National estimate and associated factors of myopia among schoolchildren in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Myopia is a global public health concern that has a significant socioeconomic and psychological impact on schoolchildren. If Myopic patients are not detected early, they are exposed to retinal detachment, cataracts, and glaucoma. There have been previous studies conducted in Ethiopia, but there is significant inconsistency among studies. Hence, the aim of this study was to provide a single figure as well as associated factors for Myopia among Ethiopian schoolchildren.

METHOD

The national and international databases and gray literature were searched for important research articles. This review included school-based cross-sectional studies that were reported in English. The data were extracted using Microsoft word and exported to Stata™ Version 17.0 statistical software for further management and analysis .The presence of heterogeneity was checked using Cochrane Q test via fixed effects model and presented by forest plots with 95% CI. Due to the presence of substantial heterogeneity, I2 test using random effects model was computed to estimate the effect size. The existing heterogeneity among studies was explained by regional difference. To identify factors associated with myopia, meta regression was computed and significant factors was reported using OR with 95% CI.

RESULTS

In this systematic review and meta-analysis, 12 studies with a total of 9688 schoolchildren were included. The national estimate of myopia among schoolchildren in Ethiopia was 6.49% (95%CI: 4.86, 8.12). Having family history of myopia (OR: 9.18, 95%CI: 3.5,24.02) and being female (OR: 0.94, 95% CI: 0.50, 0.98) were the identified factors associated with myopia.

CONCLUSION

Myopia is one of the most prevalent childhood health condition in Ethiopia, which affects about one in every fourteen schoolchildren. Schoolchildren who had family history of myopia and being female were the identified risk factors of myopia among schoolchildren. Clinical and public engagement activities are needed to address the burden of myopia.

Myopia and its associated factors among pregnant women at health institutions in Gondar District, Northwest Ethiopia: A multi-center cross-sectional study

Background

Myopia is the most common form of uncorrected refractive error with a growing burden worldwide. It is the principal complaint of most women during pregnancy. Although myopia has led to several consequences across the standard life of pregnant women, there is no previous study in Ethiopia regarding this topic. Thus, this study determined the prevalence of myopia and identifies its associated factors among pregnant women attending antenatal care units at governmental health institutions in Gondar City District, Northwest Ethiopia.

Methods

An institution-based cross-sectional study design was conducted from 08 February to 08 April 2021. From the selected health centres, study participants were recruited by systematic random sampling technique. A pre-tested, structured-interviewer-administered questionnaire consisting of socio-demographic variables, obstetric and clinical-related variables was used to collect the required data. Non-cycloplegic refraction was performed using trial lenses, trial frames, and retinoscopy in a semi-dark examination room. EpiData 3 and STATA 14 were used for data entry and statistical analysis respectively. Both bivariable and multivariable binary logistic regression analyses were executed to identify associated factors of myopia. Variables with a p-value ≤0.05 in the multivariable logistic regression analysis were declared as statistically significant with myopia. Model fitness was checked by Hosmer and Lemeshow goodness of test (at p > 0.05).

Results

A total of four-hundred and twenty-three pregnant women participated with a 100% response rate in this study. The overall prevalence of myopia among pregnant women was 26.48% (95% CI: 22.48-30.91). Eighty-Eight (20.81%) and Eighty-Four (19.85%) of the study participants had myopia in their right and left eyes respectively. The prevalence of myopia was significantly associated with age (AOR = 1.17; 95% CI: 1.09-1.28), the third trimester of gestation (AOR = 2.05, 95% CI: 1.08-3.90), multi & grand multipara (AOR = 3.15; 95% CI: 1.59-6.25), and history of contraceptive use (AOR = 3.30; 95% CI: 1. 50-7.28).

Conclusion

The finding of our study shows that there is a higher prevalence of myopia among pregnant women in our study area. Further prospective analytical studies regarding visual systems among pregnant women, particularly as a result of pregnancy, are strongly recommended.

Regional variations and temporal trends of childhood myopia prevalence in Africa: A systematic review and meta-analysis

PURPOSE

To provide contemporary and future estimates of childhood myopia prevalence in Africa.

METHODS

A systematic online literature search was conducted for articles on childhood (≤18 years) myopia (spherical equivalent [SE] ≤ -0.50D; high myopia: SE ≤ -6.00D) in Africa. Population- or school-based cross-sectional studies published from 1 Jan 2000 to 30 May 2021 were included. Meta-analysis using Freeman-Tukey double arcsine transformation was performed to estimate the prevalence of childhood myopia and high myopia. Myopia prevalence from subgroup analyses for age groups and settings were used as baseline for generating a prediction model using linear regression.

RESULTS

Forty-two studies from 19 (of 54) African countries were included in the meta-analysis (N = 737,859). Overall prevalence of childhood myopia and high myopia were 4.7% (95% CI: 3.3%-6.5%) and 0.6% (95% CI: 0.2%-1.1%), respectively. Estimated prevalence across the African regions was highest in the North (6.8% [95% CI: 4.0%-10.2%]), followed by Southern (6.3% [95% CI: 3.9%-9.1%]), East (4.7% [95% CI: 3.1%-6.7%]) and West (3.5% [95% CI: 1.9%-6.3%]) Africa. Prevalence from 2011 to 2021 was approximately double that from 2000 to 2010 for all studies combined, and between 1.5 and 2.5 times higher for ages 5-11 and 12-18 years, for boys and girls and for urban and rural settings, separately. Childhood myopia prevalence is projected to increase in urban settings and older children to 11.1% and 10.8% by 2030, 14.4% and 14.1% by 2040 and 17.7% and 17.4% by 2050, respectively; marginally higher than projected in the overall population (16.4% by 2050).

CONCLUSIONS

Childhood myopia prevalence has approximately doubled since 2010, with a further threefold increase predicted by 2050. Given this trajectory and the specific public health challenges in Africa, it is imperative to implement basic myopia prevention programmes, enhance spectacle coverage and ophthalmic services and generate more data to understand the changing myopia epidemiology to mitigate the expanding risk of the African population.

Impact of Refractive Errors on the Academic Performance of High School Children of Lahore

Introduction

The process of learning begins in childhood and accurate vision can greatly affects a child's learning capacity. It is documented that visual impairment in children can have a significant impact on their performance at school as well as their social interaction and development.

Objective

This research aimed to study the impact of refractive corrections on the academic performance of high school children in Lahore.

Methodology

A total of 2,000 students with equal distribution of gender, public, private school, and locality were included in the study. All students were screened for defective vision. The academic performance before and after corrections was recorded on the prescribed proforma.

Results

The prevalence of refractive error was high among the public high schools 244 (59.2%) as compared to the private schools 168 (40.8%). The area-based prevalence was higher among the students in urban settings 255 (62%) while in rural it was 157 (38%). It was found that in the public sector, the average score of academic results before the intervention was 56.39 ± 13.24 which was increased to 60.27 ± 14.94 after the intervention while in the private sector, before the intervention, the average score was 63.53 ± 17.50 which was improved to 67.12 ± 18.48. It was found to be statistically significant at p-value < 0.05.

Conclusion

A significant impact was observed in the average academic scores of the results after refractive corrections.

Myopia: An Increasing Problem for Medical Students at the University of Gondar

Purpose

The purpose of this study was to assess the prevalence and associated factors of myopia among medical students at the University of Gondar College of Medicine and Health Sciences, Northwest Ethiopia.

Patients and Methods

Institution-based cross-sectional study was conducted at the University of Gondar College of Medicine and Health Sciences from June 20 to August 15, 2021. A simple random sampling technique with proportional allocation was used to select 492 students. Interviewer-administered questionnaire, Snellen acuity chart, pinhole, retinoscope and direct ophthalmoscope were used to collect the data. The data were entered to EpiData version 4.6 and exported to SPSS version 25 for analysis. Descriptive statistics were summarized by measures of central tendency. Variables with p-value ≤0.2 in bivariable regression were entered into a multivariable logistic regression model. Adjusted odds ratio with 95% confidence interval was used and variables with p-values <0.05 were considered as statistically significant.

Results

A total of 492 respondents participated giving a response rate of 98.3%. The prevalence of myopia was found to be 16.7% (95% CI = 12.8–19.4%). Urban residents (AOR = 1.56; 95% CI: 1.28–6.21), family history of myopia (AOR = 2.31; 95% CI: 1.33–4.54), near-work activity of 5–7 hours (AOR = 2.41; 95% CI: 1.31–5.76) and ≥8 hours (AOR = 4.35; 95% CI: 1.96–9.66), outdoor activity for <3 hours (AOR = 1.65 95% CI: (1.14–4.53), were significantly associated with myopia.

Conclusion

The prevalence of myopia among medical students at the University of Gondar College of Medicine and Health Sciences was high. Urban residency, positive family history, longer time spent on near-work activities and less outdoor activity were positively associated with myopia.

Towards the development of a uniform screening guideline: Current status of paediatric vision screening in Abia State, Nigeria

Background: Vision screening is an important component of any child eye health system. Availability of standardised and broad screening guidelines is important to its success because it will allow for uniform and full utilisation of services through the system.Aim: This study aimed to evaluate the coverage, components, and referral criteria of the paediatric vision screening services in Abia State, Nigeria, towards the development of a uniform vision screening guideline.Methods: Eighty-three registered optometrists practising in Abia State for at least one year prior to the commencement of the study were invited to participate. Self-administered questionnaires were distributed directly or via email to the optometrists. The questionnaire covered areas such as the participation of optometrists in paediatric vision screening, coverage of the screening programmes, screening tools and referral criteria.Results: A response rate of 77.1% (64 participants) was recorded for the survey. Twenty-eight (43.8%) respondents offered more than one paediatric vision screening outside their practice in the last year before the survey. Among those respondents, 20 were from the private sector and 20 were based in urban cities. Only 10 respondents undertook more than four paediatric screening services within this period. Visual acuity measurement and ocular health assessment were the main components of the screening batteries of optometrists. While a child with any disease abnormality was referred for evaluation, the referral criteria for a full examination were inconsistent.Conclusion: The existing paediatric screening programmes in Abia State are inadequate. Of the few conditions that are screened for, varied referral criteria for further examination are applied. It therefore appears that the current screening programmes are not meeting the visual needs of the paediatric population and suggests the need for a new strategy to improve vision screening provisions to children in Abia State.

Systematic review and meta-analysis of myopia prevalence in African school children

Purpose

Increased prevalence of myopia is a major public health challenge worldwide, including in Africa. While previous studies have shown an increasing prevalence in Africa, there is no collective review of evidence on the magnitude of myopia in African school children. Hence, this study reviews the evidence and provides a meta-analysis of the prevalence of myopia in African school children.

Methods

This review was conducted using the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Five computerized bibliographic databases, PUBMED, Scopus, Web of Science, ProQuest, and Africa Index Medicus were searched for published studies on the prevalence of myopia in Africa from 1 January 2000 to 18 August 2021. Studies were assessed for methodological quality. Data were gathered by gender, age and refraction technique and standardized to the definition of myopia as refractive error ≥ 0.50 diopter. A meta-analysis was conducted to estimate the prevalence. Significant heterogeneity was detected among the various studies (I² >50%), hence a random effect model was used, and sensitivity analysis was performed to examine the effects of outliers.

Results

We included data from 24 quality assessed studies, covering 36,395 African children. The overall crude prevalence of myopia over the last two decades is 4.7% (95% CI, 3.9–5.7) in African children. Although the prevalence of myopia was slightly higher in females (5.3%, 95%CI: 4.1, 6.5) than in males (3.7%, 95% CI, 2.6–4.7; p = 0.297) and higher in older [12–18 years 5.1% (95% CI, 3.8–6.3) than younger children (aged 5–11 years, 3.4%, 95% CI, 2.5–4.4; p = 0.091), the differences were not significant. There was a significantly lower prevalence of myopia with cycloplegic compared with non-cycloplegic refraction [4.2%, 95%CI: 3.3, 5.1 versus 6.4%, 95%CI: 4.4, 8.4; p = 0.046].

Conclusions

Our results showed that myopia affects about one in twenty African schoolchildren, and it is overestimated in non-cycloplegic refraction. Clinical interventions to reduce the prevalence of myopia in the region should target females, and school children who are aged 12–18 years.

The Relationship Between Screen and Outdoor Time With Rates of Myopia in Spanish Children

Background: Nowadays, digital devices have become usual in children's lives around the world. Five percent of the children between 5 and 7 years old have their own smartphone and forty-two percent of them have their own tablet. This fact has produced a change in their lifestyle that can imply some risks, threats and/or opportunities. The light emitted by digital devices' screens could involve, among others, possible risks to children's vision. Methods: This study shows a detailed analysis of the vision of 7,497 children between 5 and 7 years old carried out in the "Annual school campaign for children's visual health" in Spain during the years 2016, 2017, and 2019. The study connects the results in the visual screening with children's lifestyle, taking into account both, the number of hours per day that they use all digital devices and the daily time of outdoor exposure. Results: The study shows that children with myopia have more screen time use and shorter outdoor activity time when compared to those without myopia (p < 0.01). Conclusions: Myopia in children is a public health problem and requires healthy lifestyle interventions at individual as well as at community level.

Prevalence and Risk Factors of Myopia in Spain

Objective

To analyse the prevalence of myopia among a sample of more than 6000 children in Spain as well as to determine the impact of risk factors in its progression.

Methodology

A total of 6,152 children aged from 5 to 7 were examined. The participants underwent an eye examination that included visual acuity, refraction without cycloplegia, and tests of accommodative and binocular function. In addition, a questionnaire regarding their lifestyle, family history, and geographical data was carried out. Finally, data were analysed using the SPSS version 25 program.

Results

The prevalence of myopia in the sample of children studied has increased from 17% in 2016 to 20% in 2017. Likewise, the number of children with high myopia has also increased, from 1.7% in 2016 to 3.6% in 2017. 43.3% of the participants spent more than 3 hours a day doing near activities, and 48.9% of this group spent more than 50% of this time using electronic devices. In addition, only 9.7% spent more than 2.5 hours outdoors each day.

Conclusion

Myopia prevalence appears to be increasing in Spain. Lifestyle factors appear to be increasing the risk of myopia.

Vision problems: A review of prevalence studies on refractive errors in school-age children

Background: Refractive errors are common eye disorders and are leading causes of visual impairment in the general population. Children with uncorrected refractive error may experience reduced visual acuity, transient blurring, headache and persistent ocular discomforts particularly for close work which can impair reading efficiency and school performance.Aim: This article documents the prevalence of refractive errors in school-age children of different ethnic origins. The goal is to identify possible variation in measuring techniques and diagnostic criteria, as well as limitations of studies, to provide a clear direction for future studies.Methods: The review was undertaken through a detailed evaluation of peer-reviewed publications of primary research on this topic. The keywords for the search included ‘refractive error’, ‘hyperopia’, ‘myopia’, ‘astigmatism’ and ‘school children’. Only epidemiological studies with participants between 5 and 18 years of age were included.Results: Although several population and school-based studies have been conducted in various racial groups and populations, their findings were diverse owing to inconsistencies in the methods applied in identifying children in need of refraction, measurement techniques and diagnostic criteria for refractive errors. There are also some limitations associated with the sampling design and characteristics, which may have influenced the outcome measures.Conclusion: Despite the problems inherent in the studies, the review indicates that refractive error in school-age children is a public health concern in those populations and warrants additional research that will provide reliable data for proper planning of intervention strategies.

Prevalence of Myopia among Children Attending Pediatrics Ophthalmology Clinic at Ohud Hospital, Medina, Saudi Arabia

Introduction

Around half of the visually impaired population has uncorrected refractive errors (URE), and myopia constitutes a high proportion of them. URE should be screened and treated early to prevent long-term complications. The aim of this study was to determine the prevalence of myopia among all patients attending a pediatric outpatient clinic at Ohud Hospital in Medina, Saudi Arabia (KSA).

Method

This study was conducted using a convenience sample of all patients attending the clinic (1500 patients) aged between 3 and 14 years, and they were enrolled in the study during the period from May 2017 until September 2017.

Result

Of 1215 subjects, only 43 (3.54%) were diagnosed with myopia. Out of the study participants, 56.8% were female and the mean age was 9.7 ± 3.6. Myopia was more prevalent in male participants than female participants (n = 525, 4%, n = 690, 3.1%, p=0.5). Low myopia was the most common form among the screened individuals. The level of myopia was associated with the degree of the strabismus angle. Approximately 22% of patients with myopia had >25° strabismus angle. There was a statistically significant association with both near work indoor and outdoor activities on weekends and the level of myopia.

Conclusion

The prevalence of myopia among pediatrics patients in Medina is 3.54%. We hope that the results of this study will contribute to a better understanding of this public health issue in Saudi Arabia in order to implant a strict screening program for early detection and interventions to reduce the risk of further progression of visual impairment.