Prevalence of myopia and its risk factors in rural school children in North India: the North India myopia rural study (NIM-R Study)

Dynamics of Myopia Progression in Ghana-Evidence From Clinical Practice: A Retrospective Cohort Study

Background and Aim

To investigate the pattern of progression of myopia among a Ghanaian clinical cohort.

Methods

A retrospective cohort analysis of a clinical data set of all healthy myopic participants attending a tertiary eye care center was performed. Participants' biennial refraction examinations were tracked for refractive changes 4 years after the date of the first visit. This covered the period from January 2015 to December 2019. Myopia progression was defined as a difference in spherical equivalent between consecutive biennial visits equal to, or greater than -0.50 D of myopia.

Results

The medical records of 169 myopic participants were reviewed, with the majority (53.8%) being female. Most of the participants (51.4%) were younger than 36 years, and at the end of the study period, 96 participants (56.8%), who made up the majority, showed progression of myopia Univariate regression revealed that the 36-59-year-old age range is associated with a 60% [cOR = 0.40, 95% CI: -0.17, 0.97; p = 0.04] reduced likelihood compared to those belonging to the 0-17-year-old age group, and the Mole-Dagbon ethnicity is associated with an almost fourfold [cOR = 3.80; 95% CI: -1.40, 10.316; p = 0.01] increased likelihood of experiencing myopia progression compared to those of Ga-Adangbe ethnicity. Multivariate regression revealed that the Mole-Dagbon ethnicity is associated with an increased likelihood of experiencing myopia progression 4 years after their initial visit [aOR = 3.49; 95% CI: -1.27, 9.63; p = 0.02] compared to those of Ga-Adangbe ethnicity.

Conclusion

Our study provides important insights into myopia progression in Ghana, with findings that are consistent with global trends. The association of myopia progression with age, place of residence, degree of myopia, and ethnicity highlights the need for tailored interventions to manage this growing public health concern in African populations.

Priorities in school eye health in low and middle-income countries a scoping review

School eye health (SEH) has been on the global agenda for many years, and there is mounting evidence available to support that school-based visual screenings are one of the most effective and cost-efficient interventions to reach children over five years old. A scoping review was conducted in MEDLINE, Web of Science, PubMed, and CINHAL between February and June 2023 to identify current priorities in recent literature on school eye health in low- and middle-income countries (LMICs). Selection of relevant publications was performed with Covidence, and the main findings were classified according to the WHO Health Promoting Schools framework (HPS). A total of 95 articles were included: cross-sectional studies (n = 55), randomised controlled trials (n = 7), qualitative research (n = 7) and others. Results demonstrate that multi-level action is required to implement sustainable and integrated school eye health programmes in low and middle-income countries. The main priorities identified in this review are: standardised and rigorous protocols; cost-effective workforce; provision of suitable spectacles; compliance to spectacle wear; efficient health promotion interventions; parents and community engagement; integration of programmes in school health; inter-sectoral, government-owned programmes with long-term financing schemes. Even though many challenges remain, the continuous production of quality data such as the ones presented in this review will help governments and other stakeholders to build evidence-based, comprehensive, integrated, and context-adapted programmes and deliver quality eye care services to children all over the world.

Effective refractive error coverage and spectacle coverage among school children in Telangana, South India

BACKGROUND

Uncorrected refractive error (URE) is one of the leading causes of childhood vision impairment. Increasing effective refractive error coverage (e-REC) is one of the main indicators of WHO's 2030 global eye health targets. The aim of this study is to estimate the e-REC and spectacle coverage among school children in Telangana, South India.

METHODS

School children aged 4-15 years in the study locations underwent vision screening using 6/12 tumbling E optotype by trained community eye health workers in the schools. Those failing the initial vision screening and/or found to be having eye conditions were referred to a nearby referral centre appropriately, where they underwent detailed eye examination.

RESULTS

A total of 774,184 children were screened in schools of which 51.49% were boys. The mean age was 9.40 ± 3.27 years. The prevalence of URE was 1.44% (95%CI:1.41-1.46) of which myopia was 1.38% (95%CI: 1.35-1.41). In multivariate analysis, the risk of myopia was higher among older children (Adj.OR: 17.04; 95%CI: 14.64-19.85), those residing in urban areas (Adj.OR:3.05, 95%CI:2.60-3.57), those with disabilities (Adj.OR:2.61, 95%CI:2.00-3.39) and among girls (Adj.OR:1.30, 95%CI:1.25-1.35) (P < 0.001). The overall e-REC was 56.97% and the spectacle coverage was 62.83%.

CONCLUSION

The need for interventions to improve e-REC to achieve 2030 global eye health target is eminent among children in this region. Improving refractive services through school eye health programs could aid in accelerating this process to achieve the target. Myopia being the most common type of RE, the risk factors included increasing age, urban location, and presence of disability.

Prevalence of visual impairment and estimation of refractive errors among school children in Kakamega, Kenya

AIM

To investigate the prevalence of visual impairment (VI) and provide an estimation of uncorrected refractive errors in school-aged children, conducted by optometry students as a community service.

METHODS

The study was cross-sectional. Totally 3343 participants were included in the study. The initial examination involved assessing the uncorrected distance visual acuity (UDVA) and visual acuity (VA) while using a +2.00 D lens. The inclusion criteria for a subsequent comprehensive cycloplegic eye examination, performed by an optometrist, were as follows: a UDVA<0.6 decimal (0.20 logMAR) and/or a VA with +2.00 D ≥0.8 decimal (0.96 logMAR).

RESULTS

The sample had a mean age of 10.92±2.13y (range 4 to 17y), and 51.3% of the children were female (n=1715). The majority of the children (89.7%) fell within the age range of 8 to 14y. Among the ethnic groups, the highest representation was from the Luhya group (60.6%) followed by Luo (20.4%). Mean logMAR UDVA choosing the best eye for each student was 0.29±0.17 (range 1.70 to 0.22). Out of the total, 246 participants (7.4%) had a full eye examination. The estimated prevalence of myopia (defined as spherical equivalent ≤-0.5 D) was found to be 1.45% of the total sample. While around 0.18% of the total sample had hyperopia value exceeding +1.75 D. Refractive astigmatism (cil<-0.75 D) was found in 0.21% (7/3343) of the children. The VI prevalence was 1.26% of the total sample. Among our cases of VI, 76.2% could be attributed to uncorrected refractive error. Amblyopia was detected in 0.66% (22/3343) of the screened children. There was no statistically significant correlation observed between age or gender and refractive values.

CONCLUSION

The primary cause of VI is determined to be uncorrected refractive errors, with myopia being the most prevalent refractive error observed. These findings underscore the significance of early identification and correction of refractive errors in school-aged children as a means to alleviate the impact of VI.

Prevalence and related factors of children myopia in Pudong New Area, Shanghai: a cross-sectional study

OBJECTIVES

This study aimed to assess the prevalence and related factors of myopia among school-aged children after COVID-19 pandemic.

DESIGN

Cross-sectional study.

SETTING

Pudong New Area, Shanghai.

PARTICIPANTS

1722 children aged 7-9 randomly selected from 8 primary schools were screened from 1 February 2023 to 30 April 2023.

MAIN OUTCOME MEASURES

Children's height, weight and eye parameters were examined. Myopia was defined as a cycloplegic spherical equivalent ≤-0.50 dioptres in either eye. A vision-related behaviour questionnaire was applied to investigate the associations between myopia and its risk factors.

RESULTS

Of the 1722 individuals enrolled, 25.6% (456) had myopia. After adjusting other characteristics, the following factors were associated with an increased rate of myopia: age (9 years vs 7 years, adjusted OR (AOR) 1.84, 95% CI 1.18 to 2.85, p=0.007), parental myopia status (both myopia vs none, AOR 5.66, 95% CI 3.71 to 8.63, p<0.001; one myopia vs none, AOR 2.92, 95% CI 1.93 to 4.42, p<0.001), reading books too close (yes vs no, AOR 1.58, 95% CI 1.20 to 2.08, p=0.001), writing with a tilted head (yes vs no, AOR 1.37, 95% CI 1.05 to 1.77, p=0.019), sleep patterns (early to bed late to rise vs early to bed early to rise, AOR 1.52, 95% CI 1.02 to 2.26, p=0.039). By contrast, a higher monthly household income and the habit of reading while lying down were associated with lower risk of myopia.

CONCLUSIONS

The prevalence of myopia is of concern among young school-aged children after COVID-19. Correcting eye use behaviour and improving sleep habits may reduce myopia. Also, gender differences should be considered in prevention strategies for children's myopia.

Steep increase in myopia among public school-going children in South India after COVID-19 home confinement

Purpose:

Novel coronavirus has brought huge changes in lifestyle, especially among children. Reports indicate that the prevalence of refractive errors among children has increased due to home confinement. Hence, this study was done to understand the current status of refractive errors among children from public schools in southern India.

Methods:

This cross-sectional study was conducted as part of school eye screening conducted between September and October 2021. Children between 14 and 17 years of age from public schools underwent a three-phased comprehensive eye examination. Children identified with refractive errors and an equal proportion of children without any refractive errors underwent a survey on outdoor activities. Prevalence estimates and 95% confidence interval were calculated. Chi-square tests and regression analysis were used to understand the association between refractive error and other variables.

Results:

From the data of 3,850 (90.69%) children, the prevalence of vision impairment, refractive errors, and myopia in at least one eye was found to be 12.83% (n = 494), 21.51% (n = 828), and 19.53% (n = 752), respectively. The average myopic spherical equivalent error was found to be -2.17 ± 1.11D (range:-0.50 D to -14.00 D). Almost 96.82% of girls had less than 3 h of outdoor activities. Refractive errors were 7.42 and 2.77 times more (95% CI: 3.51-15.70), P < 0.001) among children who had outdoor activities less than 3 h per day and sleep less than 7 h per day.

Conclusion:

Comparing to previous studies from North Indian and South Indian public schools, this study reports a three- to six-fold rise in myopia post-home confinement among public school children from India.