Purpose: To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city . Design: Populationbased, cross-sectional survey. Participants: Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households . Methods: Random selection of geographically de-fined clusters was used to ide ntify the study sample. Children in 34 clusters were enumerated through a door- to-door survey and examined in 140 schools between March and July 2003. The exa mination included visual acuity measurements; ocular motility evaluation; retino scopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus. Main Outcome Measures: Distance visual acu ity and cycloplegic refraction. Results: The examined population was 70.3%Malay , 16.5%Chinese, 8.9%Indian, and 4.3%of other ethnicity. The prevalence of unc orrected (unaided), presenting, and best-corrected visual impairment (visual ac uity ≤20/40 in the better eye) was 17.1%, 10.1%, and 1.4%, respectively. Mor e than half of those in need of corrective spectacles were without them. In eyes with reduced vision, refractive error was the cause in 87.0%, amblyopia in 2.0 %, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected am blyopia. Myopia (spherical equivalent of at least-0.50 diopter [D] in either ey e) measured with retinoscopy was present in 9.8%of children 7 years of age, inc reasing to 34.4%in 15-year-olds; and in 10.0%and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, higher parental education, and Chinese ethnicity. Hyperopia (< 2.00 D) with reti noscopy varied from 3.8%in 7-year-olds, 5.0%with autorefraction, to less tha n 1%by age 15, with either measurement method. Hyperopia was associatedwith you nger age and “other”ethnicity. Astigmatism (< 0.75 D) was present in 15.7%of children with retinoscopy and in 21.3%with autorefraction. Conclusions: Visual impairment in school-age children in urban Gombak District is overwhelmingly ca used by myopia, with a particularly high prevalence among children of Chinese et hnicity. Eye health education and screening may help address the unmet need for refractive correction. Purpose: To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city. Design: Populationbased, cross-sectional survey. Participants: Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households. Methods: Random selection of geographically de-fined clusters was used to ide ntify the study sample. Children in 34 clusters were enumerated through a door- to-door survey and examined in 140 schools between March and July 2003. The exa mination included visual acuity measurements; ocular motility evaluation; retino scopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus. Main Outcome Measures: Distance visual acuity and cycloplegic refraction. : The examined population was 70.3% Malay, 16.5% Chinese, 8.9% Indian, and 4.3% of other ethnicity. The prevalence of unc orrected (unaided), presenting, and best-co Morre than half of those in need of corrective spectacles were without them. In eyes with reduced vision, visual acuity ≤20 / 40 in the better eye was 17.1%, 10.1%, and 1.4% refractive error was the cause in 87.0%, amblyopia in 2.0%, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected am blyopia. Myopia (spherical equivalent of at least-0.50 diopter [D] in either ey e) measured with retinoscopy was present in 9.8% of children 7 years of age, inc reased to 34.4% in 15-year-olds; and in 10.0% and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, Hyperopia (<2.00 D) with reti noscopy varied from 3.8% in 7-year-olds, 5.0% with autorefraction, to less tha n 1% by age 15, with either measurement method. Hyperopia was associated with you age and “other” ethnicity. Astigmatism (<0.75 D) was present in 15.7% of children with retinosco py andin 21.3% with autorefraction. Conclusions: Visual impairment in school-age children in urban Gombak District is overwhelmingly ca used by myopia, with a particularly high prevalence of children of Chinese et hnicity. Eye health education and screening may help address the unmet need for refractive correction.