Overweight status and obesity accounted for more than 13% of high astigmatism cases among children aged 6 to 10 years.
Pediatric overweight and obesity may increase the risk for developing astigmatism, according to the results of a study published in the Canadian Journal of Ophthalmology
Overweight and obesity in childhood can have negative effects on metabolic and cardiovascular health. Some evidence suggests it may also have negative consequences for ocular development
Investigators from Hadassah-Hebrew University Medical Center and E Wolfson Medical Center analyzed data for this study from Maccabi Healthcare Services (MHS), which is the second largest health organization in Israel. Children (n=22,130) aged 6 to 10 years who underwent refractive assessment between 2012 and 2022 were evaluated for astigmatism at follow-up according to BMI. Astigmatism was defined as a mean deviation of 0.75 D or higher and weight status was defined using the United States (US) Centers for Disease Control and Prevention (CDC) percentiles.
Girls comprised 53.6% of the study population, the mean age was 8.4±1.1 years, and they had a BMI of 17.1±3.1 kg/m2. Overall, 1157 children were classified as underweight, 15,148 as normal weight, 2822 as overweight, and 3003 as obese
Given the higher prevalence of astigmatism among children with elevated BMI, closer ophthalmologic follow-up in this group may support earlier detection and correction of refractive error
At an average follow-up of 62.9 months, 30.9% of children had low to moderate astigmatism and 1.3% had high astigmatism, of whom 21.5% had against-the-rule (ATR), 7.9% had with-the-rule (WTR), and 2.8% had oblique astigmatism
Stratified by weight group, the children who were underweight, normal weight, overweight, and obese had low to moderate astigmatism rates of 30.7%, 29.8%, 32.1%, and 35.1% and high astigmatism rates of 0.7%, 1.1%, 1.6%, and 2.0% (P<.001), respectively. With increasing BMI, the prevalence of ATR increased (19.4% vs 20.1% vs 23.8% vs 27.2%) and WTR decreased (9.3% vs 8.0% vs 7.5% vs 7.1%) in the underweight, normal-weight, overweight, and obese groups (P<.001), respectively
Risk for low to moderate astigmatism associated with overweight (adjusted odds ratio [aOR], 1.104; 95% CI, 1.012-1.205; P=.026) and obesity (aOR, 1.236; 95% CI, 1.137-1.344; P<.001) and risk for high astigmatism associated with overweight (aOR, 1.404; 95% CI, 1.004-1.963; P=.048) and obesity (aOR, 1.761; 95% CI, 1.303-2.379; P<.001). In the astigmatism axis analysis, ATR was associated with overweight (aOR, 1.205; 95% CI, 1.093-1.329; P<.001) and obesity (aOR, 1.413; 95% CI, 1.289-1.550; P<.001).
Overall, with each one-unit increase in BMI, low to moderate (aOR, 1.024; 95% CI, 1.015-1.034; P <.001), high (aOR, 1.082; 95% CI, 1.049-1.226; P <.001), and ATR (aOR, 1.042; 95% CI, 1.031-1.053; P <.001) astigmatism risk was increased
“Overweight and obesity accounted for 4.3% of the low to moderate astigmatism cases and 13.4% of the high astigmatism cases. This study highlights childhood obesity as a factor associated with higher odds of astigmatism at follow-up, with implications for vision screening,” according to the research team. “Given the higher prevalence of astigmatism among children with elevated BMI, closer ophthalmologic follow-up in this group may support earlier detection and correction of refractive error.”
This study is limited by pooling ophthalmologic assessments performed by multiple clinicians and at differing follow-up times
Nitzan I, Carmon D, Spierer O. Childhood overweight and obesity as risk factors for astigmatism: a longitudinal analysis.Can J Ophthalmol. Published online July 2, 2026. doi:10.1016/j.jcjo.2026.05.019
