Rural-urban differences in myopia prevalence among myopes presenting to Bhutanese retinal clinical services: a 3-year national study.

Abstract

To determine the prevalence and demographic characteristics of myopia among patients presenting to the national vitreo-retinal (VR) services in Bhutan. The records of the VR clinic at the apex national referral centre, providing the only VR services in the country, were reviewed to identify all new myopia patients over three years. Thus, we surveyed all referrals nationally. The patients were categorised into urban and rural females and males. We assessed myopia prevalence in each group by occupational and educational categories. We examined univariate prevalence data and a multivariate logistic regression (MLR) identified independent factors. Of 2913 cases 1544 (53.0%) were males. Females presented earlier (mean ±SD): overall 45.7 ± 21.9 cf. 48.6 ± 21.6 years, p = 0.003, and among myopes 23.9 ± 13.5 cf. 27.6 ± 18.6 years, p = 0.032. Myopia constituted 92.1% of refractive error, an overall prevalence of 12.3%. Myopia was more common among females (p = 0.01) and urbanites (p = 0.02). Myopia prevalence was highest among urban females (20.9%), followed by urban males (11.9%), rural females (6.8%), and rural males (5.2%). Logistic regression revealed that the odds of having myopia were increased by being a student (4.96 ×) or professional (1.96 ×), and decreased by rural living (1.75 ×), all p ≤ 0.038. This is the first study on myopia in Bhutan. As observed throughout East and Southeast Asia, the prevalence of myopia was higher in females and urbanites and positively associated with formal education. Given known risk factors, these prevalences may be driven by educational pressures and reduced time spent outdoors.