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Causes of visual impairment: a retrospective study in Macedonian children

  • June 2020
Authors:
Daniela Dimitrova-Radojichikj at Ss. Cyril and Methodius University in Skopje
Daniela Dimitrova-Radojichikj
Daniela Tasevska
Daniela Tasevska
Daniela Tasevska
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Background: Reliable data on the prevalence and causes of visual impairment in children are necessary for developing a systematic vision screening program with valid and reliable test protocols. Purpose: The aim of the study was to investigate the prevalence, main causes, and associated factors of visual impairment among Macedonian children aged 0-18 years. Methods: This retrospective study analyzed the clinical record of 829 children, attending the department of ophthalmology from October 2013 to October 2018. The following variables were investigated: age, gender, and diagnosis. Results: The prevalence of visual impairment was statistical significance higher in girls than in boys (p<0.05), with a male to female ratio of 1/1.2 . The most frequent diagnostics were refractive errors (42.6%), ocular inflammation (20.6%), and strabismus (9%). Conclusion: In our country, data on the prevalence, magnitude, and causes of visual impairment in children are needed for planning and evaluating preventive and curative services for children, and for planning special education and low vision services.
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ISSN 0030-0675. Journal of Ophthalmology (Ukraine) - 2020 - Number 3 (494)
29
Causes of visual impairment:
a retrospective study in Macedonian children
Daniela Dimitrova-Radojichikj, Daniela Tasevska
© Daniela Dimitrova-Radojichikj, Daniela Tasevska, 2020
University Ss. Cyril and
Methodius;
Skopje (N. Macedonia)
E-mail: daniela@fzf.ukim.edu.mk
Background: Reliable data on the prevalence and causes of visual impairment in children
are necessary for developing a systematic vision screening program with valid and reliable
test protocols.
Purpose: The aim of the study was to investigate the prevalence, main causes, and associated
factors of visual impairment among Macedonian children aged 0–18 years.
Methods: This retrospective study analyzed the clinical record of 829 children, attending the
department of ophthalmology from October 2013 to October 2018. The following variables
were investigated: age, gender, and diagnosis.
Results: The prevalence of visual impairment was statistical signicance higher in girls
than in boys (p<0.05), with a male to female ratio of 1/1.2 .The most frequent diagnostics
were refractive errors (42.6%), ocular inammation (20.6%), and strabismus (9%).
Conclusion: In our country, data on the prevalence, magnitude and causes of visual
impairment in children are needed for planning and evaluating preventive and curative
services for children, and for planning special education and low vision services.
Key words:
visual impairment, causes,
prevalence
Introduction. Global estimates indicate that there are
around 19 million visually impaired (VI) children world-
wide; of these, 1.4m are blind and 17.5m have low vision.
In a recent classication by the World Health Organization
(WHO), the major cause of worldwide vision impairment
was uncorrected refractive error, approximately 12.8 mil-
lion cases (67%) [1, 2]. The prevalence of childhood VI
vary between countries, ranges from 0.3 per thousand chil-
dren in the developed countries to 1.5 per thousand in the
developing countries [3].
In the global initiative “VISION 2020 The Right to
Sight,” childhood VI and refractive error are highlighted
as a priority area [4]. However, because of the require-
ment for additional resources and expertise, along with a
general lack of authentic prevalence information, visual
impairment among Macedonian children is currently not
a priority in the planning of eye care services. Therefore,
reliable data on the prevalence and causes of VI in children
are necessary for developing a systematic vision screening
program with valid and reliable test protocols. Such data
will help to direct the application of available resources
and eorts for early detection to people who are at risk,
thereby reducing the high short- and long-term costs to the
health system and society.
The aim of the study was to investigate the prevalence,
main causes, and associated factors of visual impairment
among Macedonian children aged 0–18 years.
Material and methods
This study was conducted at the Department of Oph-
thalmology in City General Hospital 8th September, Sko-
pje, N. Macedonia. The clinical record of 829 children,
aged 0-18 years, attending the department of ophthal-
mology from October 2013 to October 2018 were in-
cluded in the study. The study adhered to the Declaration
of Helsinki.
Data analysis was carried out using SPSS version 20.0
for Windows. The dierences in prevalence between age
and sex groups were analyzed using a χ2 test. A p-value
of <0.05 was considered signicant. Also, prevalence esti-
mates of visual impairment were expressed as percentages
with 95% condence interval.
Results and discussion
The sample was divided into three groups during the
analyses by combining the age range of 0-6 years for pre-
school children, than 7-14 years for elementary school
children and 15-18 years for high school children. Accord-
ing to Table 1, it is understood that the majority of the par-
ticipants are from the groups of “15-18 years” and “7-14
years”. The ratio of the participants in the age group of
0-6 years is 9.0%. Results from statistical analyses showed
that age was signicantly associated with VI, with partici-
pants in the 0-6 age group being less likely to have VI
compared to the other age groups. Also, data from other
studies suggest that VI had a linear relationship with in-
creasing age [5]. Comparing the sexes, the prevalence of
VI was statistical signicance higher in girls than in boys
(p<0.05), with a male to female ratio of 1/1.2.
In 829 participants, refractive errors were the leading
cause of VI, accounting for 42.6%, followed by ocular in-
ammation (20.6%), and strabismus (9%) (Table 2). With
regard to the causes of VI and sex, ocular inammation
was distributed evenly between female and male study
participants (20.4% versus 20.9%), whereas refractive er-
rors were found more often in girls than in boys (44.8%
ISSN 0030-0675. Journal of Ophthalmology (Ukraine) - 2020 - Number 3 (494)
30
versus 39.9%). We also found a dierence between the
sexes, with an around 76% higher prevalence of eye in-
jures in boys, this was statistically signicant (p<0.05).
Clinical evidence suggests that refractive errors are com-
mon ophthalmic disorders in children. Also, refractive
error was the most prevalent cause of VI in our sample,
accounting for 42.6% of the total. This nding is lower to
other population-based studies, which have reported rates
of 53% to 95.6% for VI caused by ametropia [6, 7].
Conclusion
In our country, data on the prevalence, magnitude, and
causes of visual impairment in children are needed for
planning and evaluating preventive and curative services
for children, and for planning special education and low
vision services.
Reference
1. Maritto SP, Global data on visual impairment 2010. Geneva:
World Health Organization; 2012. WHO/NMH/PBD/. [Ac-
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Sudan.pdf
Table 1. Distribution of participants by age and sex
Child characteristics Girls n (%) Boys n (%) All n (%; 95% CI)* p**
All participants 456 (55.0) 373 (45.0) 829 (100.0; 0.51-0.58) <.05
Age in years
0-6 40 (8.8) 35 (9.4) 75 (9.0; 0.41-0.61)
<.05
7-14 131 (28.7) 108 (29.0) 239 (28.8; 0.48-0.61)
15-18 285 (62.5) 230 (61.6) 515 (62.2; 0.50-0.59)
* Condence intervals (CIs)
** P
values were calculated by using χ2 test
Table 2. Causes of visual impairment by sex
Rank Causes Girls
n (%)
Boys
n (%)
All
n (%; 95% CI)* p**
1 Refractive errors 204 (44.8) 149 (39.9) 353 (42.6; 0.57-0.42) <.05
2Ocular inammation 93 (20.4) 78 (20.9) 171 (20.6; 0.54-0.45) >.05
3 Strabismus 53 (11.6) 29 (7.8) 82 (9.9; 0.64-0.35) >.05
4 Eye injuries 12 (2.6) 38 (10.2) 50 (6.0; 0.24-0.76) <.05
5 Macular degeneration 22 (4.8) 22 (5.9) 44 (5.3; 0.50-0.50) >.05
6 Retinal diseases 25 (5.5) 18 (4.8) 43 (5.2; 0.58-0.41) >.05
7 Computer vision syndrome 22 (4.8) 12 (3.2) 34 (4.1; 0.64-0.35) >.05
8 Other causes 7 (1.5) 11 (3.0) 18 (2.2; 0.38-0.61) >.05
9 Amblyopia 6 (1.3) 9 (2.4) 15 (1.8; 0.40-0.60) >.05
10 Optic nerve disorders 10 (2.3) 4 (1.1) 14 (1.7; 0.71-0.28) >.05
11 Nystagmus 2 (0.4) 3 (0.8) 5 (0.6; 0.40-0.60) >.05
Total 456 (55.0) 373 (45.0) 829 (100.0)
* Condence intervals (CIs)
** P
values were calculated by using χ2 test
2. World Health Organization. Visual Impairment and Blind-
ness (2014). [Accessed 15 Februari 2020]. Available at;
http://www.who.int/mediacentre/ factsheets/fs282/en/.
3. Awan AR, Jamshed J, Khan MM, Latif Z. Prevalence
and causes of visual impairment and blindness among
school children in Muzaarabad, Pakistan. Int J Sci Rep
2018;4(4):93-8.
4. Gilbert C, Foster A. Childhood blindness in the context of
VISION 2020—the right to sight. Bull World Health Organ.
2001;79(3):227–232. Epub 2003 Jul 7.
5. Aniza I, Azmawati M N, Jamsiah M, Idayu BI, Lynn
CM. Prevalence of visual acuity impairment and its associ-
ated factors among secondary school students in Beranang,
Selangor. Malaysian Journal of Public Health Medicine.
2012;12(1):39–44.
6. He M, Zeng J, Liu Y et al. Refractive error and visual im-
pairment in urban children in southern china. Invest Ophthal-
mol Vis Sci 2004;45:793–9.
7. Naidoo KS, Raghunandan A, Mashige KP et al. Refractive
error and visual impairment in African children in South
Africa. Invest Ophthalmol Vis Sci 2003;44:3764–70.
The author declare that the research was conducted in
the absence of any commercial or nancial relationships
that could be construed as a potential conict of interest.
ResearchGate has not been able to resolve any citations for this publication.
Prevalence and causes of visual impairment and blindness among school children in Muzaffarabad, Pakistan
Article
Full-text available
  • Mar 2018
p class="abstract"> Background: Vision loss in childhood has serious implications in all stages of child’s growth and development. It poses social, educational and occupational challenges, with affected children being at greater risk of developing behavioral, psychological and emotional problems, lower self-esteem and poorer social integration. The aim of this study was to assess the prevalence and identify the causes of visual impairment and blindness in school children of UC Gojra, Muzaffarabad, Pakistan so that prevention strategies could be implemented. Methods: This was a school-based descriptive cross-sectional study conducted among public and private schools. A multi-stage stratified random sampling technique was used for selecting study participants aged 5-20 years from 24 schools in Muzaffarabad. The vision of school children was examined for visual acuity using standard Snellen chart. Those participants who had visual acuity of <6/18 in either eye underwent a more detailed ophthalmic examination to diagnose the causes of VI. An exploration of demographic variables was conducted using Chi-square test. Results: The mean age of participants was 10±2.83. The prevalence of visual impairment was 19.6% and 2.3% for severe visual impairment. The age group most affected by VI was 11-15 years (74.2%). There were increased chances of developing VI with advancing age of the participants. Males contributed 88.7% of the cases of VI while females contributed only 11.3%. The class category 5-6 had higher percentage of VI cases (32.7%). Public schools contributed 52.8% of the cases of VI while for private schools the corresponding percentage was 47.2%. The leading cause of VI was refractive error (89.3%) followed by amblyopia (5.0%). Other causes of VI included cataract (1.2%), corneal disease (1.8%), strabismus (1.8%) and nystagmus (0.6%). Conclusions: There is a need to implement school health policy on visual screening prior to admissions in schools and annual eye screening program for early detection and prompt treatment of eye problems among school children in Muzaffarabad.</p
Childhood blindness in the context of VISION 2020 - The Right to Sight
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The major causes of blindness in children vary widely from region to region, being largely determined by socioeconomic development, and the availability of primary health care and eye care services. In high-income countries, lesions of the optic nerve and higher visual pathways predominate as the cause of blindness, while corneal scarring from measles, vitamin A deficiency, the use of harmful traditional eye remedies, and ophthalmia neonatorum are the major causes in low-income countries. Retinopathy of prematurity is an important cause in middle-income countries. Other significant causes in all countries are cataract, congenital abnormalities, and hereditary retinal dystrophies. It is estimated that, in almost half of the children who are blind today, the underlying cause could have been prevented, or the eye condition treated to preserve vision or restore sight. The control of blindness in children is a priority within the World Health Organization's VISION 2020 programme. Strategies need to be region specific, based on activities to prevent blindness in the community--through measles immunization, health education, and control of vitamin A deficiency--and the provision of tertiary-level eye care facilities for conditions that require specialist management.
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To assess the prevalence of refractive error and visual impairment in school-aged African children in South Africa. Random selection of geographically defined clusters was used to identify a sample of children 5 to 15 years of age in the Durban area. From January to August 2002, children in 35 clusters were enumerated through a door-to-door survey and examined in temporary facilities. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. In nine clusters, children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance. A total of 5599 children living in 2712 households were enumerated, and 4890 (87.3%) were examined. The prevalence of uncorrected, presenting, and best-corrected visual acuity of 20/40 or worse in the better eye was 1.4%, 1.2%, and 0.32%, respectively. Refractive error was the cause in 63.6% of the 191 eyes with reduced vision, amblyopia in 7.3%, retinal disorders in 9.9%, corneal opacity in 3.7%, other causes in 3.1%, and unexplained causes in the remaining 12.0%. Exterior and anterior segment abnormalities were observed in 528 (10.8%) children, mainly corneal and conjunctival. Myopia (at least -0.50 D) in one or both eyes was present in 2.9% of children when measured with retinoscopy and in 4.0% measured with autorefraction. Beginning with an upward trend at age 14, myopia prevalence with autorefraction reached 9.6% at age 15. Myopia was also associated with increased parental education. Hyperopia (+2.00 D or more) in at least one eye was present in 1.8% of children when measured with retinoscopy and in 2.6% measured with autorefraction, with no significant predictors of hyperopia risk. The prevalence of reduced vision is low in school-age African children, most of it because of uncorrected refractive error. The high prevalence of corneal and other anterior segment abnormalities is a reflection of the inadequacy of primary eye care services in this area.
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Article
Full-text available
To assess the prevalence of refractive error and visual impairment in school-age children in a metropolitan area of southern China. Random selection of geographically defined clusters was used to identify children 5 to 15 years of age in Guangzhou. Children in 22 clusters were enumerated through a door-to-door survey and examined in 71 schools and 19 community facilities from October 2002 to January 2003. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy, and autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus. A total of 5053 children living in 4814 households were enumerated, and 4364 (86.4%) were examined. The prevalence of uncorrected, presenting, and best-corrected visual acuity 20/40 or worse in the better eye was 22.3%, 10.3%, and 0.62%, respectively. Refractive error was the cause in 94.9% of the 2335 eyes with reduced vision, amblyopia in 1.9%, other causes in 0.4%, and unexplained causes in the remaining 2.8%. External and anterior segment abnormalities were seen in 1496 (34.3%) children, mainly minor conjunctival abnormalities. Media and fundus abnormalities were observed in 32 (0.73%) children. Myopia (spherical equivalent of at least -0.50 D in either eye) measured with retinoscopy affected 73.1% of children 15 years of age, 78.4% with autorefraction. The prevalence of myopia was 3.3% in 5-year-olds with retinoscopy and 5.7% with autorefraction. Females had a significantly higher risk of myopia. Hyperopia (+2.00 D or more) measured with retinoscopy was present in 16.7% of 5-year-olds, 17.0% with autorefraction. The prevalence of hyperopia was below 1% in 15-year-olds, with both methods. Astigmatism (cylinder of > or = 0.75 D) was present in 33.6% of children with retinoscopy and in 42.7% with autorefraction. The prevalence of reduced vision because of myopia is high in school-age children living in metropolitan Guangzhou, representing an important public health problem. One third of these children do not have the necessary corrective spectacles. Effective strategies are needed to eliminate this easily treated cause of significant visual impairment.
Prevalence of visual acuity impairment and its associated factors among secondary school students in Beranang, Selangor
Article
  • Jan 2012
Prevalence of visual impairment among students is increasing in trends especially in rural area. A cross sectional study was conducted among secondary school students in Taman PKNS Beranang, Selangor in March 2008 with the objective of determining the prevalence of visual acuity impairment and its influencing factors. A total of 77 secondary school students were interviewed using guided questionnaire. The prevalence of visual acuity impairment among the respondents was 25.0% and study found that being female and have been watching television at a distance of less than two meters were significantly associated with visual acuity impairment. In conclusion, the problem occurred maybe due to the students sit nearer to the television (<2 meter) therefore health education should focus on that.