Disparity and Inequity of Elementary School Children’s Vision Health and Basic Clinic Resources in Rural and Urban Areas in Taiwan

Abstract

Highlights What are the main findings? Among 10,610 Taiwanese elementary school children, myopia and measurable astigmatism were highly prevalent. Myopia prevalence was generally higher in the upper grades. Children living in rural and especially or extremely remote areas had better uncorrected visual acuity than those living in urban areas. Rural children had lower odds of myopia, whereas children in rural and especially or extremely remote areas had higher odds of measurable astigmatism. Optometry clinics were more concentrated in urban areas, and a higher density of optometry clinics was associated with lower odds of myopia. What are the implications of the main findings? Better uncorrected visual acuity does not necessarily indicate a lower prevalence or risk of refractive error. Comprehensive vision assessment should therefore include refractive examinations, and school-based screening and referral services should be strengthened, including early screening for high astigmatism. Eye-care strategies should be tailored to regional needs. Remote areas may benefit from improved access to optometric services and affordable refractive correction, whereas urban areas may require greater emphasis on lifestyle and environmental interventions related to myopia prevention. Abstract Background/Objectives: Myopia is a major global public health concern, particularly in East Asia. Taiwan’s exceptionally high prevalence of childhood myopia provides a valuable population model for investigating refractive development and prevention. This study examined geographic disparities in visual acuity, refractive errors, and optometric resources among Taiwanese elementary school children. Methods: This retrospective nationwide study analyzed anonymized screening data from 10,610 elementary school children collected from 2014 to 2023. Children were classified as urban, rural, remote, or especially/extremely remote according to governmental criteria. Comprehensive vision examinations were performed by licensed optometrists. Refraction was assessed using autorefraction and retinoscopy without cycloplegia. Refractive errors and healthcare resources were compared across regions using multivariable logistic and linear regression analyses. Results: Myopia was present in 86.4% of male and 87.0% of female children, while measurable astigmatism (≥0.25 D) was present in 98.4% of both sexes. High myopia and high astigmatism affected 2.3% and 4.5% of children, respectively. Myopia prevalence varied across grade levels and was 88.9% among sixth-grade children. Compared with urban children, those living in especially or extremely remote areas and rural areas had higher odds of measurable astigmatism (OR = 2.81 and 1.63, respectively; p < 0.01). Rural children had significantly lower odds of myopia, while no significant association with myopia was observed among children living in specially or extremely remote areas. Optometry clinics were more concentrated in urban areas, and a higher density of optometry clinics was associated with lower odds of myopia. Conclusions: Taiwan provides a valuable model population for understanding geographic, environmental, and healthcare-related factors in childhood myopia. Better visual acuity does not necessarily indicate lower refractive risk. Region-specific strategies should strengthen comprehensive screening and referral, improve optometric access and affordable correction in remote areas, and promote lifestyle and environmental interventions in urban settings.