Introduction: Refractive error is the most common cause of visual impairment among the school children. The visual acuity screening has long been administered through the school health service in Malaysia. The objective of this study was to examine the status of refractive error in the school health screening from year 1990 to 2017. Methods: Every year an average of 1.2 million students were screened for refractive errors through school health service. Stu-dents with visual acuity reading of 6/9 or worst based on 6-meter Snellen chart ware referred for confirmation of refractive error. Secondary data on school visual acuity screening from the Health Informatics for the period of 1990 to 2017 were used to describe the changing pattern of refractive errors. Results: It was observed that the prevalent of suspected refractive errors amongst the Standard 1 student increased from 7 per 1,000 students examined in 1990 to 44.4 per 1,000 students in the 2000 and further increased to 74 per 1,000 students before slow decline to 55 per 1,000 students from year 2015 to 2017. A higher level of detection was observed for students in standard 6 and form 3 between the period of 1990 to 2009 (78/1,000 and 65/1,000 respectively) and further decline thereafter to lowest level in 2017 (33/1,000 to 21.5/1,000 respectively). Conclusion: The Standard 1 students in the 21st century have higher rate of suspected refractive errors compared to their counterpart that lived in the 20th century. Community awareness program need to be introduce for early detection of visual acuity problem.