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REFRACTIVE ERRORS: EPIDEMIOLOGICAL PROFILE IN CHILDREN IN MADAGASCAR
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Aim
To report refractive error prevalence and visual impairment in Republic of Ireland (henceforth 'Ireland') schoolchildren.
Methods
The Ireland Eye Study examined 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), in Ireland between June 2016 and January 2018. Participating schools were selected by stratified random sampling, representing a mix of school type (primary/postprimary), location (urban/rural) and socioeconomic status (disadvantaged/advantaged). Examination included monocular logarithm of the minimum angle of resolution (logMAR) presenting visual acuity (with spectacles if worn) and cycloplegic autorefraction (1% Cyclopentolate Hydrochloride). Parents completed a questionnaire to ascertain participants’ lifestyle.
Results
The prevalence of myopia (spherical equivalent refraction (SER): ≤−0.50 D), hyperopia (SER: ≥+2.00 D) and astigmatism (≤−1.00 DC) among participants aged 6–7 years old was 3.3%, 25% and 19.2%, respectively, and among participants aged 12–13 years old was 19.9%, 8.9% and 15.9%, respectively. Astigmatic axes were predominately with-the-rule. The prevalence of ‘better eye’ presenting visual impairment (≥0.3 logMAR, with spectacles, if worn) was 3.7% among younger and 3.4% among older participants. Participants in minority groups (Traveller and non-white) were significantly more likely to present with presenting visual impairment in the ‘better eye’.
Conclusions
The Ireland Eye Study is the first population-based study to report on refractive error prevalence and visual impairment in Ireland. Myopia prevalence is similar to comparable studies of white European children, but the levels of presenting visual impairment are markedly higher than those reported for children living in Northern Ireland, suggesting barriers exist in accessing eye care.
Background: Vision problems have been shown to adversely affect a child’s achievement in school.
Aim: To determine the prevalence of refractive error and visual impairment in primary school children in Onitsha, Anambra State, Nigeria.
Setting: The study was conducted in a primary school in Onitsha, Anambra State, Nigeria.
Methods: A stratified random cluster sampling method was used to select primary school children aged between 5 and 15 years from grades 1 to 6 in primary schools in Onitsha North and South. A total of 1020 children in 102 clusters were enumerated and 998 (97.8%) were examined. The examination included visual acuity measurements, ocular motilities, retinoscopy and auto-refraction under cycloplegia, and examination of the anterior segment, media and fundae.
Results: The prevalence of uncorrected, presenting and best corrected visual acuity of 20/40 or worse in the better eye was 9.7%, 7.7% and 1.3%, respectively. Refractive error accounted for 86.6% of all causes of visual impairment. Myopia was the most prevalent refractive error (46.4%), followed by astigmatism (36.1%) and hyperopia (17.5%). Refractive error and visual impairment were significantly more prevalent in females than in males (p = 0.04). Refractive error was highest among children aged between 11 and 13 years, while visual impairment was greatest among children aged between 5 and 7 years.
Conclusion: The prevalence of refractive error and visual impairment among primary school children in Onitsha was relatively high, highlighting the need for services and strategies to address these conditions in that area.
Background
Uncorrected Refractive Error is one of the leading cause amblyopia that exposes children to poor school performance. It refrain them from productive working lives resulting in severe economic and social loses in their latter adulthood lives. The objective of the study was to assess the prevalence of uncorrected refractive error and its associated factors among school children in Debre Markos District.
Method
A cross section study design was employed. Four hundred thirty two students were randomly selected using a multistage stratified sampling technique. The data were collected by trained ophthalmic nurses through interview, structured questionnaires and physical examinations. Snellens visual acuity measurement chart was used to identify the visual acuity of students. Students with visual acuity less than 6/12 had undergone further examination using auto refractor and cross-checked using spherical and cylindrical lenses. The data were entered into epi data statistical software version 3.1 and analyzed by SPSS version 20. The statistical significance was set at α ≤ 0.05. Descriptive, bivariate and multivariate analyses were done using odds ratios with 95% confidence interval.
Result
Out of 432 students selected for the study, 420 (97.2%) were in the age group 7–15 years. The mean age was 12 ± 2.1SD. Overall prevalence of refractive error was 43 (10.2%). Myopia was found among the most dominant 5.47% followed by astigmatism 1.9% and hyperopia 1.4% in both sexes. Female sex (AOR: 3.96, 95% CI: 1.55-10.09), higher grade level (AOR: 4.82, 95% CI: 1.98-11.47) and using computers regularly (AOR: 4.53, 95% CI: 1.58-12.96) were significantly associated with refractive error.
Conclusion
The burden of uncorrected refractive errors is high among primary schools children. Myopia was common in both sexes. The potential risk factors were sex, regular use of computers and higher grade level of students. Hence, school health programs should work on health information dissemination and eye health care services provision.
Background: Refractive error is defined as the inability of the eye to bring parallel rays of light into focus on the retina, resulting in nearsightedness (myopia), farsightedness (Hyperopia) or astigmatism. Uncorrected refractive error in children is associated with increased morbidity and reduced educational opportunities. Vision screening (VS) is a method for identifying children with visual impairment or eye conditions likely to lead to visual impairment. Objective: To analyze the utility of vision screening conducted by teachers and to contribute to a better estimation of the prevalence of childhood refractive errors in Apurimac, Peru. Design: A pilot vision screening program in preschool (Group I) and elementary school children (Group II) was conducted with the participation of 26 trained teachers. Children whose visual acuity was
Vision screening study in primary school children has not been done in Bayelsa State. This study aims to screen for refractive error among primary school children in Bayelsa State and use the data to plan for school Eye Health Program.
A cross sectional study on screening for refractive error in school children was carried out in Yenagoa Local Government Area of Bayelsa State in June 2009. A multistage sampling technique was used to select the study population (pupils aged between 5-15 years). Visual acuity (VA) for each eye, was assessed outside the classroom at a distance of 6 meters. Those with VA ≤6/9 were presented with a pinhole and the test repeated. Funduscopy was done inside a poorly lit classroom. An improvement of the VA with pinhole was considered refractive error. Data was analyzed with EPI INFO version 6.
A total of 1,242 school children consisting of 658 females and 584 males were examined.About 97.7% of pupils had normal VA (VA of 6/6) while 56 eyes had VAs ≤ 6/9. Of these 56 eyes, the visual acuity in 49 eyes (87.5%) improved with pinhole. Twenty seven pupils had refractive error, giving a prevalence of 2.2%. Refractive error involved both eyes in 22 pupils (81.5%) and the 8-10 years age range had the highest proportion (40.7%) of cases of refractive error followed by the 9-13 year-old age range (37%).
The prevalence of refractive error was 2.2% and most eyes (97.7%) had normal vision.
Introduction:
The uncorrected refractive error is an important cause of childhood blindness and visual impairment.
Objective:
To study the patterns of refractive errors among the urban and rural school going children of Nepal.
Subjects and methods:
A total of 440 school children of urban and rural schools within the age range of 7-15 years were selected for this study using multi-stage randomization technique.
Results:
The overall prevalance of refractive error in school children was 19.8 %. The commonest refractive error among the students was myopia (59.8 %), followed by hypermetropia (31.0 %). The children of age group 12-15 years had the higher prevalence of myopia as compared to the younger counterparts (42.5 % vs 17.2 %). The prevalence of myopia was 15.5 % among the urban students as compared to 8.2 % among the rural ones (RR = 1.89, 95 % CI = 1.1-3.24). The hypermetropia was more common in urban students than in rural ones (6.4 %) vs 5.9 %, RR = 1.08 (95 % CI: 0.52-2.24).
Conclusion:
The prevalence of refractive error in the school children of Nepal is 19.8 %. The students from urban settings are more likely to have refractive error than their rural counterparts.
Two infant vision screening programmes on total populations in the Cambridge Health District have been designed to identify manifest strabismus and strabismogenic and amblyogenic refractive errors at 7-9 months of age. The first, completed, programme used the isotropic photorefractor with cycloplegia together with a standard orthoptic examination. The second, current, programme uses the VRP-1 isotropic videorefractor to identify infants with accommodative lags which are followed up by refraction under cycloplegia. Both programmes show good agreement between infants identified at screening and retinoscopic refractions at follow-up, showing that photo- and videorefraction (with or without cycloplegia) can be effective methods for screening for ametropia in infants and young children. In each programme 5-6% of infants showed abnormal levels of hyperopia (> or = 3.5 D in any meridian), less than 1% showed anisometropia > or = 1.5 D; very few infants (0.25%) showed -3D myopia or greater. Less than 1% showed manifest strabismus. Hyperopic and anisometropic children entered a randomised controlled trial of partial refractive correction. All children identified at screening, alongside appropriate control groups, are extensively followed up to age 4 years. The first programme has found that children who were hyperopic in infancy were 13 times more likely to become strabismic, and 6 times more likely to show measurable acuity deficits by 4 years, compared with controls. Wearing a partial spectacle correction reduced these risk ratios to 4:1 and 2.5:1 respectively. The impaired acuity can be attributed, in part, to meridional amblyopia resulting from persisting astigmatism. Both hyperopic and myopic infants showed refractive changes in the direction of emmetropia between 9 months and 4 years. Wearing a partial spectacle correction did not affect this process of emmetropisation, but does provide the possibility of reducing the incidence of common pre-school vision problems.
This cross sectional study was undertaken to identify the major causes of childhood severe visual impairment/blindness (SVI/BL) among students in schools for the blind in south eastern Nigeria with a view to offering treatment to those with remediable blindness.
142 students attending three schools for the blind in the study area were interviewed and examined using the World Health Organization programme for prevention of blindness (WHO/PBL) childhood blindness proforma.
By anatomical classification, the major causes of SVI/BL identified in the children (aged 15 years or less) were lesions of the lens (30.4%), corneal lesions (21.7%), whole globe lesions (mainly phthisis bulbi) (17.4%), and glaucoma/buphthalmos (10.9%). For the young adults (more than 15 years) these lesions accounted for 31.9%, 21.3%, 23.4%, and 8.5% of SVI/BL, respectively. For all the students, the commonest single diagnoses were cataract (23.5%) and corneal scarring (21.4%), of which 86.7% were caused by measles. By aetiological classification, childhood factors (38.6%) constituted the major cause of blindness: 37.0% in the children and 39.4% in the young adults. In 74.5% of all the students, blindness was considered avoidable.
A high proportion of childhood blindness in schools for the blind in south eastern Nigeria is avoidable. Development of paediatric ophthalmology in Nigeria to manage childhood cataract and glaucoma is advocated.
Purpose:
To identify risk factors for inadequately corrected refractive error in the United States.
Methods:
This cross-sectional study included 12,758 participants 12 years of age and older from the 2005 to 2008 National Health and Nutrition Examination Survey. The primary outcome was the proportion of individuals with inadequate refractive correction for whom refractive correction would result in a visual acuity of 20/40 or better. The primary predictor was race/ethnicity. Secondary predictors included age, sex, annual household income, education, insurance, type of refractive error, current corrective lens use, presenting and best corrected visual acuity, cataract surgery, glaucoma, and age-related macular degeneration.
Results:
Overall, 50.6% of subjects had a refractive error which was correctable to 20/40 or better with refraction. The percentage of subjects with correctable refractive error who were inadequately corrected was 11.7%. Odds of inadequate refractive correction were significantly greater in Mexican Americans and non-Hispanic blacks than in their non-Hispanic white counterparts in all age groups, with the greatest disparity in the 12- to 19-year-old group. Other risk factors associated with inadequate refractive correction in adults but not in teenagers included low annual household income, low education, and lack of health insurance.
Conclusions:
Racial disparities in refractive error correction were most pronounced in those under 20 years of age, as well as in adults with low annual household income, low education level, and lack of health insurance. Targeted efforts to provide culturally appropriate education, accessible vision screening, appropriate refractive correction, and routine follow-up to these medically underserved groups should be pursued as a public health strategy.
Purpose: To determine the prevalence of refractive errors among high school students.
Methods: In a cross-sectional study, we applied stratified cluster sampling on high
school students of Aligoudarz, Western Iran. Examinations included visual acuity,
non-cycloplegic refraction by autorefraction and fine tuning with retinoscopy. Myopia
and hyperopia were defined as spherical equivalent of -0.5/+0.5 diopter (D) or worse,
respectively; astigmatism was defined as cylindrical error >0.5 D and anisometropia
as an interocular difference in spherical equivalent exceeding 1 D.
Results: Of 451 selected students, 438 participated in the study (response rate, 97.0%). Data
from 434 subjects with mean age of 16±1.3 (range, 14 to 21) years including 212 (48.8%)
male subjects was analyzed. The prevalence of myopia, hyperopia and astigmatism was
29.3% [95% confidence interval (CI), 25-33.6%], 21.7% (95%CI, 17.8-25.5%), and 20.7%
(95%CI, 16.9-24.6%), respectively. The prevalence of myopia increased significantly with
age [odds ratio (OR)=1.30, P=0.003] and was higher among boys (OR=3.10, P<0.001).
The prevalence of hyperopia was significantly higher in girls (OR=0.49, P=0.003). The
prevalence of astigmatism was 25.9% in boys and 15.8% in girls (OR=2.13, P=0.002). The
overall prevalence of high myopia and high hyperopia were 0.5% and 1.2%, respectively.
The prevalence of with-the-rule, against-the-rule, and oblique astigmatism was 14.5%, 4.8%
and 1.4%, respectively. Overall, 4.6% (95%CI, 2.6-6.6%) of subjects were anisometropic.
Conclusion: More than half of high school students in Aligoudarz had at least one type
of refractive error. Compared to similar studies, the prevalence of refractive errors was
high in this age group.
Keywords: Myopia; Hyperopia; Astigmatism; High School Children; Prevalence; Cross-Sectional Study
Purpose
To study the prevalence of hyperopia in school-aged children and to analyze the factors that increase the risk of squint or amblyopia in a retrospective study.
Methods
Three hundred eyes of 150 children with hyperopia who did not have anisometropia ≥1.5 D were selected. Complete ophthalmological examination was performed for all children. Hyperopia was defined when spherical equivalent was +0.5 D or greater. Amblyopia was screened and treated by patching therapy and then penalisation. Complete spectacle correction was achieved in children with high hyperopia (+3.5 D or greater) or in presence of squint or amblyopia. A statistical analysis compared the results using the Mann-Whitney test and the chi square test.
Results
The mean age was 9.5±2.7 years. Girls were statistically more represented than boys. The mean sphere measured overall was +2 D (±1.65). Severe hyperopia was detected in 19% of the children; it was latent in 35% of children. Strabismus was detected in 7% and was accommodative in 25%. Esotropia was the most prevalent deviation (72.8%). The prevalence of amblyopia was 12%. The mean sphere measured in amblyopic children was 5.66 D (±1.64 D). Initial depth of amblyopia was mild to moderate and 98% of the children achieved iso-acuity after patching therapy. The correlation between severe hyperopia, amblyopia, and squint was statistically significant. Indeed, the risk ratios of squint and amblyopia, 5.2 and 3.70, respectively, were significantly high in children with severe hypermetropia. Complete spectacle correction improved final visual acuity and reduced the angle deviation in accommodative esotropia.
Conclusion
Children with hyperopia of +3.5 D or greater have an increased risk of amblyopia and squint that threatens their visual function. Hyperopic correction should be prescribed even if no strabismus or amblyopia is detected in order to prevent this risk. Screening programs should also be promoted to detect these children at an early age.
Untreated refractive errors represent the main visual impairment in the world but also the easiest to avoid. The goal of this survey is to use clinical and epidemiological data to efficiently plan distribution of corrective glasses in a project supported by the Swiss Red Cross in the central region of Togo. To achieve this goal, 66 primary schools were identified randomly in the catchment area of the project. The teachers at these schools were previously trained to test visual acuity (VA). The schoolchildren referred by these teachers were examined by eye care professionals. The schoolchildren with ametropia (VA≤7/10 in at least one eye) underwent cycloplegic autorefraction. Of a total of 19,252 registered schoolchildren, 13,039 underwent VA testing by the teachers (participation rate=68%). Among them, 366 cases of ametropia were identified (prevalence about 3%). The average age of the schoolchildren examined was 10.7±2.3years, with a sex ratio of 1.06. Autorefraction, which was performed for 37% of the schoolchildren with ametropia allowed them to be classified into three groups: hyperopia (4%), myopia (5%) and astigmatism of all types (91%). Regardless of the type of ametropia, the degree of severity was mild in 88%. The results of this survey have highlighted the importance of the teachers' contribution to eye care education in the struggle against refractive errors within the school environment, as well as helping to efficiently plan actions against ametropia.
Copyright © 2013 Elsevier Masson SAS. All rights reserved.
I. Sounouvou, S. Tchabi, C. Doutetien, F. Sonon, L. Yehouessi, S.K. Bassabi
Purpose:
Determine the epidemiologic aspects and the degree of severity of different refractive errors in primary schoolchildren.
Patients and methods
: A prospective and descriptive study was conducted from 1 December 2005 to 31 March 2006 on schoolchildren ranging from 4 to 16 years of age in a public primary school in Cotonou, Benin. The refraction was evaluated for any visual acuity lower than or equal to 0.7.
Results:
The study included 1057 schoolchildren. The average age of the study population was 8.5±2.6 years with a slight predominance of females (51.8%). The prevalence of refractive error was 10.6% and astigmatism accounted for the most frequent refractive anomaly (91.9%). Myopia and the hyperopia were associated with astigmatism in 29.4% and 16.1% of the cases, respectively. The age bracket from 6 to 11 years accounted for the majority of refractive errors (75.9%), without age and sex being risk factors (p=0.811 and p=0.321, respectively). The average vision of the ametropic eye was 0.61, with a clear predominance of slight refractive errors (89.3%) and particularly of low-level simple astigmatism (45.5%).
Conclusion:
The relatively low prevalence of refractive error observed does not obviate the need for implementing actions to improve the ocular health of schoolchildren.
Children's refraction and its progression are important because refractive errors can be precisely corrected. Some types of simple ametropia can generate reversible perturbations after optical correction and others are amblyogenic and strabogenic ametropia. Definition, epidemiology (frequency and risk factors), progression of refraction, evaluation and an optical correction method are described.
To assess the prevalence of refractive errors and vision impairment in school-age children in a suburban area (La Florida) of Santiago, Chile.
Random selection of geographically defined clusters was used to identify a representative sample of children 5 to 15 years of age. Children in the 26 selected clusters were enumerated through a door-to-door survey and invited to report to a community health clinic for examination. Visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and examination of the external eye, anterior segment, media, and fundus were done from April through August 1998. Independent replicate examinations of all children with reduced vision and a sample of those with normal vision were done for quality assurance monitoring in six clusters.
A total of 6,998 children from 3,830 households were enumerated, and 5,303 children (75.8%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.50 (20/40) or worse in at least one eye was 15.8%, 14.7%, and 7.4%, respectively; 3.3% had best visual acuity 0.50 or worse in both eyes. Refractive error was the cause in 56.3% of the 1,285 eyes with reduced vision, amblyopia in 6.5%, other causes in 4.3%, with unexplained causes in the remaining 32.9%. Myopia -0.50 diopter or less in either eye was present in 3.4% of 5-year-old children, increasing to 19.4% in males and 14.7% in females by age 15. Over this same age range, hyperopia 2.00 diopters or greater decreased from 22.7% to 7.1% in males and from 26.3% to 8.9% in females. Females had a significantly higher risk of hyperopia than males.
Refractive error, associated primarily with myopia, is a major cause of reduced vision in school-age children in La Florida. More than 7% of children could benefit from the provision of proper spectacles. Efforts are needed to make existing programs that provide free spectacles for school children more effective. Further studies are needed to determine whether the upward trend in myopia continues far beyond 15 years of age.
To assess the relationship of near, midworking distance, and outdoor activities with prevalence of myopia in school-aged children.
Cross-sectional study of 2 age samples from 51 Sydney schools, selected using a random cluster design.
One thousand seven hundred sixty-five 6-year-olds (year 1) and 2367 12-year-olds (year 7) participated in the Sydney Myopia Study from 2003 to 2005.
Children had a comprehensive eye examination, including cycloplegic refraction. Parents and children completed detailed questionnaires on activity.
Myopia prevalence and mean spherical equivalent (SE) in relation to patterns of near, midworking distance, and outdoor activities. Myopia was defined as SE refraction < or = -0.5 diopters (D).
Higher levels of outdoor activity (sport and leisure activities) were associated with more hyperopic refractions and lower myopia prevalence in the 12-year-old students. Students who combined high levels of near work with low levels of outdoor activity had the least hyperopic mean refraction (+0.27 D; 95% confidence interval [CI], 0.02-0.52), whereas students who combined low levels of near work with high levels of outdoor activity had the most hyperopic mean refraction (+0.56 D; 95% CI, 0.38-0.75). Significant protective associations with increased outdoor activity were seen for the lowest (P = 0.04) and middle (P = 0.02) tertiles of near-work activity. The lowest odds ratios for myopia, after adjusting for confounders, were found in groups reporting the highest levels of outdoor activity. There were no associations between indoor sport and myopia. No consistent associations between refraction and measures of activity were seen in the 6-year-old sample.
Higher levels of total time spent outdoors, rather than sport per se, were associated with less myopia and a more hyperopic mean refraction, after adjusting for near work, parental myopia, and ethnicity.
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