Refractive errors, particularly myopia, are a common problem in industrialized countries, but the impression exists that myopia may be relatively uncommon in non-industrialized societies. We conducted a population-based survey of refractive error in two groups of Malawians: a group of rural agricultural workers (n = 510) and a group of students at an urban teachers' college (n = 534). The overall prevalence of myopia was low; 2.5% (95% confidence interval 1.3%, 3.7%) of participants had an error of -0.5 D or greater. The mean refractive error (right eye) in the urban student group was +0.52 D compared to +0.62 D among the rural agricultural workers and the excess myopia was accounted for by significant myopia (> or = -0.75 D) in a few individuals, rather than an overall shift towards myopia within the urban student group. Among the rural agricultural workers, literacy predicted refractive error (right eye), with a mean of +0.59 D in the rural literate compared to +0.67 D in the rural illiterate. These findings support the notion that myopia is uncommon in non-industrialized societies and that it is associated with increased literacy but we have not identified specific risk factors within this group to predict the occurrence of significant myopia. In settings such as Malawi, refractive services should be targeted to urban centers, where more educated populations are likely to be found.