Objective To investigate the prevalence of refractive astigmatism (RA) and corneal astigmatism (CA) among children aged 3 to 14 years in Chengdu, Sichuan Province, China.

Methods Using a random sampling method, astigmatism screening data were collected from school-aged children attending 500 schools, including kindergartens, primary schools, and junior middle schools, located in three administrative districts of Chengdu in 2024. Basic demographic information and ocular biometric parameters measured by noncycloplegic autorefractometry and optical biometry were collected. Only data from the right eye were included in the analysis. The mean astigmatism values and the prevalence of astigmatism were compared across age groups to examine the differences.

Results A total of 255959 sschool-aged children and adolescents aged 3 to 14 years in Chengdu were included in the analyses. The mean RA was (－0.56 ± 0.59) diopters (D), and the mean CA was (－1.23 ± 0.62) D, with with-the-rule (WTR) astigmatism being the predominant subtype. The prevalence rates of RA (≤ −1.00 D) and CA (≤－1.00 D) were 18.16% and 62.29%, respectively. The magnitude and prevalence of astigmatism exhibited age-dependent trends (P < 0.001). In the group of children aged 3-8 years, both the magnitude and prevalence of RA and CA gradually decreased or remained stable with increasing age, whereas in the 9-to-14-year age group, both the magnitude and prevalence increased progressively with increasing age.

Conclusion Among school-aged children and adolescents aged 3 to 14 years in Chengdu, the magnitude and prevalence of RA and CA exhibited an age-dependent pattern characterized by an initial decrease or stabilization followed by a subsequent increase. The prevalence of astigmatism was found to be higher in primary and junior middle school students.