Frontiers in medicine · 2026
Prevalence, vector evolution, and visual impact of astigmatism: a large-scale study of 79,066 children in Beijing, China.
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Wang Jingjing, Zhang Yunsheng, Wang Hui, Xie Xiaolan, Zhu Bidan
Аннотация
BACKGROUND: Astigmatism is highly prevalent among school-aged children. This study aimed to evaluate the epidemiological distribution of astigmatism in a large-scale Chinese pediatric population and investigate the independent and interactive impacts of astigmatism magnitude and axis on uncorrected visual acuity (UCVA).
METHODS: This school-based, cross-sectional study conducted in Tongzhou District, Beijing, included 79,066 students aged 6 to 20 years (mean age: 11.35 ± 3.23 years). Participants underwent standardized non-cycloplegic autorefraction and UCVA assessment. Astigmatism was quantified by cylinder power and decomposed into Thibos vector components (J 0, J 45). Generalized linear models (GLMs) were utilized to determine the independent association between astigmatism axis and visual function, adjusting for spherical power and astigmatism magnitude.
RESULTS: The overall prevalence of astigmatism was 43.6%, pre-dominantly characterized by mild severity and the with-the-rule (WTR) subtype (82.9%). Both prevalence and severity increased progressively with advancing educational stages. Crucially, multivariate analysis revealed that after adjusting for spherical equivalent (SE), advancing grade was independently associated with a slight against-the-rule (ATR) and oblique shift. Furthermore, males exhibited a higher susceptibility to the WTR orientation, whereas females were more prone to ATR and oblique. Regarding visual performance, astigmatism magnitude significantly degraded UCVA in non-myopic and low-myopic eyes, but this effect was saturated and masked in moderate-to-high myopia. Although the WTR axis was associated with a statistically worse UCVA compared to oblique subtypes, the absolute difference was clinically negligible, likely reflecting statistical amplification within this mega-cohort.
CONCLUSION: WTR is the pre-dominant astigmatism subtype in school-aged children, propelled by the concurrent myopization process. While the magnitude of astigmatism profoundly impairs UCVA-heavily modulated by the concurrent SE-the functional impact of axis orientation remains clinically insignificant. These findings suggest that targeted monitoring and correction strategies may benefit from being tailored to specific genders and refractive profiles.
METHODS: This school-based, cross-sectional study conducted in Tongzhou District, Beijing, included 79,066 students aged 6 to 20 years (mean age: 11.35 ± 3.23 years). Participants underwent standardized non-cycloplegic autorefraction and UCVA assessment. Astigmatism was quantified by cylinder power and decomposed into Thibos vector components (J 0, J 45). Generalized linear models (GLMs) were utilized to determine the independent association between astigmatism axis and visual function, adjusting for spherical power and astigmatism magnitude.
RESULTS: The overall prevalence of astigmatism was 43.6%, pre-dominantly characterized by mild severity and the with-the-rule (WTR) subtype (82.9%). Both prevalence and severity increased progressively with advancing educational stages. Crucially, multivariate analysis revealed that after adjusting for spherical equivalent (SE), advancing grade was independently associated with a slight against-the-rule (ATR) and oblique shift. Furthermore, males exhibited a higher susceptibility to the WTR orientation, whereas females were more prone to ATR and oblique. Regarding visual performance, astigmatism magnitude significantly degraded UCVA in non-myopic and low-myopic eyes, but this effect was saturated and masked in moderate-to-high myopia. Although the WTR axis was associated with a statistically worse UCVA compared to oblique subtypes, the absolute difference was clinically negligible, likely reflecting statistical amplification within this mega-cohort.
CONCLUSION: WTR is the pre-dominant astigmatism subtype in school-aged children, propelled by the concurrent myopization process. While the magnitude of astigmatism profoundly impairs UCVA-heavily modulated by the concurrent SE-the functional impact of axis orientation remains clinically insignificant. These findings suggest that targeted monitoring and correction strategies may benefit from being tailored to specific genders and refractive profiles.