Prevalence of ocular morbidities among school children in Raipur district, India

Prevalence and Pattern of Eye Disorders Among Primary Schoolchildren in Abakaliki, Nigeria: A Cross-Sectional Study

Background A child's learning ability depends on vision, and visual impairment negatively affects neurological, intellectual, and emotional development by limiting children's exposure to a range of experiences and information. This study aims to determine the prevalence and pattern of ocular morbidity among primary schoolchildren in Abakaliki and provide evidence that can be used in planning a school eye health program for the state. Methodology A school-based, cross-sectional study was conducted within the Abakaliki metropolis between January and April 2018 to determine the ocular health status of schoolchildren recruited using stratified random sampling. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY, USA) and presented using descriptive statistics. Univariate analysis was performed to determine the association between dependent and independent variables, with the level of significance determined by a p-value <0.05 (95% confidence interval (CI)). Results A total of 553 schoolchildren aged 6-16 years were examined. The prevalence of eye disorders was 23.5%. Common disorders included refractive error (12.7%) and allergic eye disease (7.1%). Other findings included glaucoma suspect (15, 2.7%), infective conjunctivitis (1, 0.2%), amblyopia (3, 0.5%), cataract (1, 0.2%), and squint (1, 0.2%). The prevalence of visual impairment was 3.1%. Univariate analysis showed a significant association between ocular morbidity and attending private schools (95% CI = 6.5-11.1, p = 0.003). Conclusions Eye disorders such as uncorrected refractive error and allergic conjunctivitis were common among schoolchildren. School eye health programs can ensure that eye screening is done periodically, allowing for early detection, referral, and prompt treatment of eye diseases that can potentially cause visual impairment.

Impact of color vision deficiency on the quality of life in a sample of Indian population: Application of the CVD-QoL tool

Purpose

To investigate the quality of life (QoL) in a sample of color vision deficit (CVD) patients in India and how color vision deficiency affects them psychologically, economically, and in productivity related to their work and occupation.

Methods

A descriptive and case-control study design using a questionnaire was conducted on N = 120 participants, of whom 60 were patients of CVD (52 male and eight female) who visited two eye facilities in Hyderabad between 2020 and 2021 and 60 were age-matched normal color vision participants who served as controls. We validated English-Telugu adapted version of CVD-QoL, developed by Barry et al. in 2017 (CB-QoL). The CVD-QoL consists of 27 Likert-scale items with factors (lifestyle, emotions, and work). Color vision was assessed using the Ishihara and Cambridge Mollen color vision tests. A six-point Likert scale was used, with lower scores indicating poor QoL (from 1 = severe issue to 6 = no problem).

Results

The CVD-QoL questionnaire's reliability and internal consistency were measured, including Cronbach's α (α =0.70-0.90). There was no significance between the group in age (t = -1.2, P = 0.67) whereas the Ishihara colour vision test, scores showed a significant difference (t = 4.50, P < 0.001). The QoL scores showed a significant difference towards lifestyle, emotions and work (P = 0.001). The CVD group had a poorer QoL score than the normal color vision group odds ratio [OR] =0.31, 95% confidence interval [CI], (P = 0.002, CI = 0.14-0.65, Z = 3.0) . In this analysis, a low CI indicated that the OR was more precise.

Conclusion

Color vision deficiency affects Indians' QoL, according to this study. The mean scores of lifestyle, emotions, and work were lower than the UK sample.Since CVD is underreported and possibly affects developing countries more, advocacy for a new health care plan on CVD is essential. Increasing public understanding and awareness could also help diagnosing the CVD population.

Cerebral visual impairment in children: Multicentric study determining the causes, associated neurological and ocular findings, and risk factors for severe vision impairment

Purpose

To evaluate the causes, associated neurological and ocular findings in children with cerebral visual impairment (CVI), and to identify risk factors for severe vision impairment.

Methods

A multicenter, retrospective, cross-sectional analysis was carried out from January 2017 to December 2019 on patients less than 16 years of age with a diagnosis of CVI.

Results

A total of 405 patients were included of which 61.2% were male and 38.8% were female. The median age at presentation was 4 years (range 3 months to 16 years). Antenatal risk factors were present in 14% of the cases. The most common cause of CVI was hypoxic-ischemic encephalopathy (35.1%), followed by seizure associated with brain damage (31.3%). The most common neurological finding was seizure (50.4%), followed by cerebral palsy (13.6%). Associated ophthalmological findings were significant refractive error (63.2%), esotropia (22.2%), exotropia, (38%), nystagmus (33.3%), and optic nerve atrophy (25.9%). Severe visual impairment (<20/200) was associated with optic atrophy (odds ratio: 2.9, 95% confidence interval: 1.4-6.0; P = 0.003) and seizure disorder (odds ratio: 1.9, 95% confidence interval: 1.2-3.3; P = 0.012).

Conclusion

The various ophthalmic, neurological manifestations and etiologies could guide the multidisciplinary team treating the child with CVI in understanding the visual impairment that affects the neuro development of the child and in planning rehabilitation strategies.

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

BACKGROUND

To assess the prevalence of myopia and its risk factors in rural school children.

METHODS

Children in classes 4-7 of eight randomly selected schools (five government and three private) in rural Haryana, with unaided vision <6/9.5 were screened, their cycloplegic refraction is done, myopes were identified. A questionnaire-based assessment of risk factors was done for myopes and compared with 10% of randomly selected children with normal vision (controls). The prevalence of myopia and its association with risk factors were assessed.

RESULTS

Children screened were 1486 (89.5% coverage). The mean age of children was 11.2 ± 1.5 years with 861 (57.9%) boys. Prevalence of myopia was 6.4% (95% Confidence intervals [CI]: 5.2%, 7.8%). Prevalence was higher among private schools (10.1%) compared to government schools (1.4%) (p < 0.001), and among girls 7.2% (45/625) compared to boys 5.8% (50/861) (p = 0.2786). The mean spherical equivalent refractive error was -1.61D ± 1.32D. The prevalence of high myopia was 1.1% (1/95). There was a 75% unmet need for spectacles. Studying in private school was positively associated with myopia as per our multivariate analysis (p = 0.016). An inverse association was found for time spent outdoors (p = 0.009). Watching television, indoor time, screen time, age, or gender were not found to be statistically significant as risk factors.

CONCLUSION

The prevalence of myopia is increasing among children of rural areas, especially those in private schools with a strong inverse association with time spent outdoors. Regular screening, lifestyle modification and awareness about modifiable risk factors are essential.

Estimation of the Prevalence of Uncorrected Refractive Error and Other Ocular Morbid Conditions in School Children of Industrial Area in a Non-metro City in India

Purpose

This study aims to estimate the prevalence of uncorrected refractive error and ocular morbid conditions in school-going children of the Pimpri Chinchwad Municipal Corporation (PCMC) industrial belt.

Methods

Ocular examination was done in a well-equipped mobile clinic on school premises in the presence of a school teacher using visual acuity (VA) charts, autorefractometer, retinoscope, and handheld slit lamp. For the age group of 5-6 years, Lea symbols and HOTV charts were used, and for the age group of >7 years, Snellen’s chart was used. A detailed anterior segment examination was done to see lid position, the presence of any lid swelling, conjunctival congestion, conjunctival xerosis, corneal opacity, and lens opacity, and findings of previous eye surgery were noted. Spectacle correction was given to these students if they were found to have a significant refractive error.

Children requiring intervention other than refractive correction were referred to a tertiary hospital.

Results

A total of 3,054 school children were examined. Most were between the age group of 11-15 years (2,448 (80.2%)), with a mean age of 12.45 ± 2.022 years; 1,470 (48.1%) were male children. A total of 368 (12.04%) children had uncorrected refractive error. Myopia was seen in 204 (6.68%) children, hypermetropia in 16 (0.52%) children, and astigmatism in 148 (4.85%) children. On classification, simple myopic astigmatism (SMA) was found in 73 (2.39%) children, compound myopic astigmatism (CMA) in 38 (1.24%) children, simple hypermetropic astigmatism (SHA) in 13 (0.34%) children, and compound hypermetropic astigmatism (CHA) in 16 (0.52%) children. Moreover, 121 children had ocular morbid conditions. Ocular morbidity with decreased vision was seen in 52 (1.7%) children with preexisting refractive error and 12 (0.39%) with amblyopia, and strabismus was seen in eight (0.26%) children. Five (0.16%) children had lens disorder, and five (0.16%) had no improvement with glasses despite normal anterior segment.

Conclusion

There was a high prevalence of uncorrected refractive error. Early detection of uncorrected refractive error and ocular morbidity will improve overall performance in school-going children.

Myopia in India

India is a culturally and geographically diverse nation. Its vast demographic nature does not allow a single definition for any of the given medical conditions in its territory. One important clinical condition which has created an uproar in the rest of the world is myopia. Its cause, prevalence, etiopathogenesis and other factors are being explored constantly; however, data with respect to Indian subcontinent are genuinely missing. Hence, in this review, we enumerate the country’s myopia journey from last 4 decades. The epidemiology, genetics, ocular/systemic association, quality of life, imaging, and management in myopia with necessary future directives are discussed to augment the overall management in future.

Prevalence of Prescription Glasses in the First-Grade Thai Students (7-8 Years Old)

PURPOSE

To study the prevalence of the prescription glasses given to first-grade students due to the "Good Sight for Thai Children" (GSTC) policy.

METHODS

This was a cross-sectional study that examined all prescription glasses given to first-grade students throughout Thailand, after visual screening due to the GSTC policy between 2016 and 2017. Trained class teachers screened their students' visual acuity and referred children who had less than 20/40 visual acuity in either eye to a hospital for an eye examination and prescription glasses.

RESULTS

A total of 786,729 students were screened. Of these, 20,401 (2.59%) students were referred to hospital. However, only 9867 (48.37%) students presented to a hospital. Glasses were prescribed for 5324 (53.96%) students following cycloplegic refraction by ophthalmologists or trained refractionists. The mean spherical equivalent was -1.08 (-19.00 to +10.00, SD 2.32) diopters. There were 1626 (30.54%) children at amblyopic risk without glasses. A 5.49% had high myopia (< -6 diopters), 5.22% had high hyperopia (> +5 diopters) and 27.82% had high astigmatism (>2 diopters). A cylindrical lens analysis showed that 81.53% had with-the-rule astigmatism, 4.07% had against-the-rule astigmatism, and 14.40% had oblique astigmatism.

CONCLUSION

Although the reliable prevalence of refractive error cannot be estimated, the prevalence of visual impairment may be estimated. There were a number of students who required glasses. The astigmatism was the most common refractive error on prescription glasses for first-grade children. With-the-rule astigmatism was the most prevalent. The visual screening program of school children proved to be valuable and should be continued and developed.

Refractive Error and Visual Impairment Among School Children: Result of a South-Eastern Nigerian Regional Survey

PURPOSE

To determine the prevalence refractive errors and causes of visual impairment in school children in the south-eastern region of Nigeria.

METHODS

School-based cross-sectional samples of children 5 to 15 of age in both urban and rural areas were profiled through cluster sampling. The main outcome measures were presenting, uncorrected, and best-corrected visual acuity using the Refractive Error in School-age Children (RESC) protocol.

RESULTS

A total of 5723 children were examined during the study period comprising 2686 (46.9%) males and 3037 (53.1%) females; (M:F ratio 0.9:1) and aged 10.49±2.74SD of mean (range, 5 to 15 years). The age group 12 to <13 accounted for the highest 776 (13.6%) number of the study participants. The uncorrected visual acuity (VA) of <20/40 (6/12) was seen in 188 (3.4%) of the study participants while the presenting and best-corrected visual acuity of <20/40 (6/12) were noted in 182 (3.4%) children and 14 (0.2%) children, respectively. Refractive error was the principal cause of visual impairment.

CONCLUSION

Prevalence of refractive error is low. Myopia is the principal cause of refractive error occurring more in females and in urban schools. The main cause of visual impairment is refractive error, and most children that need spectacle correction did not have them. Program to identify children with refractive error in addition to providing free or affordable optical services remains the key to preventing visual impairment from refractive error particularly in resource-poor settings.

The Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) Study-Defining a Threshold for Non-Cycloplegic Myopia Prevalence in Children

The aim of this study was to investigate the agreement between cycloplegic and non-cycloplegic autorefraction with an open-field auto refractor in a school vision screening set up, and to define a threshold for myopia that agrees with the standard cycloplegic refraction threshold. The study was conducted as part of the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) study, which investigated the prevalence, incidence, and risk factors for myopia among children in South India. Children from two schools aged 5 to 15 years, with no ocular abnormalities and whose parents gave informed consent for cycloplegic refraction were included in the study. All the children underwent visual acuity assessment (Pocket Vision Screener, Elite school of Optometry, India), followed by non-cycloplegic and cycloplegic (1% tropicamide) open-field autorefraction (Grand Seiko, WAM-5500). A total of 387 children were included in the study, of whom 201 were boys. The mean (SD) age of the children was 12.2 (±2.1) years. Overall, the mean difference between cycloplegic and non-cycloplegic spherical equivalent (SE) open-field autorefraction measures was 0.34 D (limits of agreement (LOA), 1.06 D to −0.38 D). For myopes, the mean difference between cycloplegic and non-cycloplegic SE was 0.13 D (LOA, 0.63D to −0.36D). The prevalence of myopia was 12% (95% CI, 8% to 15%) using the threshold of cycloplegic SE ≤ −0.50 D, and was 14% (95% CI, 11% to 17%) with SE ≤ −0.50 D using non-cycloplegic refraction. When myopia was defined as SE of ≤−0.75 D under non-cycloplegic conditions, there was no difference between cycloplegic and non-cycloplegic open-field autorefraction prevalence estimates (12%; 95% CI, 8% to 15%; p = 1.00). Overall, non-cycloplegic refraction underestimates hyperopia and overestimates myopia; but for subjects with myopia, this difference is minimal and not clinically significant. A threshold of SE ≤ −0.75 D agrees well for the estimation of myopia prevalence among children when using non-cycloplegic refraction and is comparable with the standard definition of cycloplegic myopic refraction of SE ≤ −0.50 D.

Prevalence of myopia in Indian school children: Meta-analysis of last four decades

Background

India is the second most populated country in the world with 41% of the population (492 million) under 18 years of age. While numerous studies have shown an increasing prevalence of myopia worldwide, there continues to be uncertainty about the magnitude of myopia in Indian school going population.

Design

Systematic review and meta-analysis.

Methods

We systematically identified published literature of last four decades from 1980 to March 2020 and assessed them for methodological quality. Data were gathered into 5-year age groups from 5–15, in urban or rural populations, and standardized to definition of myopia as refractive error ≥ -0.50 dioptre. Random effects meta-analysis was done.

Results

We included data from 59 quality assessed studies, covering nearly 1,66,000 urban and 1,20,000 rural children. The overall crude prevalence of myopia over last four decades is 7.5% (95% CI, 6.5–8.5%) in 5-15-year age group. The prevalence of myopia is 8.5% (95% CI, 7.1–9.9%) in urban and 6.1% (95% CI, 4.5–7.7%) in rural children, with highest prevalence in urban 11-15-year age group [15.0% in last decade]. A significant increment in prevalence is noted in the last decade in rural children from 4.6% to 6.8%, reflecting changing rural environment.

Conclusion

Myopia is an emerging public health problem in both urban and rural school going adolescents in India requiring urgent efforts.