Open AccessThe prevalence, distribution and demographic associations of refractive error in three communities in Cape Town, South Africa were assessed. In this cross-sectional study, a clustered random sampling procedure was used to recruit participants (n=176; age=40.6±14.7 years; males=76, females=96) from Khayelitsha, Milnerton, and Mitchell’s Plain. From March to May 2010, participants underwent autore-fraction and subjective refraction eye examinations.A structured interview was used to collect data on sociodemographics, age, gender, level of education, employment and race. Participants younger than 15 years, non-residents, or residents for less than six months, who declined signing the informed consent forms were excluded from the study. In this study myopia was defined as the spherical equivalent value in the better eye of −1.00D or worse and hyperopia as the spherical equivalent value in the better eye of ≥1.00D. Astigmatism was defined as −0.50 cylinder or worse in the better eye. The prevalence of myopia was 17.4% with a 90% confidence interval (CI) of 12.65-22.15, hyperopia was 13.4% (90% CI 9.13-17.67), and astigmatism was 60% (90% CI 53.86-66.14). Myopia was found to be significantly associated with race and age; while hyperopia was significantly associated with age, employment and race. The results of this study may assist in planning for eye care on district level. (S Afr Optom 2012 71(1) 32-38)