Visual impairment and refractive errors in school children in Andhra Pradesh, India

Universal eye screening: perinatal risk factors and ocular abnormalities in 1795 newborns not meeting retinopathy of prematurity criteria

OBJECTIVES

This prospective cohort study aimed to investigate the ocular outcomes of universal eye screening in newborns and assess the relationship between different perinatal risk factors and various ocular abnormalities in infants who do not meet the criteria for retinopathy of prematurity (ROP) screening.

METHODS

An universal eye screening questionnaire was utilised to screen newborn babies who did not meet the ROP screening criteria within 72 h of birth at a public and private hospital between June 2016 and April 2018. The questionnaire covered demographic characteristics, neonatal history, and eye examination findings. A trained retina specialist conducted comprehensive anterior and posterior segment examinations utilising a binocular indirect ophthalmoscope.

RESULTS

Out of the 1795 newborns screened, 55.2% were male, and 44.8% were female. The most prevalent ocular abnormality observed was retinal haemorrhage (RH), with a prevalence of 10.64% (95% CI: 9.25-12.16%). The prevalence of non-RH abnormality was 7.5% (95% CI: 6.34-8.84%). The retinal haemorrhages were associated with normal vaginal deliveries (OR: 9.91; 95% CI: 6.71-14.64, p-value < 0.001), while non-RH abnormalities were associated with pre-term babies (OR: 4.87; 95% CI: 3.03-7.83, p < 0.001), consanguinity (OR: 2.20; 95% CI: 1.28-3.8, p < 0.001), low birth weight (OR: 0.22; 95% CI: 0.14-0.34, p < 0.001) and systemic abnormalities (OR: 3.08; 95% CI: 1.94-4.91, p < 0.001).

CONCLUSIONS

Sight-threatening ocular pathology in newborns may be linked to perinatal risk factors such as preterm birth, low birth weight, consanguinity, and systemic abnormalities. Accordingly, it may be prudent to consider specialized ocular screening protocols for neonates within this high-risk cohort in future prospective studies.

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.

A review of mechanism of action of outdoor exposure in preventing myopia incidence and progression

Various studies have suggested several environmental, pharmacological, medical, and optical interventions and some are in use but their efficacy in myopia control may be transient, and the cellular, molecular, and biochemical mechanisms involved unclear. Daylight exposure is currently regarded as an effective and enduring strategy in the control of myopia development and progression. However, the mechanism behind the effect of outdoor exposure and its association with genetic predisposition and other relatively more significant environmental factors on myopia is still a conundrum. This review focuses on survey-based and intervention-based studies carried out to propose a mechanism that accounts for myopia development and important for its control.

Approaches for delivery of refractive and optical care services in community and primary care settings

BACKGROUND

Uncorrected refractive error is a leading cause of vision impairment which, in most cases, can be managed with the appropriate spectacle correction. In 2021, the World Health Assembly endorsed a global target of a 40-percentage-point increase in effective coverage of refractive error by 2030. To achieve this global target, equitable access to refractive and optical services within community and primary care settings needs to be strengthened. This review will inform the development of technical guidance to support improvements in the testing and correction of refractive error among World Health Organization (WHO) member states.

OBJECTIVES

To determine the range of approaches for delivery of refractive and optical care services in community and primary care settings, and the methods employed for their evaluation.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and Global Health databases, grey literature, and annual reports and websites of relevant organizations involved in eye-care delivery from January 2002 to November 2022 to identify approaches for refractive and optical service delivery.

SELECTION CRITERIA

We included observational and interventional studies, reviews, and reports from relevant organizations related to delivering refractive services and optical services for preschool and school-aged children and adults in community and primary care settings published between January 2002 and November 2022. We searched for studies and reports published within the last 20 years because vision impairment due to uncorrected refractive error has only recently become a public health and eye health priority, therefore we did not expect to find much relevant literature until after 2002.

DATA COLLECTION AND ANALYSIS

Two review authors screened titles, abstracts and full texts, and extracted data. We resolved any discrepancies through discussion. We synthesized data, and presented results as tables, figures, and case studies. This project was led by the World Health Organization (WHO) Vision and Eye Care Programme.

MAIN RESULTS

We identified 175 studies from searches of databases and grey literature, 146 records from company reports, and 81 records from website searches of relevant organizations that matched our inclusion criteria. Delivery approaches for refractive and optical services in community care included school-based, pharmacy, and outreach models, whereas primary care approaches comprised vision centre, health centre, and a combination of vision or health centre and door-to-door delivery. In community care, school-based and outreach approaches were predominant, while in primary care, a vision-centre approach was mainly used. In the WHO African region, the school-based and outreach approaches were mainly reported while, in the Americas, the outreach approach was mostly used. Very few approaches for service delivery were reported in the WHO Eastern Mediterranean region. Prominent gaps exist in the evaluation of the approaches, and few studies attempted to evaluate the approaches for delivery of refractive and optical care services.

AUTHORS' CONCLUSIONS

We comprehensively describe a range of approaches for delivery of refractive and optical services in community and primary care. Further evaluation of their effectiveness will better inform the application of these service-delivery approaches. The study outcomes will help guide WHO member states in strengthening refractive and optical services at community and primary care levels.

FUNDING

This scoping review was supported by the Vision and Eye care Programme, World Health Organization and ATscale Global Partnership.

REGISTRATION

The protocol of this scoping review was published in the Open Source Framework.

Determination of Refractive Error Using Direct Ophthalmoscopy in Children

Purpose

Refractive error is a major cause of visual impairment in children and its early detection can prevent ocular morbidity such as amblyopia and strabismus. Brückner test is a comprehensive test which can be easily administered in children using a direct ophthalmoscope. We aimed to determine refractive error in children by analysis of the red reflex using modified Brückner test.

Patients and Methods

This prospective observational study was conducted on 683 undilated eyes of 683 children aged four to 10 years. They were evaluated with a direct ophthalmoscope from one meter in a dimly lit room. The characteristics of the red reflex and crescent obtained were compared with photoscreener refraction value and analyzed.

Results

The presence of superior crescent was associated with hypermetropia (Chi square 37.11, p < 0.001, kappa = 0.15) and inferior crescent with myopia (Chi square 157.29, p < 0.001, kappa = 0.477). Superior crescent was 98.4% sensitive in detecting hypermetropia. Hypermetropia greater than +1.5D, was associated with larger superior crescent crossing horizontal midline of pupil (Chi square = 5.29, p = 0.021).

Conclusion

The modified Brückner test is useful in detection and quantification of refractive error in children. It is easy, simple, quick and can be employed in the community as a screening test to detect potentially amblyogenic refractive errors.

Variations in the prevalence of vision impairment across regions among school children in Telangana State, South India

Purpose

Undetected vision impairment (VI) could negatively affect the overall development in children. School vision screening program is a viable and cost-effective approach for the early identification and management of VI.

Aim

This study aims to estimate the prevalence of VI, its risk factors, and ocular morbidity among school children in Telangana, South India.

Methods

Children aged 4-15 years attending schools in the study area were screened in this study. The vision screenings were performed in schools by trained community eye health workers using 6/12 tumbling E optotypes. Children who failed the test and/or presented with other eye conditions were referred to vision centers or secondary and tertiary eye care centers. A comprehensive eye examination was conducted in these centers, including cycloplegic refraction and fundus examination.

Results

A total of 774,184 children, with a mean age of 9.4 ± 3.27 years, were screened. Overall, 51.49% (N = 398,596) were male. In total, 4.33% [N = 33,528; 95% confidence interval (CI): 4.29-4.38] required referral services, while 1.16% (N = 9,002) had a presenting visual acuity of < 6/12. Multivariate analysis showed a high risk of VI among older children [Adj. odds ratio (OR): 5.75; 95% CI: 5.18-6.38], those with disabilities (Adj. OR: 5.12; 95% CI: 4.14-6.33), female gender (Adj. OR: 1.29; 95% CI: 1.24 - 1.35), and those residing in the urban areas (Adj. OR: 2.87; 95% CI: 2.42-3.39). The main cause of VI was uncorrected refractive errors (74.14%).

Conclusion

The prevalence of VI among school children was 1.16% in Telangana, South India, and refractive error was the leading cause of VI among this population. Increasing age, urban location, female gender and other disabilities increase the risk of VI among children.