Epidemiology and demographic risk factors for myopia in Ghana: A 5-year retrospective study

Epidemiology and demographic risk factors for myopia in Ghana: A 5-year retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiology and demographic risk factors for myopia in Ghana: A 5-year retrospective study Samuel Kyei, Rexford Kwasi Gyaami, John Baptist Abowine, Ebenezer Zaabaar, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3011391/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 May, 2024 Read the published version in Discover Social Science and Health → Version 1 posted You are reading this latest preprint version Abstract Purpose To explore the epidemiology and demographic risk factors for myopia among a clinical sample. Methods In a hospital-based retrospective study, eligible subjects were grouped into either myopia or non-myopia. Demographic data, including age, sex, occupation, area of residence, region of residence, and ethnicity, were analysed. Other clinical information analysed included the degree of myopia and intervention provided for the myopia. Results Overall, 15807 were enrolled, with 50.9% being males. The mean ± SD age of the patients was 42.81 ± 18.99 years. A total of 44.4% of the patients were myopic. Age, type of ethnic group, occupation, and area of residence were associated with myopia. Demographic risk factors for myopia included occupations such as professionals (OR: 2.93; 95% CI: 2.44–3.52), technicians and associated workers (OR: 6.71; 95% CI: 5.15–8.74), service workers (OR: 11.74; 95% CI: 9.62–14.33), skilled agriculture and fishery (OR: 1.88; 95% CI: 1.41–2.50), craft workers (OR: 3.41; 95% CI: 2.75–4.25), armed forces (OR: 10.26; 95% CI: 7.54–13.97), students (OR: 3.49; 95% CI: 2.76–4.42), the unemployed (OR: 6.64; 95% CI: 5.44–8.11), as well as Ewe (OR: 1.46; 95% CI: 1.17–1.82) and Ga-Adangbe (OR: 1.28; 95% CI: 1.05–1.54) ethnicities. Conclusion Myopia is the most common presenting refractive error in eye care facilities in Ghana. Ewe and Ga-Adangbe ethnicities, and specific occupations are risk factors for myopia. Myopia Demographic Prevalence Refractive error Risk factor Figures Figure 1 INTRODUCTION Myopia is a common form of refractive error that has gained considerable public health attention across the globe in recent years. Pivotal to concerns about myopia is its attributable negative impact on vision and eye health [ 1 ], coupled with its increasing global prevalence [ 2 ]. Despite the lack of a clear pathophysiological mechanism for the onset and progression of myopia, environmental and genetic factors have been implicated by several studies [ 2 , 3 ]. While the role of genetics is thought to be involved in the onset and progression of myopia, 3 environmental factors such as the level of outdoor activities [ 4 ], level of education and greater amount of near work [ 5 ], reading distance [ 6 ], stature [ 7 ], urbanisation and socioeconomic status [ 8 ], low birth weight [ 9 ], lack of breastfeeding [ 10 ], and parental education [ 11 ] have been implicated in myopia. Furthermore, associations between myopia and ethnicity, age and sex have also been described [ 12 ]. Aside from the obvious debilitating effect of myopia on the quality of vision, myopia may also present with axial elongation [ 13 ], changes in central corneal thickness [ 14 ], deeper anterior chamber [ 15 ], decreased choroidal circulation and decreased scleral thickness [ 16 ], and thinner retina and retinal detachment [ 17 ], which may lead to permanent visual impairment. According to global estimates, myopia affects approximately 22.9% of the global population [ 18 ], while projections are that myopia and high myopia could affect approximately 49.8% and 9.8%, respectively, of the world population by 2050 [ 18 ]. According to reports, Eastern Asia is particularly noted for a relatively high prevalence of myopia: over 90% in South Korea, up to 84% in Taiwan and between 36.7–53.9% among children in China 69.5% in Singaporean children [ 19 ]; between 36.7–53.9% among children in China [ 20 , 21 ]. In Europe and North America, the prevalence of myopia ranges from 6.2–26.2%, respectively [ 22 ]. Despite global reports about the high prevalence of myopia in different geographical regions, there is inadequate information on the regional prevalence of myopia in Africa. Recently, the prevalence of myopia in Africa was estimated to be between 4.7% and 6.2% among children [ 23 , 24 ]. In Ghana, there are inadequate studies regarding the prevalence of myopia, which pegs the figures between 1.7% and 7% among school children [ 25 , 26 ]. These prevalence studies are mostly confined to specific age groups and do not cut across the different stages of life to give a holistic situational report of myopia for planning and resource allocation. Due to the alarming spate of myopia in other geographical regions of the world, it is imperative to examine the epidemiological profile of myopia in Ghana to keep eye care practitioners informed. Ultimately, this will enhance clinical practice and inform future health policies. Therefore, this study aims to explore the epidemiology and demographic risk factors for myopia in Ghana using large-scale retrospective data gathered from a tertiary eye referral hospital that approximately represents the demographic distribution of Ghana. METHODS Study setting and participants This was a 5-year hospital-based retrospective cross-sectional study conducted at Dr. Agarwal Eye Hospital in Accra, Ghana, from 2015 to 2019. This was selected to exclude the peak period of COVID-19 that affected attendance at this eye care facility. It is one of the major eye hospitals in Ghana that receives referral cases nationwide, with an annual average patient inflow of over 4000. Their services include medical and surgical eye services and refractive services, including refraction and optical correction with contact lenses and spectacle lenses, except laser refractive surgery. Therefore, all the post-laser refractive patients had already had their refractive surgeries elsewhere as captured in their ocular histories. The facility is located in Accra, in the Greater Accra Region of Ghana, which is the region with the highest population [ 27 ]. Although Accra serves as the home city of the Ga-Adangbe ethnic group, it is also highly cosmopolitan, with sizeable proportions of all the other ethnic groups in Ghana residing in the city. Thus, its population diversity makes it roughly representative of the Ghanaian population. Ghana had ten administrative regions for the period under consideration, namely, Greater Accra, Volta, Western, Central, Upper East, Upper West, Northern, Brong Ahafo, Eastern and Ashanti. These regions were originally inhabited by one or more of the five main ethnic groups, including Akan, Ewe, Ga-Adangbe, Mole-Dagbani, and Guans, with Akan being the largest ethnic group in Ghana. Data collection procedure Myopia cases were extracted from the records of patients who visited the facility from 2015–2019. Data from noncycloplegic objective refraction as obtained by an autorefractometer (Topcon RM-8800, Tokyo, Japan) during the first hospital attendance were recorded for each eye as spherical equivalent powers (SE) by obtaining the algebraic sum of half the cylinder power and the sphere power [(SE: sphere + 0.5(cylinder)] [ 25 ]. Myopia was defined as spherical equivalent power ≤ -0.50 D, and high myopia was defined as a spherical equivalent power ≤ -5.00 D in accordance with the most recent definitions [ 18 ]. Patients were classified as myopic if at least one eye was myopic by a spherical equivalent power of ≤ -0.50 dioptres, and in the case of bilateral myopia, the maximum myopic spherical equivalent power of either eye was used to classify the patient as either having myopia or high myopia. Visual impairment for each eye before and after refraction was classified based on the entrance visual acuity (VA) into mild (VA between 6/12 to 6/18), moderate (VA worse than 6/18 to 6/60), severe (VA worse than 6/60 to 3/60), and blindness (VA worse than 3/60) [ 28 ]. Demographic data, including age, sex, ethnicity, area of residence, and occupation, were extracted. The International Standard Classification of Occupations as endorsed by the International Labour Organisation in 2008 (ISCO-08) was used to broadly classify similar occupations into broad categories [ 29 ]. However, an exception to the ISCO-08 was students and the unemployed, who were considered separate categories. We further grouped the residential area data into urban, suburban and rural settlements [ 30 ]. Data from patient folders with incomplete records, those who had their refraction elsewhere, and those outside the study period were excluded. Statistical analysis The data extracted were screened for missing data, processed and analysed using IBM SPSS Statistics version 25 (IBM, Armonk, NY USA). Statistical associations were determined using Chi-square and independent t tests. Multivariate regression analysis was performed to examine the demographic factors associated with myopia. A p value < 0.05 was considered statistically significant. Ethical consideration The study protocol was approved by the Institutional Review Board of the University of Cape Coast with clearance identification number UCCIRB/CHAS/2022/40 prior to obtaining permission from the management of Dr Agarwal’s Eye Hospital. Inform consent is waived by the Institutional Review Board of the University of Cape Coast since it involved a retrospective review of patient case notes only. However, the study ensured strict anonymity and confidentiality of the medical records of patients and adhered to the tenets of the Declaration of Helsinki. RESULTS A total of 21016 patients visited the facility within the 5-year study period, of whom 15807 patients accessed refractive services and had complete data for analysis. Therefore, the accessibility rate for refractive services at the facility for the 5-year period was 75.2%. Out of these patients, 50.9% were males, and 49.1% were females. The overall mean ± SD age was 42.81 ± 18.99 years (range: 2–98 years), while the mean ages for the myopic and non-myopic groups were 40.5 ± 20.94 years and 44.7 ± 17.06 years, respectively, and the difference was significant (p < 0.001). The mean spherical equivalents were − 1.54 ± 1.31 D (range: -0.50 D to -4.63 D) and − 6.45 ± 3.91 D (range: -5.25 D to -25.00 D) for myopia and high myopia, respectively. Table 1 presents the demographic distribution of the patients and their associations with myopia. Overall, myopia was present in 7021 patients, representing a prevalence of 44.4%. On further sub-classification, the prevalence of myopia (SE > -5.00 D) and high myopia (SE ≤ -5.00 D) were 37.2% and 7.2%, respectively. Myopia was associated with age group (p < 0.001), ethnicity (p < 0.001), and occupation (p < 0.001) but not sex (p = 0.291). From Table 1 , the prevalence of myopia was highest among the 30–39 age group (18.1%) but lowest in the 0–9 age group (3.9%) (p < 0.001), which was higher among the Akans (45%) than among the rest of the ethnic groups (p < 0.001). Moreover, myopia was also more prevalent among urban dwellers (82.5%) than among suburban and rural dwellers (p < 0.001). Regarding occupations, myopia was highest among students (25.8%) but lowest among elementary occupations (p < 0.001). The distribution of myopia according to the various age groups is presented in Table 2 . It is shown that the proportions of both myopia and high myopia were still higher in the 30–39 age group followed by the 20–29 age group but least in the 0–9 age group. In terms of national distribution, 72.4% of the cases of myopia were residents of the Greater Accra region (Fig. 1 ). Table 3 summarises the relative proportions of eyes, right and left, that had various levels of visual impairment from mild to blindness before and after refractive intervention. Before analysis, 3 prosthetic right eyes and 2 prosthetic left eyes were excluded. For the right eyes, the proportion of eyes with entrance vision classified as mild, moderate, severe and blind levels of vision was reduced by 9%, 98.6%, 77.4% and 30.2%, respectively, after refraction. On the other hand, the number of left eyes with entrance vision classified as mild, moderate, severe, and blind entrance visual impairment was reduced by 54%, 68.5%, 81.4%, and 37%, respectively (Table 3 ). Spectacles were the major mode of refractive correction, accounting for 91.1% of the correction, while contact lens (0.5%), LASER refractive surgery (1.1%), both contact lens and spectacles (0.3%), and LASER combined with spectacles (0.3%) were very less frequent management options. Demographic risk factors for myopia were analysed based on the associated factors in Table 1 by estimating age-adjusted odds ratios for all the risk factors (Table 4 ). Based on the results, occupation classifications, including professionals (OR, 2.93; p < 0.001), technicians and associated professionals (OR, 6.71; p < 0.001), service and shop and market sales workers (OR, 11.74; p < 0.001), agricultural and fishery workers (OR, 1.88; p < 0.001), craft workers (OR, 3.41; P < 0.001), armed forces (OR, 10.26; P < 0.001), students (OR, 3.49; P < 0.001), and unemployed workers (OR, 6.64; P < 0.001), were all significant risk factors for myopia. Additionally, the Ewe (OR, 1.48; p = 0.001) and Ga-Adangbe (OR, 1.28; p = 0.012) ethnic groups were more likely to be myopic than the other ethnic groups. On the other hand, sex and area of residence and age groups were not risk factors for myopia. (Table 4 ) DISCUSSION The global trend of increasing prevalence of myopia [ 2 ] has necessitated several population and hospital-based studies in different countries to inform health policies. In the present hospital-based study, the overall prevalence of myopia was 44.4%, of which the Greater Accra region had the greatest proportion of cases. The location of the study setting skewed the distribution of myopia to residents of Accra due to the advantage of greater accessibility. This current estimate of myopia in Ghana is lower than that of a previous hospital-based study, which reported 54.1% [ 31 ]. Methodological limitations could account for these inconsistencies in the prevalence figures. For instance, our study facility was a private eye hospital and may not meet the financial capabilities of some section of the population, as opposed to the previous study [ 31 ], which included public facilities. Regardless, the larger sample size of this study still offers a comparatively stronger predictive power. Aside from overall myopia, the WHO also recognises myopia and high myopia as distinct types of myopic refractive error due to the increased risk of sight-threatening retinal damage and other complications associated with the latter [ 18 ]. Myopia currently refers to the range of low to moderate degrees of myopia [ 18 ], which accounts for the majority of clinically reported cases. In the current study, the prevalence of myopia and high myopia were 37.2% and 7.2%, respectively, in contrast to a previous study in Ghana that pegged myopia and high myopia at 49.4% and 4.75%, respectively [ 3 ]. An increasing amount of near-related work via digital devices and computers in recent decades poses a significant risk for myopic development and progression [ 5 ]. A possible shift of moderate myopia into high myopia over the course of time may explain the variations in estimates. Notwithstanding, longitudinal studies are recommended to unravel the time dynamics of myopia in Ghana. Overall, the prevalence of myopia and high myopia were lowest in the early years of life (0–9 years) but increased from 10–19 years, before peaking in prevalence among the 30–39 age group. Subsequently, a decline in prevalence was observed for only myopia, despite some fluctuations, from 40 years to over 70 years. However, in high myopia, a reverse trend was noticed with increasing prevalence from 60–69 years onwards. Previous epidemiological studies reported similar findings in Ghana [ 31 ] and elsewhere [ 32 , 33 ]. It is plausible that the remarkable shift in the intensity of academic demand and near-related activity associated with this period may explain the increase in myopia between 10 and 39 years. Moreover, emerging physiological evidence suggests that lens biometric changes, with a resultant decrease in the refractive index of the crystalline lens with ageing, may eliminate low degrees of myopia after age 40 years [ 34 , 35 , 36 ]. Reports of studies regarding sex-related differences in the prevalence of myopia have been contradictory. While some studies reported significant associations [ 37 , 38 ], others found otherwise [ 39 ] or differences only in a specific age group [ 40 ]. In Ghana, Koomson et al [ 31 ] reported a higher prevalence in males than in females, in contrast to other studies that found otherwise [ 37 , 38 ]. We found no sex-dependent differences in the prevalence of myopia. To the best of our knowledge, the present study is the first to examine the ethnicity-related prevalence of myopia in Ghana. From our study, myopia was significantly more prevalent among the Akan ethnic group, followed by the Ga-Adangbe ethnic group compared to the rest. This observation may be accounted for by the population of Akans and the study setting. Akans are the largest ethnic group in Ghana and are predominantly located in the middle and southern parts of the country. Thus, by virtue of their numbers, Akans would naturally have a higher hospital attendance rate for facilities located in southern Ghana compared to other ethnic groups. Nevertheless, ethnic differences in myopia prevalence have been reported by other studies in Asia [ 41 ]. Myopia was also more prevalent among urban settlers, followed by suburban dwellers, but it was least prevalent among rural dwellers. This difference could be attributed to the urban location of the study setting and its relatively reduced accessibility to suburban, and especially rural, settlers. Large national myopia studies using multi-stage random sampling should be conducted for further investigations of ethnic- and residential-dependent variations in myopia. Available evidence suggests that myopia onset and progression are influenced by the amount of near-related and outdoor activities [ 42 , 43 ]. Occupations may differ in terms of the amount near the visual task involved. In this study, students had a higher prevalence of myopia than others, while executives, senior officials and managers had the lowest prevalence. Unlike students who must read large volumes of text books to make academic progress, senior officials and executive workers may play more of a supervisory role at work. Additionally, these groups of workers are usually aged 40 and above, unlike students. Therefore, another reason for the observed difference could be the effect of age on the prevalence of myopia [ 36 ]. This study evaluated the effect of demographic risk factors on myopia. From the results, students and workers categorised under armed forces, craft-related work, agriculture, services, technicians, professionals, and the unemployed had higher odds of increased myopia prevalence. Occupational risk for myopia could be explained by the level of near and outdoor visual tasks involved [ 42 , 43 ]. Although the unemployed group was not technically involved with any work, their higher risk for myopia could be due to their previous activities, such as schooling or a greater leisure time, which increased their chances of watching TV or playing games. Additionally, the Ewe and Ga-Adangbe ethnic groups of Ghana were also at risk for increased myopia – the first of such a study in Ghana. However, due to the limitation imposed by the study setting, further population-based studies are required to further examine ethnic risk factors for myopia in Ghana on a national scale. On the other hand, urban and suburban settlements as well as ages 40–49 years, 50–59 years, and 60–69 years were all protective factors for myopia, similar to other reports on age [ 36 ] and urbanisation (the prevalence of myopia was significantly lower in those aged 40–69 years). Despite the significantly higher prevalence of myopia among urban dwellers in this study, urbanisation was not a risk factor for myopia, which corroborates another study [ 44 ]. Regarding age, other studies also reported that age 40 years and above may be protective against myopia [ 36 ]. In recent times, myopia control has garnered much popularity due to convincing evidence about the increasing prevalence of myopia [ 18 ], which is associated with an increased risk for permanent visual impairment [ 1 ]. These factors have triggered studies into the slowing of myopia progression via therapies including overnight orthokeratology, atropine, myopia control spectacles, dual defocus contact lenses, and multifocal contact lenses [ 45 ]. Despite the various myopia control options, this study shows that conventional spectacles remain the mainstay management option for myopia in Ghana. This is consistent with the recent report of a survey on eye care practitioners across Africa in which clinicians were less abreast of the current compelling evidence on myopia control [ 46 ]. Therefore, a roll-out of continuing professional development courses on the recent advances in myopia control strategies for optometrists in Ghana is highly recommended. Furthermore, this study noted that refraction was very effective at reducing the burden of myopia-related visual impairment burden. For instance, between 30 and 98.6% of both the right and left eyes that were initially classified as having moderate to blind visual impairment improved after refraction. Given that an overwhelming majority of the patients received spectacle correction and had a significant reduction in visual impairment, then by extending appropriate refractive services, the burden of myopic visual impairment in underdeveloped countries can be reduced drastically [ 25 ]. Spectacles are relatively more affordable than other means of myopia management. Therefore, programs aimed at reducing the global burden of reversible visual impairment attributable to myopia in underdeveloped countries must focus on training more optometrists. Strengths and Limitations The large size and diversity of the sample study sample is a considerable strength of this study, which makes the findings generalisable to the epidemiological profile of myopia in a hospital population and, to some extent, the general population. Nonetheless, this study has some limitations. First, as a hospital-based study, caution must be exercised in an attempt to extrapolate the findings to the general population due to the risk of overestimation. Second, the urban nature of the study setting skewed its accessibility to mostly urban and suburban dwellers relative to rural inhabitants. Notwithstanding the inherent challenges, the large sample size of this study and the inclusion of all the major ethnic groups in Ghana provided a somewhat reasonable estimation. CONCLUSIONS We conclude that myopia is the most common form of refractive error among patients seeking eyecare services in Ghana. Ewe and Ga-Adangbe ethnic groups as well as specific occupations, including students, are demographic risk factors for myopia among clinical populations in Ghana. Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Competing Interests The authors report no competing interest and have no proprietary interest in any of the materials mentioned in this article. Availability of Data and Material The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Code Availability Not applicable ACKNOWLEDGEMENTS The authors are grateful to Richard Quainoo for his assistance in the collection of the data. Contributions Conceptualisation: SK. Study design: S.K., R.K.G., J.B.A., E.Z. Data acquisition: R.K.G, A.A., E.Z., F.A. Data analysis: J.B.A, A.N. Data interpretation: S.K, R.K.G., J.B.A., E.Z., A.N., K.A. S.B.B-K., B.O-A., F.A., A.A. Supervision: S.K., E.Z., A.N., K.A. S.B.B-K., B.O-A. Writing-Original draft: S.K., J. B. A. Writing-Review and editing: S.K, R.K.G., J.B.A., E.Z., A.N., K.A. S.B.B-K., B.O-A., F.A., A.A. References Wong, T. Y., Ferreira, A., Hughes, R., Carter, G., & Mitchell, P. (2014). 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Change with age of the refractive index gradient of the human ocular lens. Investigative ophthalmology & visual science , 36 (3), 703-707. Ellingsen, K. L., Nizam, A., Ellingsen, B. A., & Lynn, M. J. (1997). Age-related refractive shifts in simple myopia. Journal of Refractive Surgery , 13 (3), 223-228. Zadnik, K., Manny, R. E., Yu, J. A., Mitchell, G. L., Cotter, S. A., Quiralte, J. C., ... & Mutti, D. O. (2003). Ocular component data in schoolchildren as a function of age and gender. Optometry and Vision Science , 80 (3), 226-236. Saxena, R., Vashist, P., Tandon, R., Pandey, R. M., Bhardawaj, A., Menon, V., & Mani, K. (2015). Prevalence of myopia and its risk factors in urban school children in Delhi: the North India Myopia Study (NIM Study). PloS one , 10 (2), e0117349. Kempf GA, Jarman BL, Collins SD. A special study of the vision of school children. Public Health Rep. 1928; 43(27); 1713-1739. Kempf, G. A., Jarman, B. L., & Collins, S. D. (1928). A special study of the vision of school children. Public Health Reports (1896-1970) , 1713-1739. Wu, H. M., Seet, B., Yap, E. P. H., Saw, S. M., Lim, T. H., & Chia, K. S. (2001). Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore. Optometry and vision science , 78 (4), 234-239. Jones, L. A., Sinnott, L. T., Mutti, D. O., Mitchell, G. L., Moeschberger, M. L., & Zadnik, K. (2007). Parental history of myopia, sports and outdoor activities, and future myopia. Investigative ophthalmology & visual science , 48 (8), 3524-3532. Mutti, D. O., Mitchell, G. L., Moeschberger, M. L., Jones, L. A., & Zadnik, K. (2002). Parental myopia, near work, school achievement, and children’s refractive error. Investigative ophthalmology & visual science , 43 (12), 3633-3640. O'Donoghue, L., Kapetanankis, V. V., McClelland, J. F., Logan, N. S., Owen, C. G., Saunders, K. J., & Rudnicka, A. R. (2015). Risk factors for childhood myopia: findings from the NICER study. Investigative ophthalmology & visual science , 56 (3), 1524-1530. Huang, J., Wen, D., Wang, Q., McAlinden, C., Flitcroft, I., Chen, H., ... & Qu, J. (2016). Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. Ophthalmology , 123 (4), 697-708. Nti, A. N., Owusu-Afriyie, B., Osuagwu, U. L., Kyei, S., Ovenseri-Ogbomo, G., Ogbuehi, K. C., ... & Naidoo, K. S. (2023). Trends in myopia management attitudes and strategies in clinical practice: Survey of eye care practitioners in Africa. Contact Lens and Anterior Eye , 46 (1), 101597. Tables Table 1 Demographic characteristics of the study participants Presence of Myopia Variables Yes N = 7021 (44.4%) No N = 8786 (55.6%) P Age groups < 0.001 0–9 271 (3.9%) 228 (2.6%) 10–19 991 (14.1%) 656 (7.5%) 20–29 1257 (17.9%) 854 (9.7%) 30–39 1293 (18.4%) 1250 (14.2%) 40–49 886 (12.6%) 2183 (24.8%) 50–59 645 (9.2%) 1828 (20.8%) 60–69 813 (11.6%) 1278 (14.5%) ≥70 865 (12.3%) 509 (5.8%) Sex 0.291 Male 3605 (51.3%) 4437 (50.5%) Female 3416 (48.7%) 4349 (49.5%) Ethnic groups < 0.001 Guan 269 (3.8%) 362 (4.1%) Mole-Dagbon 867 (12.3%) 1222 (13.9%) Akan 3159 (45%) 4502 (51.2%) Ewe 651 (9.3%) 575 (6.5%) Ga-Adangbe 2075 (29.6%) 2121 (24.1%) Occupation < 0.001 Legislators, Senior officials, and Managers 178 (2.5%) 953 (10.8%) Professionals 1043 (14.9%) 1613 (18.4%) Technicians and Associate Professionals 262 (3.7%) 155 (1.8%) Clerks 130 (1.9%) 526 (6.0%) Service and Shop and market sales workers 1157 (16.5%) 440 (5.0%) Skilled Agricultural and fishery workers 110 (1.6%) 284 (3.2%) Craft and related trades workers 382 (5.4%) 458 (5.2%) Plant and machine operators and assemblers 25 (0.4%) 182 (2.1%) Elementary occupations 68 (1.0%) 1595 (18.2%) Armed forces 207 (2.9%) 85 (1.0%) Student 1809 (25.8%) 1237 (14.1%) Unemployed 1650 (23.5%) 1258 (14.3) Area of residence < 0.001 Urban 5792 (82.5%) 8104 (92.2%) Suburban 1020 (14.5%) 626 (7.1%) Rural 209 (3.0%) 56 (0.6%) Table 2 Distribution of myopia and high myopia according to various age groups Age group Number (n) Myopia n = 5888 (37.2%) High myopia n = 1133 (7.2%) 0–9 271 221 (3.8%) 50 (4.4%) 10–19 991 832 (14.1%) 159 (14.0%) 20–29 1257 1074 (18.2%) 183 (16.2%) 30–39 1293 1103 (18.7%) 190 (16.8%) 40–49 886 788 (13.4%) 98 (8.6%) 50–59 645 541 (9.2%) 104 (9.2%) 60–69 813 637 (10.8%) 176 (15.5%) ≥ 70 865 692 (11.8%) 173 (15.3%) Table 3 Comparative proportions of visual impairment before and after refractive correction Variable Number (n) Mild VI n (%) Moderate VI n (%) Severe VI n (%) Blind n (%) Right Eyes entrance vision 7018 796 (11.3%) 1437 (20.5%) 327 (4.7%) 592 (8.4%) Right Eyes best-corrected VA 7018 723 (10.3%) 20 (0.3%) 74 (1.1%) 413 (5.9%) Proportion with improvement - 73 (9%) 1417 (98.6%) 253 (77.4%) 179 (30.2%) Left eyes entrance vision 7019 724 (10.3%) 1439 (20.5%) 334 (4.8%) 631 (9.0%) Left eyes best-corrected VA 7019 318 (4.5%) 454 (6.5%) 62 (0.9%) 398 (5.7%) Proportion with improvement - 406 (54%) 985 (68.5%) 272 (81.4%) 233 (37%) Table 4 Multivariate age-adjusted analysis of the demographic risk factors for myopia Risk factors Adjusted OR (95% CI) P Age group 0–9 Reference - 10–19 1.20 (0.96–1.50) 0.105 20–29 1.26 (0.94–1.68) 0.12 30–39 0.94 (0.64–1.38) 0.75- 40–49 0.40 (0.25–0.65) < 0.001 50–59 0.36 (0.19–0.64) 0.001 60–69 0.33 (0.17–0.65) 0.001 ≥ 70 0.75 (0.33–1.70) 0.495 Sex Females 0.93 (0.87–1.00) 0.061 Male Reference - Occupation Legislators, senior officials and managers Reference - Professionals 2.93 (2.44–3.52) < 0.001 Technicians and associate professionals 6.71 (5.15–8.74) < 0.001 Clerks 1.10(0.81–1.44) 0.71 Service and shop and market sales workers 11.74 (9.62–14.33) < 0.001 Agricultural and fishery workers 1.88 (1.41–2.50) < 0.001 Craft and related trade workers 3.41 (2.75–4.25) < 0.001 Plant and machine operators and assemblers 0.68 (0.43–1.08) 0.88 Elementary workers 0.21 (0.15–0.28) < 0.001 Armed forces 10.26(7.54–13.97) < 0.001 Students 3.49 (2.76–4.42) < 0.001 Unemployed 6.64 (5.44– 8.11) < 0.001 Ethnic groups Guan Reference - Mole-Dagbon 0.98 (0.80–1.21) 0.876 Akan 0.99 (0.82–1.19) 0.908 Ewe 1.46 (1.17–1.82) 0.001 Ga-Adangbe 1.28 (1.05–1.54) 0.010 Residence Urban 0.17 (0.12–0.24) < 0.001 Suburban 0.36 (0.25–0.52) < 0.001 Rural Reference - Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3011391","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":206495233,"identity":"50a8be43-4118-40e2-bed8-745da5c32173","order_by":0,"name":"Samuel Kyei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYDACHiBOqICwJUBsIrWcIVkLYxspWuR7zhg+eDjvsDx/A/PB2zwMtXkEtRic7TE2SNx22HDGAbZkax6G48WEtfDzmEkAtSQYMPCYSfMwHEtsIOiwfh7zH4lzQFr4vxGnheFsjxlDYgPYFjaglhrCWgzOHCuWSDiWbjjjMJux5RyDA0Q4rCd548cfNdby/O3ND2+8qagjwmEMHAYQmhls6WHCGhgY2B8g8+qI0TIKRsEoGAUjDAAAfyo5wsM8SUcAAAAASUVORK5CYII=","orcid":"","institution":"University of Cape Coast","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Kyei","suffix":""},{"id":206495234,"identity":"2ddcc38a-53ce-45d5-912e-903d7c9dcb59","order_by":1,"name":"Rexford Kwasi Gyaami","email":"","orcid":"","institution":"University of Cape Coast","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rexford","middleName":"Kwasi","lastName":"Gyaami","suffix":""},{"id":206495235,"identity":"6ee44495-a80b-4bbf-bac2-e168a9167043","order_by":2,"name":"John Baptist Abowine","email":"","orcid":"","institution":"Dr Rose Mompi Eye Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"John","middleName":"Baptist","lastName":"Abowine","suffix":""},{"id":206495236,"identity":"249982e1-7dfa-4951-98bd-0588d384834e","order_by":3,"name":"Ebenezer Zaabaar","email":"","orcid":"","institution":"University of Cape Coast","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ebenezer","middleName":"","lastName":"Zaabaar","suffix":""},{"id":206495237,"identity":"5d550b77-2616-4b7d-9cb5-6076870f1f73","order_by":4,"name":"Augustine Nti","email":"","orcid":"","institution":"University of Houston College of Optometry","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Augustine","middleName":"","lastName":"Nti","suffix":""},{"id":206495238,"identity":"9a935704-b646-49d1-a4ad-5112a0a455d7","order_by":5,"name":"Kofi Asiedu","email":"","orcid":"","institution":"University of New South Wales","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kofi","middleName":"","lastName":"Asiedu","suffix":""},{"id":206495239,"identity":"e5aea567-ad1c-47be-ad8a-8c821eeffad8","order_by":6,"name":"Samuel Bert Boadi-Kusi","email":"","orcid":"","institution":"University of Cape Coast","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"Bert","lastName":"Boadi-Kusi","suffix":""},{"id":206495240,"identity":"75f7d63c-2745-47f7-87ca-48a56c3f3a1a","order_by":7,"name":"Bismark Owusu-Afriyie","email":"","orcid":"","institution":"Cardiff University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bismark","middleName":"","lastName":"Owusu-Afriyie","suffix":""},{"id":206495241,"identity":"e6dc449c-b940-447f-baa3-65b75ff5ca78","order_by":8,"name":"Frank Assiamah","email":"","orcid":"","institution":"University of California, Davis","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Assiamah","suffix":""},{"id":206495242,"identity":"0336bc5c-2270-4a2d-8fce-1d6dc5b8497e","order_by":9,"name":"Anthony Armah","email":"","orcid":"","institution":"University of Cape Coast","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"","lastName":"Armah","suffix":""}],"badges":[],"createdAt":"2023-06-01 18:29:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3011391/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3011391/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s44155-024-00081-5","type":"published","date":"2024-05-13T00:39:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":38101169,"identity":"b515d994-b885-42a9-9465-3fb554ef0716","added_by":"auto","created_at":"2023-06-06 14:33:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13395,"visible":true,"origin":"","legend":"\u003cp\u003eGeographic distribution of the myopic and non-myopic patients among the hospital-based sample. G. Accra = Greater Accra region, ER = Eastern region, WR = Western region, CR = Central region, UER = Upper East region, BAR = Brong Ahafo region, NR = Northern region, AR = Ashanti region, UWR = Upper West region, VR = Volta region\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3011391/v1/c77a19d8f8a8b8957ea81c52.png"},{"id":56416525,"identity":"5df6b650-3fa1-4ac1-9903-dbc03e7ccf49","added_by":"auto","created_at":"2024-05-14 00:39:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":691960,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3011391/v1/9ba79091-b752-4831-a85b-1302e5d6229c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiology and demographic risk factors for myopia in Ghana: A 5-year retrospective study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMyopia is a common form of refractive error that has gained considerable public health attention across the globe in recent years. Pivotal to concerns about myopia is its attributable negative impact on vision and eye health [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], coupled with its increasing global prevalence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the lack of a clear pathophysiological mechanism for the onset and progression of myopia, environmental and genetic factors have been implicated by several studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While the role of genetics is thought to be involved in the onset and progression of myopia,\u003csup\u003e3\u003c/sup\u003e environmental factors such as the level of outdoor activities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], level of education and greater amount of near work [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], reading distance [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], stature [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], urbanisation and socioeconomic status [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], low birth weight [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], lack of breastfeeding [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and parental education [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] have been implicated in myopia. Furthermore, associations between myopia and ethnicity, age and sex have also been described [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAside from the obvious debilitating effect of myopia on the quality of vision, myopia may also present with axial elongation [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], changes in central corneal thickness [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], deeper anterior chamber [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], decreased choroidal circulation and decreased scleral thickness [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and thinner retina and retinal detachment [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which may lead to permanent visual impairment.\u003c/p\u003e \u003cp\u003eAccording to global estimates, myopia affects approximately 22.9% of the global population [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], while projections are that myopia and high myopia could affect approximately 49.8% and 9.8%, respectively, of the world population by 2050 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. According to reports, Eastern Asia is particularly noted for a relatively high prevalence of myopia: over 90% in South Korea, up to 84% in Taiwan and between 36.7\u0026ndash;53.9% among children in China 69.5% in Singaporean children [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; between 36.7\u0026ndash;53.9% among children in China [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In Europe and North America, the prevalence of myopia ranges from 6.2\u0026ndash;26.2%, respectively [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Despite global reports about the high prevalence of myopia in different geographical regions, there is inadequate information on the regional prevalence of myopia in Africa. Recently, the prevalence of myopia in Africa was estimated to be between 4.7% and 6.2% among children [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Ghana, there are inadequate studies regarding the prevalence of myopia, which pegs the figures between 1.7% and 7% among school children [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These prevalence studies are mostly confined to specific age groups and do not cut across the different stages of life to give a holistic situational report of myopia for planning and resource allocation. Due to the alarming spate of myopia in other geographical regions of the world, it is imperative to examine the epidemiological profile of myopia in Ghana to keep eye care practitioners informed. Ultimately, this will enhance clinical practice and inform future health policies. Therefore, this study aims to explore the epidemiology and demographic risk factors for myopia in Ghana using large-scale retrospective data gathered from a tertiary eye referral hospital that approximately represents the demographic distribution of Ghana.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting and participants\u003c/h2\u003e \u003cp\u003eThis was a 5-year hospital-based retrospective cross-sectional study conducted at Dr. Agarwal Eye Hospital in Accra, Ghana, from 2015 to 2019. This was selected to exclude the peak period of COVID-19 that affected attendance at this eye care facility. It is one of the major eye hospitals in Ghana that receives referral cases nationwide, with an annual average patient inflow of over 4000. Their services include medical and surgical eye services and refractive services, including refraction and optical correction with contact lenses and spectacle lenses, except laser refractive surgery. Therefore, all the post-laser refractive patients had already had their refractive surgeries elsewhere as captured in their ocular histories. The facility is located in Accra, in the Greater Accra Region of Ghana, which is the region with the highest population [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Although Accra serves as the home city of the Ga-Adangbe ethnic group, it is also highly cosmopolitan, with sizeable proportions of all the other ethnic groups in Ghana residing in the city. Thus, its population diversity makes it roughly representative of the Ghanaian population. Ghana had ten administrative regions for the period under consideration, namely, Greater Accra, Volta, Western, Central, Upper East, Upper West, Northern, Brong Ahafo, Eastern and Ashanti. These regions were originally inhabited by one or more of the five main ethnic groups, including Akan, Ewe, Ga-Adangbe, Mole-Dagbani, and Guans, with Akan being the largest ethnic group in Ghana.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eMyopia cases were extracted from the records of patients who visited the facility from 2015\u0026ndash;2019. Data from noncycloplegic objective refraction as obtained by an autorefractometer (Topcon RM-8800, Tokyo, Japan) during the first hospital attendance were recorded for each eye as spherical equivalent powers (SE) by obtaining the algebraic sum of half the cylinder power and the sphere power [(SE: sphere\u0026thinsp;+\u0026thinsp;0.5(cylinder)] [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Myopia was defined as spherical equivalent power \u0026le; -0.50 D, and high myopia was defined as a spherical equivalent power \u0026le; -5.00 D in accordance with the most recent definitions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Patients were classified as myopic if at least one eye was myopic by a spherical equivalent power of \u0026le; -0.50 dioptres, and in the case of bilateral myopia, the maximum myopic spherical equivalent power of either eye was used to classify the patient as either having myopia or high myopia. Visual impairment for each eye before and after refraction was classified based on the entrance visual acuity (VA) into mild (VA between 6/12 to 6/18), moderate (VA worse than 6/18 to 6/60), severe (VA worse than 6/60 to 3/60), and blindness (VA worse than 3/60) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Demographic data, including age, sex, ethnicity, area of residence, and occupation, were extracted. The International Standard Classification of Occupations as endorsed by the International Labour Organisation in 2008 (ISCO-08) was used to broadly classify similar occupations into broad categories [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, an exception to the ISCO-08 was students and the unemployed, who were considered separate categories. We further grouped the residential area data into urban, suburban and rural settlements [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Data from patient folders with incomplete records, those who had their refraction elsewhere, and those outside the study period were excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data extracted were screened for missing data, processed and analysed using IBM SPSS Statistics version 25 (IBM, Armonk, NY USA). Statistical associations were determined using Chi-square and independent t tests. Multivariate regression analysis was performed to examine the demographic factors associated with myopia. A p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e The study protocol was approved by the Institutional Review Board of the University of Cape Coast with clearance identification number UCCIRB/CHAS/2022/40 prior to obtaining permission from the management of Dr Agarwal\u0026rsquo;s Eye Hospital. Inform consent is waived by the Institutional Review Board of the University of Cape Coast since it involved a retrospective review of patient case notes only. However, the study ensured strict anonymity and confidentiality of the medical records of patients and adhered to the tenets of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 21016 patients visited the facility within the 5-year study period, of whom 15807 patients accessed refractive services and had complete data for analysis. Therefore, the accessibility rate for refractive services at the facility for the 5-year period was 75.2%. Out of these patients, 50.9% were males, and 49.1% were females. The overall mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD age was 42.81\u0026thinsp;\u0026plusmn;\u0026thinsp;18.99 years (range: 2\u0026ndash;98 years), while the mean ages for the myopic and non-myopic groups were 40.5\u0026thinsp;\u0026plusmn;\u0026thinsp;20.94 years and 44.7\u0026thinsp;\u0026plusmn;\u0026thinsp;17.06 years, respectively, and the difference was significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean spherical equivalents were \u0026minus;\u0026thinsp;1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31 D (range: -0.50 D to -4.63 D) and \u0026minus;\u0026thinsp;6.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91 D (range: -5.25 D to -25.00 D) for myopia and high myopia, respectively.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic distribution of the patients and their associations with myopia. Overall, myopia was present in 7021 patients, representing a prevalence of 44.4%. On further sub-classification, the prevalence of myopia (SE \u0026gt; -5.00 D) and high myopia (SE \u0026le; -5.00 D) were 37.2% and 7.2%, respectively. Myopia was associated with age group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), ethnicity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and occupation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but not sex (p\u0026thinsp;=\u0026thinsp;0.291). From Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, the prevalence of myopia was highest among the 30\u0026ndash;39 age group (18.1%) but lowest in the 0\u0026ndash;9 age group (3.9%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), which was higher among the Akans (45%) than among the rest of the ethnic groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, myopia was also more prevalent among urban dwellers (82.5%) than among suburban and rural dwellers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regarding occupations, myopia was highest among students (25.8%) but lowest among elementary occupations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eThe distribution of myopia according to the various age groups is presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. It is shown that the proportions of both myopia and high myopia were still higher in the 30\u0026ndash;39 age group followed by the 20\u0026ndash;29 age group but least in the 0\u0026ndash;9 age group. In terms of national distribution, 72.4% of the cases of myopia were residents of the Greater Accra region (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the relative proportions of eyes, right and left, that had various levels of visual impairment from mild to blindness before and after refractive intervention. Before analysis, 3 prosthetic right eyes and 2 prosthetic left eyes were excluded. For the right eyes, the proportion of eyes with entrance vision classified as mild, moderate, severe and blind levels of vision was reduced by 9%, 98.6%, 77.4% and 30.2%, respectively, after refraction. On the other hand, the number of left eyes with entrance vision classified as mild, moderate, severe, and blind entrance visual impairment was reduced by 54%, 68.5%, 81.4%, and 37%, respectively (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Spectacles were the major mode of refractive correction, accounting for 91.1% of the correction, while contact lens (0.5%), LASER refractive surgery (1.1%), both contact lens and spectacles (0.3%), and LASER combined with spectacles (0.3%) were very less frequent management options.\u003c/p\u003e\n\u003cp\u003eDemographic risk factors for myopia were analysed based on the associated factors in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e by estimating age-adjusted odds ratios for all the risk factors (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). Based on the results, occupation classifications, including professionals (OR, 2.93; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), technicians and associated professionals (OR, 6.71; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), service and shop and market sales workers (OR, 11.74; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), agricultural and fishery workers (OR, 1.88; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), craft workers (OR, 3.41; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), armed forces (OR, 10.26; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), students (OR, 3.49; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and unemployed workers (OR, 6.64; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), were all significant risk factors for myopia. Additionally, the Ewe (OR, 1.48; p\u0026thinsp;=\u0026thinsp;0.001) and Ga-Adangbe (OR, 1.28; p\u0026thinsp;=\u0026thinsp;0.012) ethnic groups were more likely to be myopic than the other ethnic groups. On the other hand, sex and area of residence and age groups were not risk factors for myopia. (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe global trend of increasing prevalence of myopia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] has necessitated several population and hospital-based studies in different countries to inform health policies. In the present hospital-based study, the overall prevalence of myopia was 44.4%, of which the Greater Accra region had the greatest proportion of cases. The location of the study setting skewed the distribution of myopia to residents of Accra due to the advantage of greater accessibility. This current estimate of myopia in Ghana is lower than that of a previous hospital-based study, which reported 54.1% [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Methodological limitations could account for these inconsistencies in the prevalence figures. For instance, our study facility was a private eye hospital and may not meet the financial capabilities of some section of the population, as opposed to the previous study [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], which included public facilities. Regardless, the larger sample size of this study still offers a comparatively stronger predictive power.\u003c/p\u003e \u003cp\u003eAside from overall myopia, the WHO also recognises myopia and high myopia as distinct types of myopic refractive error due to the increased risk of sight-threatening retinal damage and other complications associated with the latter [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Myopia currently refers to the range of low to moderate degrees of myopia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], which accounts for the majority of clinically reported cases. In the current study, the prevalence of myopia and high myopia were 37.2% and 7.2%, respectively, in contrast to a previous study in Ghana that pegged myopia and high myopia at 49.4% and 4.75%, respectively [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. An increasing amount of near-related work via digital devices and computers in recent decades poses a significant risk for myopic development and progression [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A possible shift of moderate myopia into high myopia over the course of time may explain the variations in estimates. Notwithstanding, longitudinal studies are recommended to unravel the time dynamics of myopia in Ghana.\u003c/p\u003e \u003cp\u003eOverall, the prevalence of myopia and high myopia were lowest in the early years of life (0\u0026ndash;9 years) but increased from 10\u0026ndash;19 years, before peaking in prevalence among the 30\u0026ndash;39 age group. Subsequently, a decline in prevalence was observed for only myopia, despite some fluctuations, from 40 years to over 70 years. However, in high myopia, a reverse trend was noticed with increasing prevalence from 60\u0026ndash;69 years onwards. Previous epidemiological studies reported similar findings in Ghana [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and elsewhere [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. It is plausible that the remarkable shift in the intensity of academic demand and near-related activity associated with this period may explain the increase in myopia between 10 and 39 years. Moreover, emerging physiological evidence suggests that lens biometric changes, with a resultant decrease in the refractive index of the crystalline lens with ageing, may eliminate low degrees of myopia after age 40 years [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eReports of studies regarding sex-related differences in the prevalence of myopia have been contradictory. While some studies reported significant associations [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], others found otherwise [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] or differences only in a specific age group [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In Ghana, Koomson et al [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] reported a higher prevalence in males than in females, in contrast to other studies that found otherwise [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. We found no sex-dependent differences in the prevalence of myopia.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, the present study is the first to examine the ethnicity-related prevalence of myopia in Ghana. From our study, myopia was significantly more prevalent among the Akan ethnic group, followed by the Ga-Adangbe ethnic group compared to the rest. This observation may be accounted for by the population of Akans and the study setting. Akans are the largest ethnic group in Ghana and are predominantly located in the middle and southern parts of the country. Thus, by virtue of their numbers, Akans would naturally have a higher hospital attendance rate for facilities located in southern Ghana compared to other ethnic groups. Nevertheless, ethnic differences in myopia prevalence have been reported by other studies in Asia [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Myopia was also more prevalent among urban settlers, followed by suburban dwellers, but it was least prevalent among rural dwellers. This difference could be attributed to the urban location of the study setting and its relatively reduced accessibility to suburban, and especially rural, settlers. Large national myopia studies using multi-stage random sampling should be conducted for further investigations of ethnic- and residential-dependent variations in myopia.\u003c/p\u003e \u003cp\u003eAvailable evidence suggests that myopia onset and progression are influenced by the amount of near-related and outdoor activities [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Occupations may differ in terms of the amount near the visual task involved. In this study, students had a higher prevalence of myopia than others, while executives, senior officials and managers had the lowest prevalence. Unlike students who must read large volumes of text books to make academic progress, senior officials and executive workers may play more of a supervisory role at work. Additionally, these groups of workers are usually aged 40 and above, unlike students. Therefore, another reason for the observed difference could be the effect of age on the prevalence of myopia [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study evaluated the effect of demographic risk factors on myopia. From the results, students and workers categorised under armed forces, craft-related work, agriculture, services, technicians, professionals, and the unemployed had higher odds of increased myopia prevalence. Occupational risk for myopia could be explained by the level of near and outdoor visual tasks involved [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Although the unemployed group was not technically involved with any work, their higher risk for myopia could be due to their previous activities, such as schooling or a greater leisure time, which increased their chances of watching TV or playing games. Additionally, the Ewe and Ga-Adangbe ethnic groups of Ghana were also at risk for increased myopia \u0026ndash; the first of such a study in Ghana. However, due to the limitation imposed by the study setting, further population-based studies are required to further examine ethnic risk factors for myopia in Ghana on a national scale.\u003c/p\u003e \u003cp\u003eOn the other hand, urban and suburban settlements as well as ages 40\u0026ndash;49 years, 50\u0026ndash;59 years, and 60\u0026ndash;69 years were all protective factors for myopia, similar to other reports on age [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and urbanisation (the prevalence of myopia was significantly lower in those aged 40\u0026ndash;69 years). Despite the significantly higher prevalence of myopia among urban dwellers in this study, urbanisation was not a risk factor for myopia, which corroborates another study [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Regarding age, other studies also reported that age 40 years and above may be protective against myopia [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent times, myopia control has garnered much popularity due to convincing evidence about the increasing prevalence of myopia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], which is associated with an increased risk for permanent visual impairment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These factors have triggered studies into the slowing of myopia progression via therapies including overnight orthokeratology, atropine, myopia control spectacles, dual defocus contact lenses, and multifocal contact lenses [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Despite the various myopia control options, this study shows that conventional spectacles remain the mainstay management option for myopia in Ghana. This is consistent with the recent report of a survey on eye care practitioners across Africa in which clinicians were less abreast of the current compelling evidence on myopia control [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Therefore, a roll-out of continuing professional development courses on the recent advances in myopia control strategies for optometrists in Ghana is highly recommended.\u003c/p\u003e \u003cp\u003eFurthermore, this study noted that refraction was very effective at reducing the burden of myopia-related visual impairment burden. For instance, between 30 and 98.6% of both the right and left eyes that were initially classified as having moderate to blind visual impairment improved after refraction. Given that an overwhelming majority of the patients received spectacle correction and had a significant reduction in visual impairment, then by extending appropriate refractive services, the burden of myopic visual impairment in underdeveloped countries can be reduced drastically [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Spectacles are relatively more affordable than other means of myopia management. Therefore, programs aimed at reducing the global burden of reversible visual impairment attributable to myopia in underdeveloped countries must focus on training more optometrists.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe large size and diversity of the sample study sample is a considerable strength of this study, which makes the findings generalisable to the epidemiological profile of myopia in a hospital population and, to some extent, the general population. Nonetheless, this study has some limitations. First, as a hospital-based study, caution must be exercised in an attempt to extrapolate the findings to the general population due to the risk of overestimation. Second, the urban nature of the study setting skewed its accessibility to mostly urban and suburban dwellers relative to rural inhabitants. Notwithstanding the inherent challenges, the large sample size of this study and the inclusion of all the major ethnic groups in Ghana provided a somewhat reasonable estimation.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eWe conclude that myopia is the most common form of refractive error among patients seeking eyecare services in Ghana. Ewe and Ga-Adangbe ethnic groups as well as specific occupations, including students, are demographic risk factors for myopia among clinical populations in Ghana.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no competing interest and have no proprietary interest in any of the materials mentioned in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to Richard Quainoo for his assistance in the collection of the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualisation: SK. Study design: S.K., R.K.G., J.B.A., E.Z. Data acquisition: R.K.G, A.A., E.Z., F.A. Data analysis: J.B.A, A.N. Data interpretation: S.K, R.K.G., J.B.A., E.Z., A.N., K.A. S.B.B-K., B.O-A., F.A., A.A. Supervision: S.K., E.Z., A.N., K.A. S.B.B-K., B.O-A. \u0026nbsp; \u0026nbsp; \u0026nbsp; Writing-Original draft: S.K., J. B. A. Writing-Review and editing: S.K, R.K.G., J.B.A., E.Z., A.N., K.A. S.B.B-K., B.O-A., F.A., A.A.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWong, T. Y., Ferreira, A., Hughes, R., Carter, G., \u0026amp; Mitchell, P. (2014). Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: an evidence-based systematic review. \u003cem\u003eAmerican journal of ophthalmology\u003c/em\u003e, \u003cem\u003e157\u003c/em\u003e(1), 9-25.\u003c/li\u003e\n\u003cli\u003eMorgan, I. G., Ohno-Matsui, K., \u0026amp; Saw, S. M. (2012). 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Prevalence of myopia in adults: implications for refractive surgeons. \u003cem\u003eJournal of Refractive Surgery\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(3), 229-234.\u003c/li\u003e\n\u003cli\u003eTheophanous, C., Modjtahedi, B. S., Batech, M., Marlin, D. S., Luong, T. Q., \u0026amp; Fong, D. S. (2018). Myopia prevalence and risk factors in children. \u003cem\u003eClinical ophthalmology\u003c/em\u003e, 1581-1587.\u003c/li\u003e\n\u003cli\u003eMutti, D. O., \u0026amp; Zadnik, K. (2000). Age-related decreases in the prevalence of myopia: longitudinal change or cohort effect?. \u003cem\u003eInvestigative ophthalmology \u0026amp; visual science\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(8), 2103-2107.\u003c/li\u003e\n\u003cli\u003eHemenger, R. P., Garner, L. F., \u0026amp; Ooi, C. S. (1995). Change with age of the refractive index gradient of the human ocular lens. \u003cem\u003eInvestigative ophthalmology \u0026amp; visual science\u003c/em\u003e, \u003cem\u003e36\u003c/em\u003e(3), 703-707.\u003c/li\u003e\n\u003cli\u003eEllingsen, K. L., Nizam, A., Ellingsen, B. A., \u0026amp; Lynn, M. J. (1997). Age-related refractive shifts in simple myopia. \u003cem\u003eJournal of Refractive Surgery\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(3), 223-228.\u003c/li\u003e\n\u003cli\u003eZadnik, K., Manny, R. E., Yu, J. A., Mitchell, G. L., Cotter, S. A., Quiralte, J. C., ... \u0026amp; Mutti, D. O. (2003). Ocular component data in schoolchildren as a function of age and gender. \u003cem\u003eOptometry and Vision Science\u003c/em\u003e, \u003cem\u003e80\u003c/em\u003e(3), 226-236.\u003c/li\u003e\n\u003cli\u003eSaxena, R., Vashist, P., Tandon, R., Pandey, R. M., Bhardawaj, A., Menon, V., \u0026amp; Mani, K. (2015). Prevalence of myopia and its risk factors in urban school children in Delhi: the North India Myopia Study (NIM Study). \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(2), e0117349.\u003c/li\u003e\n\u003cli\u003eKempf GA, Jarman BL, Collins SD. A special study of the vision of school children. \u003cem\u003ePublic Health\u003c/em\u003e Rep. 1928; 43(27); 1713-1739.\u003c/li\u003e\n\u003cli\u003eKempf, G. A., Jarman, B. L., \u0026amp; Collins, S. D. (1928). A special study of the vision of school children. \u003cem\u003ePublic Health Reports (1896-1970)\u003c/em\u003e, 1713-1739.\u003c/li\u003e\n\u003cli\u003eWu, H. M., Seet, B., Yap, E. P. H., Saw, S. M., Lim, T. H., \u0026amp; Chia, K. S. (2001). Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore. \u003cem\u003eOptometry and vision science\u003c/em\u003e, \u003cem\u003e78\u003c/em\u003e(4), 234-239.\u003c/li\u003e\n\u003cli\u003eJones, L. A., Sinnott, L. T., Mutti, D. O., Mitchell, G. L., Moeschberger, M. L., \u0026amp; Zadnik, K. (2007). Parental history of myopia, sports and outdoor activities, and future myopia. \u003cem\u003eInvestigative ophthalmology \u0026amp; visual science\u003c/em\u003e, \u003cem\u003e48\u003c/em\u003e(8), 3524-3532.\u003c/li\u003e\n\u003cli\u003eMutti, D. O., Mitchell, G. L., Moeschberger, M. L., Jones, L. A., \u0026amp; Zadnik, K. (2002). Parental myopia, near work, school achievement, and children\u0026rsquo;s refractive error. \u003cem\u003eInvestigative ophthalmology \u0026amp; visual science\u003c/em\u003e, \u003cem\u003e43\u003c/em\u003e(12), 3633-3640.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Donoghue, L., Kapetanankis, V. V., McClelland, J. F., Logan, N. S., Owen, C. G., Saunders, K. J., \u0026amp; Rudnicka, A. R. (2015). Risk factors for childhood myopia: findings from the NICER study. \u003cem\u003eInvestigative ophthalmology \u0026amp; visual science\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(3), 1524-1530.\u003c/li\u003e\n\u003cli\u003eHuang, J., Wen, D., Wang, Q., McAlinden, C., Flitcroft, I., Chen, H., ... \u0026amp; Qu, J. (2016). Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. \u003cem\u003eOphthalmology\u003c/em\u003e, \u003cem\u003e123\u003c/em\u003e(4), 697-708.\u003c/li\u003e\n\u003cli\u003eNti, A. N., Owusu-Afriyie, B., Osuagwu, U. L., Kyei, S., Ovenseri-Ogbomo, G., Ogbuehi, K. C., ... \u0026amp; Naidoo, K. S. (2023). Trends in myopia management attitudes and strategies in clinical practice: Survey of eye care practitioners in Africa. \u003cem\u003eContact Lens and Anterior Eye\u003c/em\u003e, \u003cem\u003e46\u003c/em\u003e(1), 101597.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of the study participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePresence of Myopia\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;7021 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;8786 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e271 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e228 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e991 (14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e656 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1257 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e854 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1293 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1250 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e886 (12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2183 (24.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e645 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1828 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e813 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1278 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e865 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e509 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3605 (51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4437 (50.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3416 (48.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4349 (49.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthnic groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e269 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e362 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMole-Dagbon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e867 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1222 (13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAkan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3159 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4502 (51.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEwe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e651 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e575 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGa-Adangbe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2075 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2121 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLegislators, Senior officials, and Managers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e953 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1043 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1613 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTechnicians and Associate Professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e262 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClerks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e526 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eService and Shop and market sales workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1157 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e440 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSkilled Agricultural and fishery workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e284 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCraft and related trades workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e382 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e458 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlant and machine operators and assemblers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e182 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary occupations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1595 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArmed forces\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e207 (2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1809 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1237 (14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1650 (23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1258 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArea of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5792 (82.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8104 (92.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSuburban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1020 (14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e626 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e209 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of myopia and high myopia according to various age groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber (n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMyopia\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;5888 (37.2%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh myopia\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;1133 (7.2%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e221 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e832 (14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1074 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1103 (18.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e788 (13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e541 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e637 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e176 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e865\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e692 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparative proportions of visual impairment before and after refractive correction\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber (n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMild VI\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate VI\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSevere VI\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBlind\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRight Eyes entrance vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e796 (11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1437 (20.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e327 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e592 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRight Eyes best-corrected VA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e723 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20 (0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e413 (5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProportion with improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1417 (98.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e253 (77.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e179 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeft eyes entrance vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e724 (10.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1439 (20.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e334 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e631 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeft eyes best-corrected VA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e318 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e454 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62 (0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e398 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProportion with improvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e406 (54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e985 (68.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e272 (81.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e233 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate age-adjusted analysis of the demographic risk factors for myopia\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRisk factors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.20 (0.96\u0026ndash;1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.26 (0.94\u0026ndash;1.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94 (0.64\u0026ndash;1.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40 (0.25\u0026ndash;0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36 (0.19\u0026ndash;0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u0026ndash;69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33 (0.17\u0026ndash;0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.75 (0.33\u0026ndash;1.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93 (0.87\u0026ndash;1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLegislators, senior officials and managers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProfessionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.93 (2.44\u0026ndash;3.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTechnicians and associate professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.71 (5.15\u0026ndash;8.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClerks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.10(0.81\u0026ndash;1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eService and shop and market sales workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.74 (9.62\u0026ndash;14.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgricultural and fishery workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.88 (1.41\u0026ndash;2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCraft and related trade workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.41 (2.75\u0026ndash;4.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePlant and machine operators and assemblers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.68 (0.43\u0026ndash;1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21 (0.15\u0026ndash;0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArmed forces\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.26(7.54\u0026ndash;13.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.49 (2.76\u0026ndash;4.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.64 (5.44\u0026ndash; 8.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthnic groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGuan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMole-Dagbon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98 (0.80\u0026ndash;1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.876\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAkan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99 (0.82\u0026ndash;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.908\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEwe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.46 (1.17\u0026ndash;1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGa-Adangbe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.28 (1.05\u0026ndash;1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17 (0.12\u0026ndash;0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSuburban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36 (0.25\u0026ndash;0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Myopia, Demographic, Prevalence, Refractive error, Risk factor","lastPublishedDoi":"10.21203/rs.3.rs-3011391/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3011391/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo explore the epidemiology and demographic risk factors for myopia among a clinical sample.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn a hospital-based retrospective study, eligible subjects were grouped into either myopia or non-myopia. Demographic data, including age, sex, occupation, area of residence, region of residence, and ethnicity, were analysed. Other clinical information analysed included the degree of myopia and intervention provided for the myopia.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall, 15807 were enrolled, with 50.9% being males. The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD age of the patients was 42.81\u0026thinsp;\u0026plusmn;\u0026thinsp;18.99 years. A total of 44.4% of the patients were myopic. Age, type of ethnic group, occupation, and area of residence were associated with myopia. Demographic risk factors for myopia included occupations such as professionals (OR: 2.93; 95% CI: 2.44\u0026ndash;3.52), technicians and associated workers (OR: 6.71; 95% CI: 5.15\u0026ndash;8.74), service workers (OR: 11.74; 95% CI: 9.62\u0026ndash;14.33), skilled agriculture and fishery (OR: 1.88; 95% CI: 1.41\u0026ndash;2.50), craft workers (OR: 3.41; 95% CI: 2.75\u0026ndash;4.25), armed forces (OR: 10.26; 95% CI: 7.54\u0026ndash;13.97), students (OR: 3.49; 95% CI: 2.76\u0026ndash;4.42), the unemployed (OR: 6.64; 95% CI: 5.44\u0026ndash;8.11), as well as Ewe (OR: 1.46; 95% CI: 1.17\u0026ndash;1.82) and Ga-Adangbe (OR: 1.28; 95% CI: 1.05\u0026ndash;1.54) ethnicities.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMyopia is the most common presenting refractive error in eye care facilities in Ghana. Ewe and Ga-Adangbe ethnicities, and specific occupations are risk factors for myopia.\u003c/p\u003e","manuscriptTitle":"Epidemiology and demographic risk factors for myopia in Ghana: A 5-year retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-06 14:33:09","doi":"10.21203/rs.3.rs-3011391/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"28cabefa-8642-47d1-981c-1b1bad0330c4","owner":[],"postedDate":"June 6th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-14T00:39:24+00:00","versionOfRecord":{"articleIdentity":"rs-3011391","link":"https://doi.org/10.1007/s44155-024-00081-5","journal":{"identity":"discover-social-science-and-health","isVorOnly":false,"title":"Discover Social Science and Health"},"publishedOn":"2024-05-13 00:39:24","publishedOnDateReadable":"May 13th, 2024"},"versionCreatedAt":"2023-06-06 14:33:09","video":"","vorDoi":"10.1007/s44155-024-00081-5","vorDoiUrl":"https://doi.org/10.1007/s44155-024-00081-5","workflowStages":[]},"version":"v1","identity":"rs-3011391","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3011391","identity":"rs-3011391","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}