Background The prevalence of myopia has increased in recent years, with changes being dynamic and uneven in different regions. The purpose of this study is to evaluate the prevalence of visual impairment caused by myopia in Bulgarian school children, associated risk factors, and health care coverage. Methods A cross-sectional study among 1401 children (mean age 10.38, standard deviation 2.70) is conducted in three locations in Bulgaria from 2016 to 2020. Refractive error is measured with an auto-refractor in the absence of cycloplegia, the visual acuity is assessed without refractive error correction. A paper-based preliminary questionnaire is used to collect data on previous eye examinations, prescribed optical vision correction, regularity of wearing corrective glasses and risk factors. Results Children with myopic objective refraction ≤ -0.75 D and decimal visual acuity ≤ 0.8 on at least one of the eyes are 236 out of 1401 or 16.85%. The prevalence of myopia varies depending on age, geographical location, and school profile. The rate of myopic children in age group 6–10 is 14.2% compared to 19.9% in age group 11–15. The prevalence of myopic children in the urban populations is 31.4% (capital) and 19.9% (medium-sized town) respectively, and only 8.4% in the rural population. Our results show 53% increase of the prevalence of myopia in the age group 11–15 compared to a 2009 report. The analysis of data associated with health care coverage factors of all myopic pupils shows that 71.6% had a previous eye examination, 43.2% have prescription for corrective glasses, 27.5% wear their glasses regularly. Risk factors for higher odds of myopia are gender (female), age (adolescence), and parents with impaired vision. Residence in a small town and daily sport activities correspond to lower odds for myopia. The screen time (time in front of the screen calculated in hours per day) is self-reported and is not associated with increased odds of myopia when accounted for the other risk factors. Conclusions The prevalence of myopia in this study is higher compared to previous studies in Bulgaria. Additional studies would be helpful in planning adequate prevention and vision care.

The study presents the organization and implementation of vision screening in the primary school “Bacho Kiro”, Veliko Tarnovo. Screening is used as a tool of identifying so far unrecognized eye problems that affect children's vision, and with it, the opportunity for quality training and comprehensive education, as well as future professional guidance. At the same time it was carried out as a practice of students from the specialty “Optometry”, at the Physical Faculty of Sofia University “St. Kliment Ohridski”, as well as a STEAM-based approach, part of the training of pupils in the natural sciences. As a result of the event, an opportunity was provided to take timely measures for the prevention of eye health, for full neuropsychological development, educational progress and adequate professional guidance in the future.

Within 3-days-program almost 200 children and 50 adults had their vision checked by an international qualified team of eye specialists in the local school in Sapareva Banya. Visual acuity, objective and subjective refraction, color perception, binocular vision, cover test, pupillary reaction and other tests were performed. Apart from the ophthalmic examination, all the patients’ parents also filled in questionnaire regarding visual strain regimen, previous eye doctor visits and other details. The aim was to promote visual health, establish and possibly treat refractive errors and amblyopia, to facilitate access to specialized medical care, optical and optometrist’s service for children’s population of remote municipalities with population under 10 000 people. The visual screening of Sapareva Banya school children was of great value because only 38% of children had been examined before. There were no major deviations, severe anisometropia and ametropia values or very low visual acuity patients not wearing optical correction. A surprisingly high incidence of color vision deficiency was found 9, 2% males and 4, 3 % females.

Background: The prevalence of myopia has increased in recent years, with changes being dynamic and uneven in different regions. The purpose of this study is to evaluate the prevalence of visual impairment caused by myopia in Bulgarian school children, associated risk factors, and health care coverage.Methods: A cross-sectional study among 1401 children (mean age 10.38, standard deviation 2.70) is conducted in three locations in Bulgaria from 2016 to 2020. Refractive error is measured with an auto-refractor in the absence of cycloplegia, the visual acuity is assessed without refractive error correction. A paper-based preliminary questionnaire is used to collect data on previous eye examinations, prescribed optical vision correction, regularity of wearing corrective glasses and risk factors.Results: Children with myopic objective refraction ≤ -0.75 D and decimal VA≤0.8 on at least one of the eyes are 236 out of 1401 or 16.85%. The prevalence of myopia varies depending on age, geographical location, and school profile. The rate of myopic children at primary schools is 14.3% compared to 19.9% at secondary schools. The prevalence of myopic children in Sofia (the capital) is 31.4% compared to 19.9% in Veliko Tarnovo (medium-sized town) and 8.4% in Devnya (small town). Only 8.8% are the myopic children in the sport school. The health care coverage of all myopic pupils shows that 71.6% have a previous eye examination, 43.2% have prescribed corrective glasses, 27.5% wear their glasses regularly. Risk factors for higher odds of myopia are gender (female), age (adolescence), and parents with impaired vision. Residence in a small town and daily sport activities correspond to lower odds for myopia. The screen time (time in front of the screen calculated in hours per day) is self-reported and is not associated with increased odds of myopia when accounted for the other risk factors.Conclusions: The prevalence of myopia in this study is higher compared to previous studies in Bulgaria. The reported low levels of health care coverage indicate the need to update health policies and improve awareness of the issues of all stakeholders.