Author's details
Reviewer's details
Uncorrected Refractive Error in Children: A Nigerian Perspective
Uncorrected refractive error (URE) is the leading cause of visual impairment globally and a significant public health problem in Nigeria. In children, the burden is especially concerning as poor vision impacts educational performance, psychosocial development, and long-term productivity. Refractive error occurs when the eye is unable to focus light properly on the retina, due to myopia, hyperopia, or astigmatism. Without timely correction, children are at risk of amblyopia (lazy eye), strabismus, and irreversible visual loss.
At ECWA Eye Hospital, Kano, we see over 5,000 children annually in our paediatric clinic, and about 50% of them have refractive errors. Unfortunately, about half of their parents refuse spectacles, often claiming that “the child is too young to wear glasses.” This misconception contributes to delayed treatment, amblyopia, and poor compliance with subsequent amblyopia therapies like patching.
Symptoms
- Poor school performance due to difficulty seeing the chalkboard or books.
- Squinting, rubbing of eyes, or sitting too close to objects/television.
- Complaints of headaches or eye strain.
- Children appearing inattentive or labelled as “slow learners.”
Clinical Findings
- Reduced visual acuity, often improving with pinhole.
- Abnormal visual behavior (e.g., eye rubbing, head tilting).
- Strabismus in some cases.
- Signs of amblyopia in long-standing, untreated cases.
Differential Diagnoses
- Congenital cataract
- Corneal opacity (from measles keratitis, trauma, or infection)
- Glaucoma in children
- Retinal diseases (e.g., retinopathy of prematurity, hereditary retinal dystrophies)
Investigations
- Visual acuity assessment (age-appropriate methods: Lea symbols, HOTV, Snellen).
- Cycloplegic refraction (gold standard in children).
- Fundus examination to exclude other ocular pathology.
- Orthoptic assessment if strabismus or amblyopia is suspected.
Treatment
- Prescription of spectacles is the mainstay of treatment. Early correction prevents amblyopia and improves school performance.
- In cases with amblyopia, occlusion therapy (patching) or atropine penalization is recommended, though compliance remains a challenge in our setting.
- Strabismus surgery may be needed if refractive correction alone is insufficient.
- Referral to specialized centers is necessary in complex cases or where parental counseling fails.
Follow-Up
- Children should be reviewed every 3–6 months to monitor compliance, visual improvement, and refractive stability.
- Continuous counseling of parents and teachers is vital to encourage spectacle wear and adherence to amblyopia therapy.
Prevention and Control
- Public health education to dispel myths that children are “too young” to wear glasses.
- School eye health programs for early detection of refractive errors.
- Affordable and durable spectacles for children.
- Training community health workers and teachers to identify children with visual difficulties.
Conclusion
Uncorrected refractive error in Nigerian children is a silent but preventable cause of visual impairment. Timely detection and correction with spectacles remain the most cost-effective interventions. However, myths, stigma, and poor compliance hinder success. Community education and integration of paediatric eye care into school health programs can significantly reduce the burden.
A 7-year-old boy presented with poor school performance and was repeatedly punished by his teachers for being “dull.” On cycloplegic refraction, he had high hyperopia (+5.00D both eyes). His parents initially refused spectacles, insisting he was too young. After intensive counseling and fitting with child-friendly frames, his vision improved dramatically. Three months later, his teachers reported better classroom participation, and the boy expressed excitement at being able to see the chalkboard for the first time. This case highlights the transformative power of simple interventions when parental misconceptions are overcome.
Author and Reviewer’s Reflections
From our experience at ECWA Eye Hospital, Kano, we see thousands of children annually, with refractive error being the most common problem. Despite limited resources, we achieve significant improvement in children’s lives through the timely prescription of spectacles and amblyopia therapy. Our greatest challenge is parental refusal and poor compliance with patching. By persistent counseling, engaging teachers, and providing affordable glasses, we have seen many children avoid lifelong visual disability.
Our reflection is that eye health education is as important as treatment. With increased awareness and school-based programs, Nigeria can significantly reduce the burden of amblyopia caused by uncorrected refractive error.
- Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, Rabiu MM. Causes of blindness and visual impairment in Nigeria: the Nigeria national blindness and visual impairment survey. Investigative ophthalmology & visual science. 2009 Sep 1;50(9):4114-20.
- Ajaiyeoba AI, Isawumi MA, Adeoye AO, Oluleye TS. Prevalence and causes of eye diseases amongst students in South-Western Nigeria.
- Ovenseri-Ogbomo GO, Omuemu VO. Prevalence of refractive error among school children in the Cape Coast Municipality, Ghana. Clinical Optometry. 2010; 4:873-878.
Author's details
Reviewer's details
Uncorrected Refractive Error in Children: A Nigerian Perspective
Uncorrected refractive error (URE) is the leading cause of visual impairment globally and a significant public health problem in Nigeria. In children, the burden is especially concerning as poor vision impacts educational performance, psychosocial development, and long-term productivity. Refractive error occurs when the eye is unable to focus light properly on the retina, due to myopia, hyperopia, or astigmatism. Without timely correction, children are at risk of amblyopia (lazy eye), strabismus, and irreversible visual loss.
At ECWA Eye Hospital, Kano, we see over 5,000 children annually in our paediatric clinic, and about 50% of them have refractive errors. Unfortunately, about half of their parents refuse spectacles, often claiming that “the child is too young to wear glasses.” This misconception contributes to delayed treatment, amblyopia, and poor compliance with subsequent amblyopia therapies like patching.
- Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, Rabiu MM. Causes of blindness and visual impairment in Nigeria: the Nigeria national blindness and visual impairment survey. Investigative ophthalmology & visual science. 2009 Sep 1;50(9):4114-20.
- Ajaiyeoba AI, Isawumi MA, Adeoye AO, Oluleye TS. Prevalence and causes of eye diseases amongst students in South-Western Nigeria.
- Ovenseri-Ogbomo GO, Omuemu VO. Prevalence of refractive error among school children in the Cape Coast Municipality, Ghana. Clinical Optometry. 2010; 4:873-878.
Content
Author's details
Reviewer's details
Uncorrected Refractive Error in Children: A Nigerian Perspective
Background
Uncorrected refractive error (URE) is the leading cause of visual impairment globally and a significant public health problem in Nigeria. In children, the burden is especially concerning as poor vision impacts educational performance, psychosocial development, and long-term productivity. Refractive error occurs when the eye is unable to focus light properly on the retina, due to myopia, hyperopia, or astigmatism. Without timely correction, children are at risk of amblyopia (lazy eye), strabismus, and irreversible visual loss.
At ECWA Eye Hospital, Kano, we see over 5,000 children annually in our paediatric clinic, and about 50% of them have refractive errors. Unfortunately, about half of their parents refuse spectacles, often claiming that “the child is too young to wear glasses.” This misconception contributes to delayed treatment, amblyopia, and poor compliance with subsequent amblyopia therapies like patching.
Further readings
- Abdull MM, Sivasubramaniam S, Murthy GV, Gilbert C, Abubakar T, Ezelum C, Rabiu MM. Causes of blindness and visual impairment in Nigeria: the Nigeria national blindness and visual impairment survey. Investigative ophthalmology & visual science. 2009 Sep 1;50(9):4114-20.
- Ajaiyeoba AI, Isawumi MA, Adeoye AO, Oluleye TS. Prevalence and causes of eye diseases amongst students in South-Western Nigeria.
- Ovenseri-Ogbomo GO, Omuemu VO. Prevalence of refractive error among school children in the Cape Coast Municipality, Ghana. Clinical Optometry. 2010; 4:873-878.
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