A prescription does not always become a pair of glasses a child actually wears.
At Teaching Hospital Jaffna in Sri Lanka’s Northern Province, researchers reviewed 253 schoolchildren with refractive errors and found a clear break in that care pathway. More than half of the children had previously been prescribed spectacles, but only one-third of those children were wearing them at the time of assessment. Effective refractive error coverage was 18.6%, suggesting that many children who had reached care were still not consistently receiving the benefit of correction.
That gap matters because pediatric refractive error care depends on more than detection. Once a child is identified, families still need clear information, affordable glasses, encouragement around wear, and follow-up when problems arise. Without those supports, even a correct prescription may not translate into clearer vision at school or at home.
What the Jaffna Data Showed
The Cureus paper examined schoolchildren ages 6 to 18 who attended the Ophthalmology Unit of Teaching Hospital Jaffna, the primary tertiary referral center for eye care in Sri Lanka’s Northern Province. All participants were enrolled in regular schooling, spoke Tamil, and had diagnosed refractive errors. Researchers collected information on visual acuity, refractive error patterns, spectacle use, family history, screen exposure, outdoor activity, and barriers to wearing prescribed correction.
Within this hospital sample, astigmatism was the most common refractive error pattern, affecting 46.6% of participants. Myopic astigmatism followed at 26.1%, and myopia accounted for 22.9%. Hyperopia and hyperopic astigmatism were less common, but they appeared in very small subgroups where percentages should be interpreted cautiously.
The setting is important for understanding the numbers. Children who arrive at a tertiary eye unit may have more noticeable symptoms, more complex needs, or more advanced concerns than children identified through a broad school or community survey. For that reason, the value of the report is not that it provides a general prevalence estimate for every child in Northern Sri Lanka. Its value is that it shows what can happen among children who have already entered the eye care system and may still be missing sustained correction.
The Point Where Care Breaks Down
The most practical finding was the distance between being prescribed spectacles and actually wearing them. Of the 253 children included, 141 had previously been prescribed spectacles, yet only 47 of those children were current users when assessed. In other words, many children had already passed through diagnosis and prescription but were not receiving effective correction in daily life.
That distinction is easy to underestimate. A clinic record may show that a refractive error was diagnosed and spectacles were prescribed, but those facts do not confirm that the child can see clearly in class, while reading, or during everyday activities. The care pathway only becomes meaningful when the recommended correction is accessible, understood, worn, and updated when needed.
Researchers reported that lack of information was the leading barrier to spectacle nonuse, accounting for 61.7% of reported reasons among children who were not wearing prescribed spectacles. Affordability was the next most common barrier at 21.3%, followed by dislike of spectacles, peer pressure, perceived limits in daily activities, and other reasons.
Those barriers point to two different but connected needs. Families need practical guidance about why glasses have been prescribed, when they should be worn, and why consistent correction can matter for a child’s visual development and school experience. At the same time, local systems need to consider whether children can realistically obtain, replace, and maintain spectacles over time.
Why Spectacle Use Needs Follow-Up
Children do not always explain blurred vision clearly. Some adapt to it, some avoid tasks, and others may not realize that what they see is different from what their classmates see. Even after glasses are prescribed, children may resist wearing them if the frames are uncomfortable, if they feel self-conscious, or if parents are unsure whether the prescription is truly necessary.
That is why follow-up should be treated as part of refractive error care rather than an optional extra. The question is not only whether a child was examined. It is whether the child received correction that is being used consistently enough to make a difference.
For school vision programs, this means screening must be connected to a reliable referral process. For clinics, it means asking families about wear habits and barriers instead of assuming that a prescription has solved the problem. For parents and caregivers, it means receiving information that is clear enough to act on, especially when a child does not complain about vision difficulty.
Amblyopia Findings Add Urgency, With Limits
The hospital sample also showed a high amblyopia burden. Amblyopia was present in 152 of the 253 children with refractive errors, or 60.1% of participants. The percentage was especially high among children with hyperopic astigmatism and hyperopia, although those groups included only five and six children, respectively.
Those details need careful interpretation. A tertiary hospital eye unit is more likely to see children with significant or referred vision concerns, so this amblyopia figure should not be treated as a community-wide estimate. The very small hyperopia and hyperopic astigmatism groups also limit how much can be concluded from those subtype percentages.
Even with those limitations, the finding reinforces the stakes of early and consistent correction. Uncorrected or inconsistently corrected refractive errors can contribute to avoidable visual problems during childhood, when timely intervention may matter most. The broader message is not that every population will show the same amblyopia rate, but that children with refractive errors need a care pathway that does not stop at identification.
From Screening to Actual Correction
Vision screening is often treated as the first major step in pediatric eye care, and it is an important one. Screening can help identify children who need a full examination, especially in school-age populations where vision problems may otherwise go unnoticed. The challenge is that screening alone does not improve vision unless it leads to completed referral, appropriate correction, and continued use.
The Jaffna findings make that gap visible. Some children had already been prescribed spectacles, yet many were not wearing them. That means the problem was not simply whether refractive error could be detected. The larger issue was whether the system around the child helped turn detection into usable correction.
A stronger pediatric vision pathway would look beyond the exam result and track whether each step is completed. Was the child who needed care actually examined? Were glasses prescribed? Did the family obtain them? Is the child wearing them? Are cost, comfort, understanding, or stigma getting in the way? Those follow-up questions help move care from documentation to impact.
Affordability and Education Belong in the Care Conversation
When lack of information and affordability are the leading reasons children do not wear prescribed glasses, the solution cannot rest only with the prescription itself. Families may leave an eye care visit without fully understanding whether glasses should be worn all day, during school, for reading, or whenever symptoms appear. They may also be unsure whether inconsistent wear could affect the child’s vision over time.
Cost adds another layer. Children may need frames adjusted, lenses replaced, or prescriptions updated as they grow. A pair of glasses that is difficult to afford once may be even harder to maintain over several years, especially if breakage or replacement becomes necessary.
These practical issues are often treated as separate from clinical care, but for children they determine whether care actually works. A refractive error can be diagnosed accurately and still remain effectively uncorrected if the family cannot obtain the glasses or does not understand how important they are.
The authors’ conclusion reflects this need for a fuller pathway. They call for stronger screening systems, better awareness of spectacle compliance, and improved access to affordable eye care services for children in Northern Sri Lanka.
What Pediatric Vision Teams Can Take From This
For eye care professionals, schools, and public health teams, the strongest takeaway is that pediatric refractive error programs should be evaluated beyond the point of diagnosis. A child who receives a prescription still needs support that makes wearing glasses possible and acceptable in everyday life.
That support may include clearer parent education, practical counseling about when and why spectacles should be worn, school-based reinforcement, affordability programs, and follow-up systems that identify children who fall out of care. Different communities will need different solutions, but the underlying goal is the same: close the gap between finding the problem and helping the child see clearly.
The Cureus paper also points to the need for broader research. Because the Jaffna report was based in a tertiary hospital setting, larger community-based and multicenter studies would be needed to understand the wider population burden and to guide national childhood eye health planning.
For now, the message is practical and immediate. Pediatric refractive error care should not be measured only by screenings completed or prescriptions written. The more meaningful measure is whether children end up with correction they can use, understand, and continue wearing.
External Source
Muthusamy M, Jeyaratnam T, Thirunavukarasu K, Kumaran S, Uruthirakumar P, Kanmanirajah J, Kumutharanjan A. A Descriptive Study of the Pattern of Refractive Errors, Amblyopia Burden, and Effective Refractive Error Coverage Among Children Attending a Tertiary Hospital in Northern Sri Lanka. Cureus. Published August 5, 2026. https://doi.org/10.7759/cureus.114006
