Association of visual acuity with educational outcomes: a prospective cohort study

Modality matters: Three auditory conflict tasks to measure individual differences in attention control

Early work on selective attention used auditory-based tasks, such as dichotic listening, to shed light on capacity limitations and individual differences in these limitations. Today, there is great interest in individual differences in attentional abilities, but the field has shifted towards visual-modality tasks. Furthermore, most conflict-based tests of attention control lack reliability due to low signal-to-noise ratios and the use of difference scores. Critically, it is unclear to what extent attention control generalizes across sensory modalities, and without reliable auditory-based tests, an answer to this question will remain elusive. To this end, we developed three auditory-based tests of attention control that use an adaptive response deadline (DL) to account for speed-accuracy trade-offs: Auditory Simon DL, Auditory Flanker DL, and Auditory Stroop DL. In a large sample (N = 316), we investigated the psychometric properties of the three auditory conflict tasks, tested whether attention control is better modeled as a unitary factor or modality-specific factors, and estimated the extent to which unique variance in modality-specific factors contributed incrementally to the prediction of dichotic listening and multitasking performance. Our analyses indicated that the auditory conflict tasks have strong psychometric properties and demonstrate convergent validity with visual tests of attention control. Auditory and visual attention control factors were highly correlated (r = .81)-even after controlling for perceptual processing speed (r = .75). Modality-specific attention control factors accounted for unique variance in modality-matched criterion measures, but the majority of the explained variance was modality-general. The results suggest an interplay between modality-general attention control and modality-specific processing.

Eye health knowledge, attitude, and practice among special school managers and barriers to eye health programmes in special schools in Hyderabad, India

BACKGROUND

Children with special education needs (SEN) are at high risk of developing vision problems. In India, there is no data available on the awareness level of eye health needs of children with SEN among special school managers (SSM) and on the barriers to providing eye care for these children in schools. This study aimed to identify the awareness level among SSM and the barriers to organizing School Eye Health (SEH) programmes in special schools, as reported by the eye health program organizers.

METHODS

A mixed-method study was conducted between July and August 2020 among SSM and eye health programme organizers from a local eye care provider in Hyderabad, India. SSM participants completed an online questionnaire assessing their knowledge, attitude, and practice concerning the eye health needs of children with SEN. Quantitative responses were described with summary statistics. Qualitative interviews with eye health programme organizers were conducted via telephone, and transcripts were thematically analysed. Results: In total, 13/67 (19.4%) invited SSM participated and 2/4 invited eye health programme organizers (50%) were interviewed. Among the SSM participants, 92.3% were aware of vision impaired (VI) children in their schools. Awareness of potential causes of VI ranged from 53.9%-92.3%, common eye conditions ranged from 7.7%-69.2%, and difficulties experienced by children with SEN in classroom activities ranged from 46.2%-76.9%. Only 30.8% of the special schools organized SEH programmes at least once a year. Eye health programme organizers reported barriers, such as a lack of interest from SSM, unavailability of qualified screening staff, and a lack of provision for spectacles and low-vision devices.

CONCLUSION

This study identified varied levels of knowledge, attitudes, and practices of SSM related to the eye health needs of children with SEN. Key barriers to conducting SEH programmes included a lack of demand, inadequate human resource availability, and limited access to government-funded resources. As the study was negatively impacted by the Covid pandemic, further research with wider representation is needed to plan comprehensive eye health programmes for children with SEN.

Visual impairment and cognitive performance: A nationwide study of 1.4 million adolescents

PURPOSE

Previous research highlights the adverse effects of visual impairment (VI) on academic achievement in children, yet its impact on cognitive performance among adolescents and young adults remains under-studied. Therefore, this investigation aimed to analyse this association in a nationwide sample of Israeli adolescents.

METHODS

A retrospective population-based cross-sectional study was conducted among 1,410,616 Israeli-born adolescents aged 16-19 years, who were assessed before mandatory military service between 1993 and 2017. The definition of VI was based on best-corrected visual acuity (BCVA) measurements using a standard Snellen chart. Adolescents with BCVA worse than 6/9 in either or both eyes were classified as having unilateral or bilateral VI, respectively. Cognitive performance was measured using the General Intelligence Score (GIS), based on a validated four-domain test. Relationships were analysed using regression models yielding adjusted odds ratios (ORs) for low (<-1 standard deviation [SD]) and high (≥1 SD) cognitive Z-scores.

RESULTS

Of 1,410,616 adolescents (56.1% men), 13,773 (1.0%) had unilateral and 3980 (0.3%) had bilateral VI. Unilateral VI was associated with adjusted ORs for low and high cognitive Z-scores of 1.24 (1.19-1.30) and 0.84 (0.80-0.89), respectively. ORs were accentuated for bilateral VI, reaching 1.62 (1.50-1.75) and 0.81 (0.74-0.90) for low and high cognitive Z-scores, respectively. Cognitive performance subscores mirrored these results, with the visual-spatial functioning subtest demonstrating the greatest effect size. These associations persisted in sub-analyses restricted to adolescents with amblyopia-related VI, mild VI and unimpaired health status.

CONCLUSIONS

Visual impairment, including mild and unilateral cases, is associated with reduced cognitive performance scores assessed in late adolescence. Further research is required to gain a comprehensive understanding of the dynamics underlying this relationship.

Colombian Ocular Diseases Epidemiology Study (CODES): Prevalence Incidence, and Sociodemographic Characterization of Vision Impairment (2015-2019), A Nationwide Study

PURPOSE

To describe the prevalence, incidence, and sociodemographic characterization of moderate to severe vision impairment (MSVI) and blindness in Colombia based on the National Health Registry Integrated Social Protection Information System (SISPRO) Database.

METHODS

We performed a nationwide population-based study using SISPRO and the International Classification of Diseases. Total and new cases were identified to calculate the prevalence and incidence per 100,000 inhabitants of MSVI and blindness between 2015 and 2019. Blindness was defined as a best-corrected visual acuity (BCVA) of less than 20/400 in the better-seeing eye. Meanwhile, MSVI is a BCVA from 20/70 to equal or better than 20/400 in the better-seeing eye. An ANOVA test was performed to identify age differences. A conditional autoregressive model was also employed to depict standardized morbidity rate maps.

RESULTS

From the 50 million inhabitants, the average prevalence and incidence of MSVI were 13.94 and 13.34 between 2015 and 2019, respectively, while for blindness, they were 4.03 and 3.53. Females accounted for most reported cases, and there was a notable shift towards individuals over 50 years (p < 0.001). Valle del Cauca was the region with the most cases reported and the greatest disease burden.

CONCLUSION

This is the first nationwide population-based study describing the prevalence, incidence, and sociodemographic characterization of blindness and MSVI in Colombia. In recent years, there has been an increased number of cases, prevalence, and incidence, with females over 50 particularly affected. This research provides insight into the country's vision impairment epidemiology landscape and contributes to formulating public health policies to improve eye health care.

Service Quality and Residents' Preferences for Facilitated Self-Service Fundus Disease Screening: Cross-Sectional Study

BACKGROUND

Fundus photography is the most important examination in eye disease screening. A facilitated self-service eye screening pattern based on the fully automatic fundus camera was developed in 2022 in Shanghai, China; it may help solve the problem of insufficient human resources in primary health care institutions. However, the service quality and residents' preference for this new pattern are unclear.

OBJECTIVE

This study aimed to compare the service quality and residents' preferences between facilitated self-service eye screening and traditional manual screening and to explore the relationships between the screening service's quality and residents' preferences.

METHODS

We conducted a cross-sectional study in Shanghai, China. Residents who underwent facilitated self-service fundus disease screening at one of the screening sites were assigned to the exposure group; those who were screened with a traditional fundus camera operated by an optometrist at an adjacent site comprised the control group. The primary outcome was the screening service quality, including effectiveness (image quality and screening efficiency), physiological discomfort, safety, convenience, and trustworthiness. The secondary outcome was the participants' preferences. Differences in service quality and the participants' preferences between the 2 groups were compared using chi-square tests separately. Subgroup analyses for exploring the relationships between the screening service's quality and residents' preference were conducted using generalized logit models.

RESULTS

A total of 358 residents enrolled; among them, 176 (49.16%) were included in the exposure group and the remaining 182 (50.84%) in the control group. Residents' basic characteristics were balanced between the 2 groups. There was no significant difference in service quality between the 2 groups (image quality pass rate: P=.79; average screening time: P=.57; no physiological discomfort rate: P=.92; safety rate: P=.78; convenience rate: P=.95; trustworthiness rate: P=.20). However, the proportion of participants who were willing to use the same technology for their next screening was significantly lower in the exposure group than in the control group (P<.001). Subgroup analyses suggest that distrust in the facilitated self-service eye screening might increase the probability of refusal to undergo screening (P=.02).

CONCLUSIONS

This study confirms that the facilitated self-service fundus disease screening pattern could achieve good service quality. However, it was difficult to reverse residents' preferences for manual screening in a short period, especially when the original manual service was already excellent. Therefore, the digital transformation of health care must be cautious. We suggest that attention be paid to the residents' individual needs. More efficient man-machine collaboration and personalized health management solutions based on large language models are both needed.

Academic performance and musculoskeletal pain in adolescents with uncorrected vision problems

BACKGROUND

Undetected vision problems are common in school children, and a prevalence of up to 40% has previously been reported. Uncorrected vision and lack of optimal eye wear can have a significant impact on almost all aspects of everyday life, such as development and learning, academic performance, pain and discomfort, and quality of life. This study aimed to analyze the relationship between uncorrected vision problems, educational outcomes, and musculoskeletal pain symptoms.

METHODS

A total of 152 school children (15.1 ± 0.8 years, mean ± SD; 40% males) were included in the study. All participants were recruited from a free-of-charge school vision testing program in Kathmandu, Nepal. Academic grades were collected from the school records of the participants' nationwide final grade examinations. A questionnaire was used to record the use of digital devices, screen time, and associated symptoms, including musculoskeletal pain (Wong-Baker FACES Pain Rating Scales).

RESULTS

A total of 61 children (40%) had uncorrected vision, with a cycloplegic refraction of SER - 0.53 ± 0.52 (mean ± SD). Children with uncorrected vision had significantly more third division grades (26 vs. 9%, p = 0.004) and shoulder pain in general/during screen use (66 vs. 43/40%, p = 0.008/0.003; 2.1/1.9 vs. 1.1/1.0 mean pain score, p = 0.002/0.001) compared with children with normal vision. Sex based subanalyses showed that only girls with uncorrected vision had more third division grades (25 vs. 4%, p = 0.006), and only boys with uncorrected vision had more shoulder pain in general/during screen use (76 vs. 28/31%, p < 0.001; 2.2/2.4 vs. 0.7 mean pain score, p < 0.001), compared with children with normal vision.

CONCLUSIONS

The results of this study showed that even small refractive errors may impact educational outcomes and musculoskeletal pain in adolescents. Most of the participating children had low myopia, easily corrected with glasses. This suggests that regular eye examinations are important in school children, and there is a need for raised awareness among parents, and school- and healthcare personnel.

Relationship between visual impairment and school entrance age in rural China

CLINICAL RELEVANCE

Children with uncorrected visual impairment have lower scores on various motor and cognitive tests. Exploring the association between visual impairment and school entrance age among school children in rural China may assist in enhancing the visual health of early-entry school students.

BACKGROUND

Educational pressures may play a role in the visual health of students. School entrance age is associated with educational pressures. This study explored whether school entrance age can contribute to visual impairment among younger generations.

METHODS

A cross-sectional study was conducted with 17,510 students from 252 primary schools in two prefectures in western China. Information on the sampled students was collected through questionnaires and vision examinations. The relationship between visual impairment and school entrance age was further analysed by multiple regression. The school entrance age was classified as early-entry and late-entry, early-entry was defined as students entering school at the age 6 years.

RESULTS

The results showed that the myopia rate of early-entry students (26.92%) was higher than late-entry students (23.86%). Multiple regression showed that visual impairment increased with the earlier age of school entry (P = 0.044). The prevalence of myopia was also significantly higher in higher grades for children of the same age. The prevalence of myopia in 10-year-old and 11-year-old fourth- and fifth-grade students was 20.6% to 30.5%, 21.7% to 27.4% (P < 0.001). The near work with eyes was significantly different among children of the same age in different grades during this study (P < 0.001).

CONCLUSION

Myopia is related to the school entrance age of children. Children who start school earlier are more likely to suffer from myopia. Educational pressures and digital screens may play a role in the association. Changes in the current education mode by reducing the study burden in the early years of learning may be significant.

Integration of hospital and community care for paediatric ophthalmology: A mixed-methods study

BACKGROUND

To explore collaborative care models for paediatric eye care that integrate hospital and community-based care to address access blocks.

METHODS

Sequential referrals to a tertiary paediatric ophthalmology clinic between April and October 2019 and subsequent encounters up until July 2020 at a major metropolitan public children's hospital in Sydney, Australia, were reviewed to identify those cases suitable for community care. Semi-structured phone interviews were conducted with eye health service providers, including ophthalmologists, orthoptists and optometrists, as well as service users to explore their perspectives on potential changes to service delivery. Qualitative data were analysed deductively using the Levesque model for access to healthcare and Consolidated Framework for Implementation Research (CFIR) to inform implementation strategies for future models of care.

RESULTS

One-third of the 439 audited referrals (30.5%; 134/439) were identified as suitable for community management. Interviews revealed five themes relating to potential models of care, which would support and promote access: integrated health systems, standardised quality of care, interprofessional trust, multidisciplinary governance and patient-centred care. Key recommendations for future implementation included: (i) identifying and preparing clinical champions, (ii) conducting educational meetings, (iii) conducting local needs assessments and (iv) informing local opinion leaders.

CONCLUSIONS

This audit highlights access blocks and poor targeting of referrals to tertiary paediatric ophthalmology services in a metropolitan hospital. Integration with community practitioners was identified as an acceptable way to streamline services, and strategies that may support successful implementation in this setting were identified.

Screening for Patients with Visual Acuity Loss in Primary Health Care: A Cross Sectional Study in a Deprived Hungarian Population

Screening for visual acuity loss (VAL) is not applied systematically because of uncertain recommendations based on observations from affordable countries. Our study aimed to evaluate the effectiveness of primary health care-based screening. A cross-sectional investigation was carried out among adults who did not wear glasses and did not visit an ophthalmologist in a year (N = 2070). The risk factor role of sociodemographic factors and the cardiometabolic status for hidden VAL was determined by multivariable linear regression models. The prevalence of unknown VAL of at least 0.5 was 3.7% and 9.1% in adults and in the above-65 population. Female sex (b = 1.27, 95% CI: 0.35; 2.18), age (b = 0.15, 0.12; 0.19), and Roma ethnicity (b = 2.60, 95% CI: 1.22; 3.97) were significant risk factors. Higher than primary school (b_{secondaryschoolwithoutgraduation} = -2.06, 95% CI: -3.64; -0.47; and b_{secondaryschoolwithgraduation} = -2.08, 95% CI: -3.65; -0.51), employment (b = -1.33, 95% CI: -2.25; 0.40), and properly treated diabetes mellitus (b = -2.84, 95% CI: -5.08; -0.60) were protective factors. Above 65 years, female sex (b = 3.85, 95% CI: 0.50; 7.20), age (b = 0.39, 95% CI: 0.10; 0.67), Roma ethnicity (b = 24.79, 95% CI: 13.83; 35.76), and untreated diabetes (b = 7.30, 95% CI: 1.29; 13.31) were associated with VAL. Considering the huge differences between the health care and the population's social status of the recommendation-establishing countries and Hungary which represent non-high-income countries, the uncertain recommendation of VAL screening should not discourage general practitioners from organizing population-based screening for VAL in non-affordable populations.

Factors Associated with the Spectacle Wear Compliance among Primary School Students with Refractive Error in Rural China

PURPOSE

To study the factors determining spectacle-wear compliance and reasons for non-wear among students in rural China.

METHODS

This study was based on a spectacle intervention trial among 162 schools in rural China. Students with refractive errors were randomly assigned to either a free or voucher group to receive spectacles at baseline. Spectacle-wear compliance was assessed through an unannounced follow-up 7 months after spectacles were distributed. Students not wearing spectacles were also asked their reasons for non-wear. The collected data underwent descriptive, bivariate, and logistic regression analyses.

RESULTS

A total of 1904 students received spectacles at baseline, 1826 (95.9%) of whom were present at the 7-month follow-up. Among those students, 41.7% wore their spectacles. There was no significant difference in compliance rates between the free and voucher groups. Predictors of wearing spectacles at follow-up included older age (Odds ratio = 1.56, 95% CI: 1.12-2.19), the severity of refractive error (3.68, 2.23-6.07), wearing spectacles before baseline (3.91, 2.53-6.04) and having friends who wore spectacles (1.87, 1.32-2.63). When students could see the blackboard from their seats (0.68, 0.51-0.89) and thought that wearing spectacles was bad looking (0.76, 0.57-1.00), they were reluctant to wear spectacles. The two main reasons for non-wear were the widespread perception that wearing spectacles would weaken eyesight (32.8%) and the inconvenience of wearing spectacles during activities (23.6%).

CONCLUSIONS

The main reason that accounts for the low compliance of spectacle wear was misconceptions around spectacle. School-based spectacle programs should consider enhancing the compliance rates to maximize the benefits of spectacle wear.

Vision Screening in Children: The New South Wales Statewide Eyesight Preschooler Screening Program

PURPOSE

The aim was to investigate universality of access, screening rate, and outcomes from the New South Wales (NSW) Statewide Eyesight Preschooler Screening (StEPS) over the period of 2009 to 2016.

DESIGN

Cross-sectional, observational study.

METHODS

The StEPS program provides vision screening to 4-year-old children residing in NSW and is administered within Local Health Districts (LHDs). Visual acuity (VA) was examined by trained lay and nurse screeners using HOTV logMAR. Children who had VA <6/9-2 were referred to local practitioners while those with VA <6/18 were referred to public hospital pediatric ophthalmic outpatient clinics where available. Activity data were collected by NSW Health and screening rates determined from population projections of 4-year-olds per LHD based on adjusted 2014 Census data. To determine factors impacting screening and referral rates, a random effects panel analysis was undertaken.

RESULTS

A total of 719,686 (96.4%) NSW 4-year-old children were offered StEPS vision screening between 2009 and 2016, 84% accepted and 564,825 children (75.6%) were screened. The screening rate increased from 67.3% in 2009 to 74.5% in 2016, with an 80% target reached for 3 consecutive years from 2013 to 2015. Of those screened, 19.2% were referred to an eye health professional or advised to have a vision retest in 12 months. This referral rate remained steady over the period studied, with little variation between metropolitan, and rural and regional LHDs.

CONCLUSIONS

StEPS is an ideal service model for preschool vision screening providing coverage that is comparable to school-based screening programs and at an age likely to facilitate optimal treatment outcomes.

Effect of physical activity combined with extra ciliary-muscle training on visual acuity of children aged 10-11

This study is intended for exploring the effects of the physical activity combined with extra ciliary-muscle training with different frequencies on children's kinetic visual acuity and uncorrected distance visual acuity, and eventually figuring out the optimal frequency of ciliary-muscle training for each physical education class. To do the present research, A total of 160 students aged 10-11 from a school in Suzhou (a major city located in southeastern Jiangsu Province, East China) were randomly selected and divided into control group (n = 33), 15-frequency group (n = 44), 30-frequency group (n = 40) and 60-frequency group (n = 43), and the latter three experimental groups participated in a specially designed physical activity plan based on the training principles of ciliary muscle, while the control group participated in normal physical activity as usual. The experimental intervention period was 16 weeks, and all students' kinetic visual acuity and uncorrected distance visual acuity were measured before and after the experiment. The result showed that the kinetic visual acuity of the students in the 30 and 60-frequency groups got improved significantly after the experiment (p < 0.05), with the highest improvement occurring in the 30-frequency group, while there was no significant change in the 15-frequency group and the control group; The uncorrected distance visual acuity of the students in the 30 and 60-frequency groups was significantly improved after the experiment (p < 0.05), and the improvement range in these two groups was similar. In contrast, there was no significant change in the 15-frequency group, while the control group showed a significant decrease (p < 0.05). Physical activity combined with extra ciliary-muscle training has a positive effect on improving children's vision; at the same time, ciliary-muscle training with different frequencies bring out different outcomes on children's vision improvement, among which ciliary-muscle training with frequency of 30 in each physical education class is the best choice to enhance children's kinetic visual acuity and uncorrected distance visual acuity.

Simulations to Assess the Performance of Multifactor Risk Scores for Predicting Myopia Prevalence in Children and Adolescents in China

Background: Myopia is the most common visual impairment among Chinese children and adolescents. The purpose of this study is to explore key interventions for myopia prevalence, especially for early-onset myopia and high myopia.

Methods: Univariate and multivariate analyses were conducted to evaluate potential associations between risk factor exposure and myopia. LASSO was performed to prioritize the risk features, and the selected leading factors were used to establish the assembled simulation model. Finally, two forecasting models were constructed to predict the risk of myopia and high myopia.

Results: Children and adolescents with persistently incorrect posture had a high risk of myopia (OR 7.205, 95% CI 5.999–8.652), which was 2.8 times higher than that in students who always maintained correct posture. In the cohort with high myopia, sleep time of less than 7 h per day (OR 9.789, 95% CI 6.865–13.958), incorrect sitting posture (OR 8.975, 95% CI 5.339–15.086), and siblings with spherical equivalent &lt;−6.00 D (OR 8.439, 95% CI 5.420–13.142) were the top three risk factors. The AUCs of integrated simulation models for myopia and high myopia were 0.8716 and 0.8191, respectively.

Conclusion: The findings illustrate that keeping incorrect posture is the leading risk factor for myopia onset, while the onset age of myopia is the primary factor affecting high myopia progression. The age between 8 and 12 years is the crucial stage for clinical intervention, especially for children with parental myopia.

Association of School Education With Eyesight Among Children and Adolescents

IMPORTANCE

Myopia in youths is an increasingly common global problem, associated with significant social and economic burden worldwide.

OBJECTIVES

To explore the association of school education with myopia and investigate its scale, controlling confounding factors, such as age and socioeconomic status.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study was conducted from July 2019 to December 2020 using regression discontinuity (RD) based on the Compulsory Education Law to examine the complex association of school education with myopia. Participants were youths from grades 1 to 12 before tertiary or university studies in China, including individuals from 815 primary schools, 373 junior high schools, and 145 senior high schools. Data were analyzed from February through June 2021.

EXPOSURES

Participants born earlier in a year (ie, January to August) were assigned 1 more year of education and were considered to be in the treated group, while participants born September to December were considered to be in the control group.

MAIN OUTCOMES AND MEASURES

Differences in mean spherical equivalent refractive error (MSE) and uncorrected visual acuity (UVA) between treated and control groups were calculated.

RESULTS

Among a mean (SD) of 812 979 (55 953) participants across 5 surveys survey (mean SD 44.9% [0.5%] female participants; mean [SD] age, 11.19 [2.60] years), the mean (SD) MSE was -1.30 (2.93) diopters and mean (SD) UVA was 4.77 (0.34) points. Every additional year at school was associated with an decrease in MSE of -0.17 diopters/y (95% CI, -0.22 to -0.11 diopters/y) and a decrease in UVA of -0.03 points/y (95% CI, -0.04 to -0.02 points/y), which accounts for nearly 66.4% (95% CI, 85.9% to 43.0%) and 78.9% (95% CI, 102.6% to 55.3%) of changes of MSE and UVA, respectively, among all factors for youths. The greatest MSE shifts occurred in grades 3 and 7 (eg, for the June 2019 census, the RD was -0.26 diopters/y [95% CI, -0.33 to -0.20 diopters/y] for grade 3 and -0.41 diopters/y [95% CI, -0.66 to -0.15 diopters/y] for grade 7).

CONCLUSIONS AND RELEVANCE

These findings suggest that receiving more years of education, instead of age, may be a risk factor associated with myopia progression in youths.

Advancing the Sustainable Development Goals through improving eye health: a scoping review

UN member states have committed to achieving the Sustainable Development Goals (SDGs) by 2030. This Review examines the published evidence on how improving eye health can contribute to advancing the SDGs (beyond SDG 3). We identified 29 studies that showed direct benefits from providing eye health services on SDGs related to one or more of poverty (SDGs 1, 2, and 8), education (SDG 4), equality (SDGs 5 and 10), and sustainable cities (SDG 11). The eye health services included cataract surgery, free cataract screening, provision of spectacles, trichiasis surgery, rehabilitation services, and rural community eye health volunteers. These findings provide a comprehensive perspective on the direct links between eye health services and advancing the SDGs. In addition, eye health services likely have indirect effects on multiple SDGs, mediated through one of the direct effects. Finally, there are additional plausible links to other SDGs, for which evidence has not yet been established.

The Prevalence of Myopia in Children in Spain: An Updated Study in 2020

Background: In recent years, there was a significant increase in myopia incidence worldwide. However, it is still not clear how it affects Spanish children. Since 2016, this research team analyzed myopia prevalence and risk in 9668 children aged between 5 and 7 years. It was shown that the prevalence rates increased from 16.8% in 2016 to 20.4% in 2019. The objective of this study is to update the prevalence rate of myopia in Spain in 2020 and analyze the risk and prevention factors of myopia. Methods: The participants underwent an optometric examination, and a questionnaire on their lifestyle, family history, and geographical origin was carried out. Finally, data were analyzed using the SPSS version 27 program. Results: 1601 children from various Autonomous Communities of Spain were examined. In 2020 the myopia rates did not increase compared to 2019 (p < 0.05), although the number of hyperopes decreased and the number of emmetropes increased. Regarding age, the prevalence of myopia increased progressively over the years (p < 0.001). There was no association between gender and myopia (p > 0.05). There was a link between the time spent in near vision and family history with the prevalence of myopia (p < 0.05). Conclusions: The prevalence of myopia in Spain in children between 5 and 7 years old increased significantly between 2016 and 2020.

Global economic productivity losses from vision impairment and blindness

BACKGROUND

In the absence of accessible, good quality eye health services and inclusive environments, vision loss can impact individuals, households and communities in many ways, including through increased poverty, reduced quality of life and reduced employment. We aimed to estimate the annual potential productivity losses associated with reduced employment due to blindness and moderate and severe vision impairment (MSVI) at a regional and global level.

METHODS

We constructed a model using the most recent economic, demographic (2018) and prevalence (2020) data. Calculations were limited to the working age population (15-64 years) and presented in 2018 US Dollars purchasing power parity (ppp). Two separate models, using Gross Domestic Product (GDP) and Gross National Income (GNI), were calculated to maximise comparability with previous estimates.

FINDINGS

We found that 160.7 million people with MSVI or blindness were within the working age and estimated that the overall relative reduction in employment by people with vision loss was 30.2%. Globally, using GDP we estimated that the annual cost of potential productivity losses of MSVI and blindness was $410.7 billion ppp (range $322.1 - $518.7 billion), or 0.3% of GDP. Using GNI, overall productivity losses were estimated at $408.5 billion ppp (range $320.4 - $515.9 billion), 0.5% lower than estimates using GDP.

INTERPRETATION

These findings support the view that blindness and MSVI are associated with a large economic impact worldwide. Reducing and preventing vision loss and developing and implementing strategies to help visually impaired people to find and keep employment may result in significant productivity gains.

FUNDING

MJB is supported by the Wellcome Trust (207472/Z/17/Z). JR's appointment at the University of Auckland is funded by the Buchanan Charitable Foundation, New Zealand. The Lancet Global Health Commission on Global Eye Health was supported by grants from The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity (GR001061), NIHR Moorfields Biomedical Research Centre, The Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The SEVA Foundation, The British Council for the Prevention of Blindness and Christian Blind Mission. The funders had no role in the design, conduct, data analysis of the study, or writing of the manuscript.

[Prevalence of visual impairment in school-age children: Data analysis from PlanVue® pilot project]

PURPOSE

To assess the prevalence of visual disturbances among school-aged children in prioritized education zones in France.

METHODS

The PlanVue® pilot project was designed to detect and manage visual disturbances in school-aged children in the prioritized education areas of the city of Nanterre, France. During this pilot study, a cohort of 515 children aged 4 to 13 years underwent a school vision screening between January and March 2019, consisting of an overall evaluation of the child's visual behavior, measurement of uncorrected visual acuity in each eye, objective refraction with a photoscreener and strabismus screening. If the examination was abnormal as determined by impaired vision or an algorithm based on the abnormalities found, the children were referred to an ophthalmologist.

RESULTS

Decreased visual acuity was found in 20% of school-aged children. Out of the 515 children screened, 22% were referred to an ophthalmologist. Among these children, 13% were diagnosed with amblyopia, 73% with spherical ametropia, 57% with astigmatism and 2% with strabismus. Of the entire population screened, 12% of the children needed optical correction but had not received glasses.

CONCLUSION

This study confirms the high prevalence of uncorrected refractive errors among school-age children. A screening program carried out in a school environment by paramedical professionals might make it possible to considerably reduce the rate of uncorrected visual disorders and their consequences.

Associations between Poor Vision, Vision-Related Behaviors and Mathematics Achievement in Chinese Students from the CNAEQ-PEH 2015

Purpose: Poor vision is prevalent in school-aged students, especially in East Asia. This can not only cause irreversibly physical health impairments like glaucoma and cataracts, but also the loss of individual education and employment opportunities and deterioration of the quality of life. The present study aims to investigate the associations between poor vision, vision-related risk behaviors, and mathematics achievement in youth from China. Methods: The present study included a total of 106,192 Grade 4 students and 70,236 Grade 8 students from the China National Assessment of Educational Quality-Physical Education & Health 2015 (CNAEQ-PEH 2015). We conducted a standard logarithmic visual acuity scale for vision screening, a self-reported questionnaire for vision-related risk behavior and a standardized mathematics assessment for mathematics performance. Poor vision is defined as the visual acuity below 5.0 by using the standard logarithmic visual acuity chart. Linear regression was conducted. Results: The prevalence rate of poor vision in China was 37.1% in Grade 4 and 66.2% in Grade 8 in 2015. Students who had poor vision were more likely to have better mathematics achievement than those with normal vision. Reading in bed, insufficient sleep, and screen time during weekdays and weekends were associated with higher odds of poor vision. Conclusions: Poor vision was positively associated with mathematics academic achievements, while vision-related risk behaviors such as screen time, homework time and reading in bed were associated with a high prevalence of poor vision in compulsory education cycle students.

Impact of spectacles wear on uncorrected visual acuity among urban migrant primary school children in China: a cluster-randomised clinical trial

OBJECTIVE

To estimate the effect of providing free spectacles on uncorrected visual acuity (VA) among urban migrant Chinese school children.

DESIGN

Exploratory analysis from a parallel cluster-randomised clinical trial.

METHODS

After baseline survey and VA screening, eligible children were randomised by school to receive one of the two interventions: free glasses and a teacher incentive (tablet computer if ≥80% of children given glasses were wearing them on un-announced examination) (treatment group) or glasses prescription and letter to parents (control group). The primary outcome was uncorrected logarithm of the minimal angle of resolution (LogMAR) VA at study closeout, adjusted for baseline uncorrected VA.

RESULTS

Among 4376 randomly selected children, 728 (16.6%, mean age 10.9 years, 51.0% boys) at 94 schools failed VA screening and met eligibility criteria. Of these, 358 children (49.2%) at 47 schools were randomised to treatment and 370 children (50.8%) at 47 schools to control. Among these, 679 children (93.3%) completed follow-up and underwent analysis. Spectacle wear in the treatment and control groups was 68.3% and 29.3% (p<0.001), respectively. Uncorrected final VA for eyes of treatment children was significantly better than control children, adjusting only for baseline VA (difference of 0.039 LogMAR units, 95% CI: 0.008, 0.070, equivalent to 0.39 lines, p=0.014) or baseline VA and other baseline factors (0.040 LogMAR units, 95% CI 0.007 to 0.074, equivalent to 0.40 lines, p=0.020).

CONCLUSION

We found no evidence that spectacles wear worsens children's uncorrected VA among urban migrant Chinese school children.

Prevalence, causes and risk factors of reduced VA and persistent reduced VA among preschool children in Eastern China

AIMS

To determine prevalence, causes, and risk factors of reduced uncorrected visual acuity (UCVA), reduced presenting visual acuity (PVA), and persistent reduced visual acuity (VA) among Chinese preschool children.

METHODS

The longitudinal, population-based Nanjing Eye Study (NES) was carried out. Children underwent baseline comprehensive ocular examinations in 2016 (at 48-60 months old) and the follow-up ocular examinations in 2017. A comprehensive questionnaire about children and their families was completed by their legal guardians. For children having reduced PVA at baseline, a follow-up questionnaire about potential factors concerning VA correction was completed. Reduced VA was defined as VA worse than 0.30 logMAR (Snellen equivalent 6/12, 20/40), and persistent reduced VA was defined as reduced PVA in both 2016 and 2017.

RESULTS

Among 1448 participants with both eye examinations and questionnaires completed, prevalence of reduced UCVA, reduced PVA, and persistent reduced VA at age of 60-72 months were 5.94%, 3.04%, and 1.59% respectively. Causes for reduced PVA were refractive error (79.5%), amblyopia (18.2%), and amblyopia combined nystagmus (2.3%). Among 23 children having persistent reduced VA, causes of reduced PVA remained unchanged in 13 children and 4 children developed amblyopia from refractive error. Younger age (OR = 1.09 for each month decrease, p = 0.01) and non-breastfeeding (OR = 2.08, p = 0.03) were risk factors for reduced UCVA. Younger children with reduced UCVA were at higher risk of having reduced PVA (OR = 1.18 for each month decrease, p = 0.04). Children with siblings (OR = 5.95, p = 0.02) were more likely to have persistent reduced VA.

CONCLUSIONS

Future vision health promotion strategies among preschool children should focus on early vision-screening and timely refractive correction. Apart from children of non-breastfeeding mothers, attention should also be paid to children with siblings.

Visual Health and Academic Performance in School-Aged Children

BACKGROUND

Academic performance at different educational levels has become a very important subject of study in local, national and international institutions. A visual system working properly is critical to improving academic performance. It is important to check children's vision during the different stages of elementary school.

METHODS

A visual screening was carried out in elementary school children, aged between 6 and 12, across Spain. The screening included: the collection of demographic data, surveys of children and families about their vision habits and a basic optometric screening to detect visual problems.

RESULTS

Children with bad academic performance had worse visual health than those with good academic performance.

CONCLUSIONS

It would be highly recommendable to introduce policies that ensure the early detection of visual disorders in schools and primary care in order to improve the academic performance of elementary students.

Effect of a complex intervention to improve post-vision screening referral compliance among pre-school children in China: A cluster randomized clinical trial

BACKGROUND

We investigated whether specific appointments for quality-assured care could increase referral uptake, often low in China, in children's vision screening.

METHODS

We randomized children aged 4-7 years in Yudu, Jiangxi, China, by school to Control (free school-based eye screening, parents of children failing screening recommended for further examination [usual practice]) or Intervention (identical examinations, with parents additionally provided with specific appointments for further examinations by quality-assured doctors at a designated local hospital). Both groups could select any hospital for referral exams, which were not free. Six months after screening, parents were interviewed on referral compliance at any hospital (primary outcome) and potential determinants. This trial is registered at the ClinicalTrials.gov, number NCT03251456.

FINDINGS

Among 9936 children at 63 schools randomized to Intervention (32 schools, 5053 [50·9%] children) or Control (31 schools, 4883 [49·1%] children), 1114 children (11·2%) failed screening. Among 513 referred Intervention children (46·1%, 32 schools, mean age 5·36 years, 53·0% boys) and 601 referred Control children (53·9%, 31 schools, mean age 5·30 years, 57·7% boys), 104 (20·3%) and 135 (22·5%) were lost to follow-up respectively. Under Intention to Treat analysis, assuming children lost to follow-up were non-compliant, Intervention children had significantly higher compliance than Controls (308/513 = 60·0% vs. 225/601 = 37·4%, P < 0·001). In regression models, Intervention group membership (Relative risk [RR] 1·53, 95% confidence interval, 1·36-1·72), travel time to hospital (RR: 0·97, 0·95-0·999), baseline glasses wear (RR: 1·37, 1·17-1·60), strabismus (RR: 1·17, 1·01-1·36) and worse uncorrected vision (RR: 1·41, 1·03-1·92) were associated with compliance.

INTERPRETATION

Providing specific appointments for quality-assured eye care improved referral compliance in this setting.

Association of Visual Impairment With Economic Development Among Chinese Schoolchildren

IMPORTANCE

Few studies have reported the association of economic growth with trends of visual impairment in schoolchildren in China or elsewhere.

OBJECTIVES

To describe 30-year trends and patterns in visual impairment in China and to explore the association between visual impairment and economic development.

DESIGN, SETTING, AND PARTICIPANTS

In this time series analysis of 7 successive cross-sectional surveys from 1985 to 2014, a total of 1 951 084 schoolchildren aged 7 to 18 years from all provinces and autonomous regions of mainland China, excluding Tibet, were studied. In 1985, the survey was conducted between March to June; In 1991-2014, the surveys were conducted between September and November. Data analysis was performed from April 1, 2018, to January 31, 2019.

EXPOSURES

The province-level gross domestic product (GDP) per capita was extracted from the China Statistical Yearbook.

MAIN OUTCOMES AND MEASURES

Visual impairment, defined as unaided distance visual acuity of worse than 6/7.5 (20/25 Snellen equivalent), and moderate to severe visual impairment, defined as unaided distance visual acuity of worse than 6/18 (20/63 Snellen equivalent), in the worse eye.

RESULTS

A total of 1 951 084 participants (mean [SD] age, 12.6 [3.4] years; 50.5% male) were included in the analysis. Among students aged 7 to 18 years, the prevalence of visual impairment increased from 23.7% (95% CI, 23.6%-23.8%) in 1985 to 35.1% (95% CI, 34.9%-35.3%) in 1995 to 55.0% (95% CI, 54.8%-55.3%) in 2014. In 2014, the prevalence was higher among girls (58.3%; 95% CI, 54.8%-55.3%) vs boys (51.8%; 95% CI, 51.5%-52.1%) (prevalence ratio [PR] girls vs boys, 1.12; 95% CI, 1.11-1.13) and among students living in urban (59.9%; 95% CI, 59.6%-60.2%) vs rural (50.2%; 95% CI, 49.9%-50.5%) areas (PR urban vs rural, 1.17; 95% CI, 1.16-1.18), although a more rapid relative increase in prevalence occurred in rural areas (15.3% in 1985 to 50.2% in 2014) than in urban areas (31.5% in 1985 to 59.9% in 2014). From 1995 to 2014, the GDP in China increased from $1263 to $7594 (in 2014 US$ constant price). After demographic characteristics (cluster effect of school, age, sex, urban vs rural location, and relative socioeconomic status within province) were adjusted for, the regression model revealed that every 100% increase in GDP was associated with a 20% (PR, 1.20; 95% CI, 1.20-1.21) increase in the relative risk of visual impairment and a 27% (PR, 1.27; 95% CI, 1.26-1.27) increase in the relative risk of moderate to severe visual impairment. The association was stronger in male (PR, 1.22; 95% CI, 1.21-1.23 for male [as reference] vs 1.19; 95% CI, 1.18-1.19 for female; P < .001), rural (PR, 1.32; 95% CI, 1.31-1.33 for rural [as reference] vs 1.12; 95% CI, 1.12,-1.33 for urban; P < .001), and younger age groups (PR, 1.27; 95% CI, 1.24-1.29 for 7-9 years of age [as reference] vs 1.34; 95% CI, 1.32-1.36 for 10-12 years of age; P < .001; 1.21; 95% CI, 1.20-1.22 for 13-15 years of age; P < .001; and 1.12; 95% CI, 1.11,-1.13 for 16-18 years of age; P < .001).

CONCLUSIONS AND RELEVANCE

The rapid increase of visual impairment prevalence and the association between GDP and visual impairment over time suggest that further exacerbation of childhood visual impairment may occur as economic development continues in China.