Association Between Refractive Errors and Positive Scoliosis Screening Results: A Cross-Sectional Study of 101,404 School-Aged Children

Purpose : This study aimed to assess the prevalence of positive scoliosis screening and its associated factors in a large cohort of school-aged children, with a focus on the role of different types and severities of refractive error as potential risk factors, and to analyze the modifying effect of corrective lenses. Methods : This cross-sectional study included 101,404 primary and secondary school students. Truncal asymmetry screening utilized the forward bend test and a scoliometer to measure the Angle of Trunk Rotation (ATR). A persistent ATR ≥ 5° was defined as a positive screening result. Refractive errors were diagnosed based on spherical equivalent (SE). Logistic regression and stratified analyses assessed associations between refractive errors and positive screening results. Results: The overall prevalence of a positive screening result was 2.89%. After adjusting for covariates, positive screenings were independently associated with mild-to-moderate myopia, high hyperopia, high astigmatism, and mild-to-moderate anisometropia (all P<.005).The stratified analysis revealed a dichotomy: in the subgroup of participants not wearing corrective lenses, myopia was a significant risk factor. However, this association was nullified in the subgroup wearing corrective lenses, whereas the associations with high hyperopia, high astigmatism, and anisometropia persisted regardless of lens use. Conclusion: Refractive error are significant factors associated with positive scoliosis screening. The association between myopia and truncal asymmetry can be corrected by wearing glasses, whereas the associations for other refractive errors may stem from common underlying etiological pathways. These findings support the integration of vision and spinal health screenings.