Distance refractive error among Aboriginal people attending eye clinics in remote South Australia

Refractive status of patients attending eye clinics of the Public Health System from Aguascalientes, Mexico

PURPOSE

This paper aims to evaluate the prevalence of REs in a clinic from Aguascalientes, Mexico by analysing clinical records from the local public health system. Refractive errors (REs) are quite common globally, but no data have been published regarding their frequency in clinics from Mexico. A priori, the frequency of ametropias should be high as admixture ancestry from this region is mainly European and Amerindian, the regions with high prevalence worldwide.

METHODS

This cross-sectional study was conducted on 2195 subjects from records of public optometry services during the year 2018. Information obtained included age, gender, sphere, cylinder and axis. The prevalence of myopia, hyperopia and astigmatism was determined by gender and age groups in paediatric and adult patients. Chi-square testing was applied to determine significant differences in prevalence across age groups and gender. A p-value <0.05 was considered significant.

RESULTS

In subjects under 18 years of age, the prevalence of emmetropia, astigmatism, myopia and hyperopia was 20.1%, 51.1%, 7.0% and 11.8%, respectively. In adults, emmetropia was present at a frequency of 20.1%, while 57.1% presented astigmatism, 12.4% hyperopia and 8.6% presented myopia. A significant association was observed between the presence of REs and age and gender.

CONCLUSIONS

In this first report of prevalence of REs from western Mexico, astigmatism was the most prevalent RE in children, adolescents and adults while the least common was myopia. Important differences were found in prevalence in comparison to national and international reports.

Gender and ethnic differences in pterygium prevalence: an audit of remote Australian clinics

CLINICAL RELEVANCE

Developing an accurate picture of the demographic profile and refractive status of Aboriginal and non-Aboriginal individuals with pterygium will facilitate health planning and appropriate deployment of health-care resources in rural Australia.

BACKGROUND

To date, there is a paucity of reports in the literature regarding Aboriginal ocular health and refractive error. This study examines clinical data from a rural ophthalmology outreach clinic - a predominantly Aboriginal population.

METHODS

An assessment was undertaken of data of 293 patients noted to have pterygium present in at least one eye, from a sample of 2,072 individuals seen in rural northern Western Australia in 2017 by the Lions Outback Vision Visiting Optometry Service.

RESULTS

Pterygium was found in 14.1 per cent (n = 293) of patients using the Lions Outback Vision service. The mean age of those with pterygium (n = 293) was 57.1 ± 11.9-years (mean ± standard deviation); 188 were female (64.1 per cent); 260 identified as Aboriginal (88.7 per cent), 22 identified as non-Aboriginal (7.5 per cent) and 11 did not specify (3.8 per cent). There were more males than females with pterygium in the non-Aboriginal group (18.0 per cent versus 6.4 per cent); however, the reverse was true in the Aboriginal group (11.7 per cent versus 17.0 per cent). Analysis of the subjective refractive data in those with pterygium revealed an overall mean spherical equivalent value of +0.66 ± 1.28 DS. The median (interquartile range) best-corrected visual acuity was 0.0 (-0.1 to 0.0) logMAR (6/6 Snellen equivalent).

CONCLUSIONS

This paper increases our knowledge of ocular health in a remote Australian population, with an emphasis on the differences between Aboriginal and non-Aboriginal individuals, males and females.

Global and regional estimates of prevalence of refractive errors: Systematic review and meta-analysis

Purpose

The aim of the study was a systematic review of refractive errors across the world according to the WHO regions.

Methods

To extract articles on the prevalence of refractive errors for this meta-analysis, international databases were searched from 1990 to 2016. The results of the retrieved studies were merged using a random effect model and reported as estimated pool prevalence (EPP) with 95% confidence interval (CI).

Results

In children, the EPP of myopia, hyperopia, and astigmatism was 11.7% (95% CI: 10.5–13.0), 4.6% (95% CI: 3.9–5.2), and 14.9% (95% CI: 12.7–17.1), respectively. The EPP of myopia ranged from 4.9% (95% CI: 1.6–8.1) in South–East Asia to 18.2% (95% CI: 10.9–25.5) in the Western Pacific region, the EPP of hyperopia ranged from 2.2% (95% CI: 1.2–3.3) in South-East Asia to 14.3% (95% CI: 13.4–15.2) in the Americas, and the EPP of astigmatism ranged from 9.8% in South-East Asia to 27.2% in the Americas. In adults, the EPP of myopia, hyperopia, and astigmatism was 26.5% (95% CI: 23.4–29.6), 30.9% (95% CI: 26.2–35.6), and 40.4% (95% CI: 34.3–46.6), respectively. The EPP of myopia ranged from 16.2% (95% CI: 15.6–16.8) in the Americas to 32.9% (95% CI: 25.1–40.7) in South-East Asia, the EPP of hyperopia ranged from 23.1% (95% CI: 6.1%–40.2%) in Europe to 38.6% (95% CI: 22.4–54.8) in Africa and 37.2% (95% CI: 25.3–49) in the Americas, and the EPP of astigmatism ranged from 11.4% (95% CI: 2.1–20.7) in Africa to 45.6% (95% CI: 44.1–47.1) in the Americas and 44.8% (95% CI: 36.6–53.1) in South-East Asia. The results of meta-regression showed that the prevalence of myopia increased from 1993 (10.4%) to 2016 (34.2%) (P = 0.097).

Conclusion

This report showed that astigmatism was the most common refractive errors in children and adults followed by hyperopia and myopia. The highest prevalence of myopia and astigmatism was seen in South-East Asian adults. The highest prevalence of hyperopia in children and adults was seen in the Americas.

Increasing Prevalence of Myopia in Europe and the Impact of Education

Purpose

To investigate whether myopia is becoming more common across Europe and explore whether increasing education levels, an important environmental risk factor for myopia, might explain any temporal trend.

Design

Meta-analysis of population-based, cross-sectional studies from the European Eye Epidemiology (E³) Consortium.

Participants

The E³ Consortium is a collaborative network of epidemiological studies of common eye diseases in adults across Europe. Refractive data were available for 61 946 participants from 15 population-based studies performed between 1990 and 2013; participants had a range of median ages from 44 to 78 years.

Methods

Noncycloplegic refraction, year of birth, and highest educational level achieved were obtained for all participants. Myopia was defined as a mean spherical equivalent ≤−0.75 diopters. A random-effects meta-analysis of age-specific myopia prevalence was performed, with sequential analyses stratified by year of birth and highest level of educational attainment.

Main Outcome Measures

Variation in age-specific myopia prevalence for differing years of birth and educational level.

Results

There was a significant cohort effect for increasing myopia prevalence across more recent birth decades; age-standardized myopia prevalence increased from 17.8% (95% confidence interval [CI], 17.6–18.1) to 23.5% (95% CI, 23.2–23.7) in those born between 1910 and 1939 compared with 1940 and 1979 (P = 0.03). Education was significantly associated with myopia; for those completing primary, secondary, and higher education, the age-standardized prevalences were 25.4% (CI, 25.0–25.8), 29.1% (CI, 28.8–29.5), and 36.6% (CI, 36.1–37.2), respectively. Although more recent birth cohorts were more educated, this did not fully explain the cohort effect. Compared with the reference risk of participants born in the 1920s with only primary education, higher education or being born in the 1960s doubled the myopia prevalence ratio–2.43 (CI, 1.26–4.17) and 2.62 (CI, 1.31–5.00), respectively—whereas individuals born in the 1960s and completing higher education had approximately 4 times the reference risk: a prevalence ratio of 3.76 (CI, 2.21–6.57).

Conclusions

Myopia is becoming more common in Europe; although education levels have increased and are associated with myopia, higher education seems to be an additive rather than explanatory factor. Increasing levels of myopia carry significant clinical and economic implications, with more people at risk of the sight-threatening complications associated with high myopia.