Self-Reported Visual Clarity and Its Association with Refractive Error and Visual Acuity among Schoolchildren in Kuala Lumpur

Abstract

Objective: To determine the pattern of self-reported visual clarity across refractive error groups and examine its association with visual acuity among primary schoolchildren in Kuala Lumpur.Material and Methods: This retrospective cross-sectional study analysed the vision screening data from 10 primary schools in Kuala Lumpur. A total of 930 children aged 7–9 years with complete records were included. Extracted variables comprised self-reported visual clarity, monocular distance visual acuity, and subjective refraction findings. Refractive errors were classified as myopia, hyperopia, mixed astigmatism, or antimetropia, while children without refractive error were categorised as emmetropic. Associations between self-reported visual clarity, refractive error type, and visual acuity were examined using chi-square tests.Results: Myopia was the most prevalent refractive error (39.6%), followed by hyperopia (25.9%), mixed astigmatism (7.4%), and antimetropia (7.0%); 20.1% were emmetropic. Although 56.3% of children demonstrated suboptimal visual acuity, 71.6% reported clear vision. Self-reported visual clarity was significantly associated with refractive error overall (p-value=0.018), with a significant association observed for myopia (p-value<0.001). No significant associations were identified for hyperopia, mixed astigmatism, or antimetropia. Visual clarity was also significantly associated with visual acuity in both eyes (p-value<0.001), despite many children with reduced acuity reporting clear vision.Conclusion: A discrepancy exists between subjective visual clarity and objective visual acuity among schoolchildren, particularly those with myopia. Reliance on self-reported measures alone may contribute to under-detection of visual impairment. Incorporating objective visual assessments into school screening programmes is important for improving the early identification and management of refractive errors at the primary school level.