Prevalence of refractive errors among school-going children in a multistate study in India

Retinoscopes: Past and present

BACKGROUND

Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors. Advantages of retinoscopy include its non-invasive nature, ability to assess patients of all ages, and usefulness in patients with limited cooperation or communication skills.

AIM

To discuss the history of retinoscopes and examine current literature on the subject.

METHODS

A search was conducted on the PubMed and with the reference citation analysis (https://www.referencecitationanalysis.com) database using the term “Retinoscopy,” with a range restricted to the last 10 years (2013-2023). The search string algorithm was: "Retinoscopy" (MeSH Terms) OR "Retinoscopy" (All Fields) OR "Retinoscopes" (All Fields) AND [(All Fields) AND 2013: 2023 (pdat)].

RESULTS

This systematic review included a total of 286 records. Publications reviewed iterations of the retinoscope into autorefractors, infrared photo retinoscope, television retinoscopy, and the Wifi enabled digital retinoscope.

CONCLUSION

The retinoscope has evolved significantly since its discovery, with a significant improvement in its diagnostic capabilities. While it has advantages such as non-invasiveness and broad applicability, limitations exist, and the need for skilled interpretation remains. With ongoing research, including the integration of artificial intelligence, retinoscopy is expected to continue advancing and playing a vital role in eye care.

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 Refractive Errors Among School-Going Children in Urban Versus Rural Areas

BACKGROUND

The most common cause of visual impairment globally is refractive error. The prevalence of refractive error has been on the rise since the coronavirus disease 2019 (COVID-19) pandemic, possibly due to increased indoor activities and excessive use of electronic devices. Impaired vision during childhood can affect the overall development of a child adversely, and it often remains unreported due to the inability of children to complain about impaired vision.

AIM

The main aim of this study was to assess the prevalence of refractive errors among school-going children in urban and rural areas.

METHODS

This was a cross-sectional study that included 2024 children going to schools situated in urban and rural areas. All study subjects were tested for visual acuity for distance using Snellen's chart with and without glasses after taking a brief history regarding visual complaints. All children who had visual acuity less than 6/6 on Snellen's chart underwent refraction check-ups. Retinoscopy was performed in all study subjects. Analysis of the collected data was done using SPSS for Windows, Version 16.0 (Released 2007; SPSS Inc., Chicago, United States). The analysis of numerical data was done by an unpaired t-test, and the analysis of categorical data was done by a chi-square test. A P-value of less than 0.05 was considered statistically significant.

RESULTS

The mean age of the children was 10.92 ± 2.73 years, with 10.93 ± 2.73 years in urban and 10.91 ± 2.73 years in rural groups. Females (n=1031; 50.93%) were more in number than males (n=993; 49.06%). The overall prevalence of refractive error was 17.43%. The prevalence was higher in urban areas (22.14%) than in rural areas (12.71%). The age group below 10 years comprised 886 (43.77%) study subjects, and 218 (62.1%) children with refractive error had no ocular complaints. The most common refractive error found in this study was simple myopia in both groups, and the least common was astigmatism. The prevalence of uncorrected refractive error was higher in urban school-going children as compared to rural children.

CONCLUSION

The prevalence of refractive error was 17.43% in our study. The prevalence was high in urban areas (22.67%) as compared to rural areas (13.12%). Regular screening of school-going children for refractive errors should be done. Also, awareness regarding the use of electronic gadgets must be raised, especially among urban children.

Refractive Error among Children Visiting the Department of Paediatric Opthalmology of a Tertiary Eye Care Center

Introduction

Refractive error is the inability of eyes to focus clearly on images. Visual impairment due to refractive error has a major impact on children's education and daily activities. The hospital has no documentation of the ocular morbidity related to refractive errors in children. The aim of this study was to find out the prevalence of refractive error in children visiting the Department of Paediatric Ophthalmology of a tertiary care centre.

Methods

A descriptive cross-sectional study was done in the Outpatient Department of Paediatric Ophthalmology in a tertiary care centre from 8 September 2022 to 7 March 2023 after obtaining ethical approval from the Institutional Review Committee. A convenience sampling method was used. The point estimate was calculated at 95% Confidence Interval.

Results

Among 3600 children, the prevalence of refractive error was seen in 668 children (18.56%) (15.61-21.51, 95% Confidence Interval). Refractive error was seen in 363 (54.34%) boys and 305 (45.66%) girls. Myopia was found in 340 (50.90%), astigmatism in 207 (30.99%), and hyperopia in 121 (18.11%).

Conclusions

The prevalence of refractive error among children attending a tertiary care centre was found to be higher than studies done in similar settings. Regular screening of refractive error for visual impairment is recommended among school going children.

Keywords

astigmatism; hyperopia; myopia; refractive error; visual impairment.