{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T05:09:13Z","timestamp":1778476153966,"version":"3.51.4"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"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":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Astigmatism is highly prevalent among school-aged children. This study aimed to evaluate the epidemiological distribution of astigmatism in a large-scale Chinese pediatric population and investigate the independent and interactive impacts of astigmatism magnitude and axis on uncorrected visual acuity (UCVA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This school-based, cross-sectional study conducted in Tongzhou District, Beijing, included 79,066 students aged 6 to 20 years (mean age: 11.35 \u00b1 3.23 years). Participants underwent standardized non-cycloplegic autorefraction and UCVA assessment. Astigmatism was quantified by cylinder power and decomposed into Thibos vector components (\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ,\n                      <jats:italic>J<\/jats:italic>\n                      <jats:sub>45<\/jats:sub>\n                      ). Generalized linear models (GLMs) were utilized to determine the independent association between astigmatism axis and visual function, adjusting for spherical power and astigmatism magnitude.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall prevalence of astigmatism was 43.6%, pre-dominantly characterized by mild severity and the with-the-rule (WTR) subtype (82.9%). Both prevalence and severity increased progressively with advancing educational stages. Crucially, multivariate analysis revealed that after adjusting for spherical equivalent (\n                      <jats:italic>SE<\/jats:italic>\n                      ), advancing grade was independently associated with a slight against-the-rule (ATR) and oblique shift. Furthermore, males exhibited a higher susceptibility to the WTR orientation, whereas females were more prone to ATR and oblique. Regarding visual performance, astigmatism magnitude significantly degraded UCVA in non-myopic and low-myopic eyes, but this effect was saturated and masked in moderate-to-high myopia. Although the WTR axis was associated with a statistically worse UCVA compared to oblique subtypes, the absolute difference was clinically negligible, likely reflecting statistical amplification within this mega-cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      WTR is the pre-dominant astigmatism subtype in school-aged children, propelled by the concurrent myopization process. While the magnitude of astigmatism profoundly impairs UCVA\u2014heavily modulated by the concurrent\n                      <jats:italic>SE<\/jats:italic>\n                      \u2014the functional impact of axis orientation remains clinically insignificant. These findings suggest that targeted monitoring and correction strategies may benefit from being tailored to specific genders and refractive profiles.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1837925","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:26:53Z","timestamp":1778473613000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence, vector evolution, and visual impact of astigmatism: a large-scale study of 79,066 children in Beijing, China"],"prefix":"10.3389","volume":"13","author":[{"given":"Jingjing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Tongzhou Maternal and Child Health Hospital of Beijing","place":["Beijing, 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