THE ESCALATING BURDEN OF CHILDHOOD MYOPIA (4-16 YEARS) IN PUNJAB, PAKISTAN: A REVIEW OF PREVALENCE, RISK FACTORS, AND PREVENTIVE STRATEGIES

Background: Childhood myopia is a rising public health concern globally, with increasing prevalence in developing countries. In Punjab, Pakistan, myopia among school-aged children poses significant risks for long-term ocular health and vision quality. Objective: To review the prevalence, risk factors, and preventive strategies for myopia in children aged 4–16 years in Punjab. Methods: A systematic search of PubMed, Google Scholar, ResearchGate, and institutional repositories (2015–2025) was conducted. Forty distinct prevalence data points were compiled from urban and rural cohorts, age-specific groups, and gender-specific findings. Data were extracted on geographic location, age, myopia prevalence, study design, and associated risk factors. Quality of Refractive Error Care (Q.REC) studies were analyzed to assess the adequacy of refractive correction services. A qualitative synthesis identified behavioral and environmental risk factors. Results: Myopia prevalence varied from 3.35% in Rawalpindi to over 67% in hospital-based urban cohorts. Urbanization and academic intensity were strongly associated with higher prevalence, particularly among children aged 12–16 years. Key modifiable risk factors included prolonged near work, extended study hours, high digital screen use, and limited outdoor activity. Female students showed slightly higher rates, likely due to socio-cultural indoor activity patterns. Q.REC data indicated that only 42.7% of spectacles dispensed were of optimal quality, highlighting gaps in effective correction. Conclusion: Chi Background: Childhood myopia has emerged as a rapidly growing public health concern worldwide, with marked increases reported across both developed and developing countries. In Punjab, Pakistan, the rising burden among children aged 4–16 years is particularly alarming due to its association with long-term visual impairment, reduced quality of life, and increased risk of sight-threatening conditions in adulthood. The accelerated pace of urbanization, changing educational demands, reduced outdoor activity, and higher digital device use have collectively contributed to this growing epidemiological challenge in the region. Objective: To examine the prevalence, associated risk factors, and preventive strategies for childhood myopia among children aged 4–16 years in Punjab, Pakistan. Methods: A systematic search of PubMed, Google Scholar, ResearchGate, and institutional repositories was conducted for studies published between 2015 and 2025. Eligible studies included school-based surveys, hospital reports, and population cohorts. Forty distinct prevalence data points were extracted from urban and rural settings, age-specific and gender-specific groups, and optical service datasets across Punjab. Extracted variables included geographic location, sample age range, myopia prevalence (defined as ≤−0.50 D), study design, and reported risk factors. Quality of Refractive Error Care (Q.REC) findings were incorporated to evaluate the adequacy of spectacle dispensing and refractive services. A qualitative synthesis was performed to identify common behavioral, demographic, and environmental determinants. Results: Myopia prevalence ranged widely, from 3.35% in Rawalpindi to 67.7% in Lahore’s hospital-based refractive error cohorts. Urban school children showed significantly higher prevalence—up to 52% in high schools—compared with 28% in rural cohorts. Age-stratified findings showed a progressive increase: 20.5% at 12 years, 35.1% at 14 years, and 42.9% at 16 years. Private schools reported myopia frequencies of 40.8–46.58%, while public schools ranged from 26.1–59.2%. Q.REC assessments revealed that only 42.7% of spectacles dispensed met optimal quality standards. Prolonged near work, high digital screen exposure, limited outdoor time, and female gender were consistently reported as key risk factors. Conclusion: Childhood myopia in Punjab is escalating rapidly, driven predominantly by modifiable lifestyle and environmental factors, with significantly higher rates in urban and academically demanding settings. Targeted actions—such as mandatory annual vision screening, daily outdoor activity promotion, and strengthened refractive care quality—are urgently required to mitigate early onset, slow progression, and minimize long-term ocular morbidity. ldhood myopia in Punjab is a rapidly escalating public health issue driven by environmental and lifestyle factors. Urgent, targeted interventions are needed, including annual vision screening, school-based lifestyle modifications promoting outdoor activity, and quality-assured refractive services, to prevent onset and progression and reduce long-term ocular morbidity.