【In Press】 The prevalence of uncorrected refractive error in urban, suburban, exurban and rural primary school children in Indonesia

AIM: To determine the frequency and patterns of uncorrected refractive error (URE) across 4 gradients of residential densities (urban, exurban, suburban and rural) in Indonesia.METHODS: This was a cross-sectional study of school children from 3 districts in Yogyakarta and 1 district near Yogyakarta, Indonesia. The information regarding age, sex, school and school grader were recorded. The Snellen’s chart was used to measure the visual acuity and to perform the subjective refraction. The district was then divided into urban, suburban, exurban and rural area based on their location and population.RESULTS: In total, 410 school children were included in the analyses (urban=79, exurban=73, suburban=160 and rural=98 school children). Urban school children revealed the worst visual acuity (P<0.001) and it was significant when compared with exurban and rural. The proportion of URE among urban, suburban, exurban and rural area were 10.1%, 12.3%, 3.8%, and 1%, respectively, and it was significant when compared to the proportion of emetropia and corrected refractive error across residential densities (P=0.003). The risk of URE development in urban, suburban, exurban, and rural were 2.218 (CI: 0.914-5.385), 3.019 (CI: 1.266-7.197), 0.502(CI: 0.195-1.293), and 0.130 (CI: 0.017-0.972), respectively.CONCLUSION: URE is a major health problem among school children. Urban school children showed the worst VA. The school children in urban and suburban residential area had 2 and 3 times higher risk of developing the URE.