\/bjo.2003.035154","article-title":"Visual function in low birthweight children","volume":"88","author":"O'Connor","year":"2004","journal-title":"Br J Ophthalmol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/j.ophtha.2011.01.027","article-title":"Prevalence and risk factors for visual impairment in preschool children: the Sydney paediatric eye disease study","volume":"118","author":"Pai","year":"2011","journal-title":"Ophthalmol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"F82","DOI":"10.1136\/fn.76.2.F82","article-title":"Visual impairment in very low birthweight children","volume":"76","author":"Powls","year":"1997","journal-title":"Arch Dis Child Fetal Neonat Ed."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/2576117X.2023.2287633","article-title":"Long-term visual outcomes in prematurely born children","volume":"74","author":"Robitaille","year":"2024","journal-title":"J Binocul Vis Ocul Motil"},{"key":"B37","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1001\/jamaophthalmol.2016.0391","article-title":"Ophthalmologic outcome of extremely preterm infants at 6.5 years of age: extremely preterm infants in Sweden study (EXPRESS)","volume":"134","author":"Hellgren","year":"2016","journal-title":"JAMA Ophthalmol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"158","DOI":"10.4103\/meajo.MEAJO_64_17","article-title":"Visual outcome of preterm infants screened in a tertiary care hospital","volume":"26","author":"Sathar","year":"2019","journal-title":"Middle East Afr J Ophthalmol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2562","DOI":"10.3390\/jcm11092562","article-title":"The association between gestational age and risk for long term ophthalmic morbidities among offspring delivered in different preterm subgroups","volume":"11","author":"Tsumi","year":"2022","journal-title":"J Clin Med."},{"key":"B40","doi-asserted-by":"publisher","first-page":"e","DOI":"10.2196\/21923","article-title":"Smartphone overuse and visual impairment in children and young adults: systematic review and meta-analysis","volume":"22","author":"Wang","year":"2020","journal-title":"J Med Int Res."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1661710\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T05:36:46Z","timestamp":1761025006000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1661710\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":40,"alternative-id":["10.3389\/fmed.2025.1661710"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1661710","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]},"article-number":"1661710"}}