Spectrum of Astigmatism in Children Visiting a Tertiary Care Hospital of South Punjab, Pakistan

Abstract: Background: Astigmatism is considered to be a common refractive error (RE) among pediatric age groups. In Pakistan, the burden of pediatric REs remains underexplored, particularly in underserved regions such as South Punjab. Objective: To assess the spectrum of astigmatism among children presenting to a tertiary care hospital in South Punjab, Pakistan. Materials and Methods: This cross-sectional study was conducted at the Ophthalmology Department of Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur, Pakistan during January 2025 to May 2025 AFTER obtaining approval from institutional review board (letter number 2853/DME/QAMC Bahawalpur, dated: 30-12-2024). A total of 329 children aged 5-15 years, with complaints of visual disturbances were included. Demographic information like gender, age and residential affiliations were noted. All children underwent a comprehensive ophthalmologic examination and astigmatism was labeled as a cylindrical refractive error (RE) of ≥0.50 D in either eye. Data were entered and analyzed using IBM-SPSS, version 26.0. Result: In a total of 329 children, 180 (54.7%) were male. The mean age was 10.2±2.8 years. Astigmatism was identified in 130 (39.5%) children. The mean cylindrical error among children with astigmatism was 1.34±0.62 D. Frequency astigmatism was found to be significantly differing based on age (p<0.001), residence (p<0.001), socio-economic status (p=0.005), and maternal illiteracy (p=0.001). Among 130 children with astigmatism, the severity was mild, moderate, and severe in 58 (44.6%), 48 (36.9%), and 24 (18.5%) children, respectively. Evaluation of astigmatism types showed that with-the-rule astigmatism, against-the-rule, and oblique were noted among 76 (58.5%), 36 (27.7%), and 18 (13.8%) children, respectively. Frequency of severity of astigmatism was significantly differed among different age groups (p=0.045). Conclusion: Astigmatism is a prevalent refractive error among children in South Punjab, Pakistan, with a significant difference of frequency based on age, rural residence, low socioeconomic status, and maternal illiteracy. The findings underlines an urgent need of screening for refractive error among adolescents and community based education for early detection. Keywords: Astigmatism, Illiterate, Oblique, Ophthalmology, Refractory error.