{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T10:00:07Z","timestamp":1788084007354,"version":"build-2784847793"},"reference-count":34,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T00:00:00Z","timestamp":1669680000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Early detection and treatment of refractive defects during school age are essential to avoid irreversible future vision loss and potential school problems. Previously, vision screening of preschool children used methods based on subjective visual acuity; however, technologies such as photorefraction have promoted the detection of refractive errors quickly and easily. In this study, 1347 children from 10 schools in Madrid aged 4 to 12 years participated in a program of early detection of visual problems, which consisted of visual screening composed of anamnesis and photorefraction with a PlusOptix A12R. The prevalence of refractive errors was analyzed in terms of spherical equivalent, cylinder and its orientation, and potential cases of development of high myopia or amblyopia. Hyperopia predominates in the early years, but the number of myopic subjects is higher than that of hyperopic subjects from the age of ten onwards. At all ages, the predominant orientation of astigmatism was with-the-rule. On average, 80% of the myopic subjects were uncorrected. Potential high myopia increased with age, from 4 to 21% of the measured population. Potential amblyopia cases decreased across age groups, from 19 to 13.7%. There is a need to raise awareness of the importance of vision screening at school age to address vision problems.<\/jats:p>","DOI":"10.3390\/ijerph192315880","type":"journal-article","created":{"date-parts":[[2022,11,29]],"date-time":"2022-11-29T02:53:29Z","timestamp":1669690409000},"page":"15880","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Early Detection of Refractive Errors by Photorefraction at School Age"],"prefix":"10.3390","volume":"19","author":[{"given":"Marta","family":"Alvarez","sequence":"first","affiliation":[{"name":"Indizen Optical Technologies S.L., 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Benedi-Garcia","sequence":"additional","affiliation":[{"name":"Indizen Optical Technologies S.L., 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Concepcion-Grande","sequence":"additional","affiliation":[{"name":"Indizen Optical Technologies S.L., 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Dotor","sequence":"additional","affiliation":[{"name":"Indizen Optical Technologies S.L., 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Indizen Optical Technologies S.L., 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Chamorro","sequence":"additional","affiliation":[{"name":"Indizen Optical Technologies S.L., 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2908-6616","authenticated-orcid":false,"given":"Jose Miguel","family":"Cleva","sequence":"additional","affiliation":[{"name":"Indizen Optical Technologies S.L., 28002 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,29]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2010). Global Data on Visual Impairment 2010."},{"key":"ref_2","unstructured":"Heath, D.A., Amos, J.F., and Miller, S.C. (2008). Care of the Patient with Learning Related Vision Problems, American Optometric Association."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1016\/S0140-6736(12)60272-4","article-title":"Myopia","volume":"379","author":"Morgan","year":"2012","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1016\/j.ophtha.2012.02.034","article-title":"Prevalence and Risk Factors for Myopic Retinopathy in a Japanese Population: The Hisayama Study","volume":"119","author":"Asakuma","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1001\/jamaophthalmol.2018.2658","article-title":"Incidence of and Factors Associated with Myopia and High Myopia in Chinese Children, Based on Refraction Without Cycloplegia","volume":"136","author":"Wang","year":"2018","journal-title":"JAMA Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/opo.12305","article-title":"Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children","volume":"36","author":"Chua","year":"2016","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1001\/jamaophthalmol.2020.3451","article-title":"Association of Age at Myopia Onset with Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort","volume":"138","author":"Hu","year":"2020","journal-title":"JAMA Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ophtha.2011.06.024","article-title":"Amblyopia Prevalence and Risk Factors in Australian Preschool Children","volume":"119","author":"Pai","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3411","DOI":"10.1167\/iovs.09-4461","article-title":"Prevalence of Amblyopia and Strabismus in Young Singaporean Chinese Children","volume":"51","author":"Chia","year":"2010","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jaapos.2016.04.006","article-title":"A comparison of plusoptiX A12 measurements with cycloplegic refraction","volume":"20","author":"Doron","year":"2016","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/ICU.0b013e328244dfed","article-title":"Diagnosis and treatment of refractive errors in the pediatric population","volume":"18","author":"Braverman","year":"2007","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_12","first-page":"3","article-title":"Is noncycloplegic photorefraction applicable for screening refractive amblyopia risk factors?","volume":"7","author":"Rajavi","year":"2012","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1097\/OPX.0b013e3180dc99ea","article-title":"Noncycloplegic Photorefractive Screening in Pre-School Children with the \u201cPowerRefractor\u201d in a Pediatric Practice","volume":"84","author":"Schaeffel","year":"2007","journal-title":"Optom. Vis. Sci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.jaapos.2010.09.015","article-title":"Screening for refractive errors in children: The plusoptiX S08 and the Retinomax K-plus2 performed by a lay screener compared to cycloplegic retinoscopy","volume":"14","author":"Paff","year":"2010","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/00006324-200010000-00008","article-title":"Laboratory, Clinical, and Kindergarten Test of a New Eccentric Infrared Photorefractor (PowerRefractor)","volume":"77","author":"Choi","year":"2000","journal-title":"Optom. Vis. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.jaapos.2008.04.004","article-title":"Performance of the Plusoptix vision screener for the detection of amblyopia risk factors in children","volume":"12","author":"Matta","year":"2008","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1364\/JOSA.64.000240","article-title":"Photorefraction: A technique for study of refractive state at a distance","volume":"64","author":"Howland","year":"1974","journal-title":"J. Opt. Soc. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.4103\/2008-322X.170360","article-title":"Accuracy and repeatability of refractive error measurements by photorefractometry","volume":"10","author":"Sabbaghi","year":"2015","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/S0161-6420(87)33348-2","article-title":"Two-flash Photorefraction in Screening of Amblyogenic Refractive Errors","volume":"94","author":"Kaakinen","year":"1987","journal-title":"Ophthalmology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3129\/i10-110","article-title":"Accuracy of Plusoptix SO4 in children and teens","volume":"46","author":"Ayse","year":"2011","journal-title":"Can. J. Ophthalmol."},{"key":"ref_21","unstructured":"(2022, May 06). Working Principle of a Transillumination Test. Available online: https:\/\/www.plusoptix.com\/fileadmin\/Downloads\/Anleitungen_manuals\/Fact_Sheets\/Transillumination\/Plusoptix_FactSheet_201904_Working_principle_of_a_transillumination_test.pdf."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1136\/bjo.2008.138123","article-title":"Plusoptix Vision Screener: The accuracy and repeatability of refractive measurements using a new autorefractor","volume":"93","author":"Comyn","year":"2009","journal-title":"Br. J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1136\/bjo.2007.123497","article-title":"Spectacle prescribing in childhood: A survey of hospital optometrists","volume":"92","author":"Farbrother","year":"2008","journal-title":"Br. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"15189","DOI":"10.1038\/s41598-020-72240-y","article-title":"Axial growth and refractive change in white European children and young adults: Predictive factors for myopia","volume":"10","author":"McCullough","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"213","DOI":"10.3928\/01913913-20130326-01","article-title":"Amblyopia Risk Factor Prevalence","volume":"50","author":"Arnold","year":"2013","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jaapos.2012.09.012","article-title":"Guidelines for automated preschool vision screening: A 10-year, evidence-based update","volume":"17","author":"Donahue","year":"2013","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00417-004-1056-y","article-title":"Accuracy of a new photorefractometer in young and adult patients","volume":"243","author":"Schimitzek","year":"2005","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1590\/1413-81232015205.02252014","article-title":"Moderate hyperopia prevalence and associated factors among elementary school students","volume":"20","author":"Castagno","year":"2015","journal-title":"Cienc. Saude Coletiva"},{"key":"ref_29","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":"Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1167\/iovs.61.13.20","article-title":"Racial and Ethnic Differences in Myopia Progression in a Large, Diverse Cohort of Pediatric Patients","volume":"61","author":"Luong","year":"2020","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.ajo.2013.01.009","article-title":"Racial Variations in the Prevalence of Refractive Errors in the United States: The Multi-Ethnic Study of Atherosclerosis","volume":"155","author":"Pan","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/00006324-199905000-00011","article-title":"Factors Associated with the Prevalence of Myopia in 6-Year-Olds","volume":"76","author":"Robinson","year":"1999","journal-title":"Optom. Vis. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"601","DOI":"10.2147\/OPTH.S2836","article-title":"The prevalence rates of refractive errors among children, adolescents, and adults in Germany","volume":"2","author":"Jobke","year":"2008","journal-title":"Clin. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/S0033-3506(96)80010-2","article-title":"Vision screening in junior schools","volume":"110","author":"Cummings","year":"1996","journal-title":"Public Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/15880\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:29:01Z","timestamp":1760146141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/15880"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,29]]},"references-count":34,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["ijerph192315880"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192315880","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,29]]}}}