Profile of ocular conditions from school eye screening in Southern India

Purpose:To profile the presentation of ocular conditions among school children aged 6 to 17 years from the south Indian state of Tamil Nadu.Methods:The study was conducted as part of a school eye health program in Kanchipuram district, Tamil Nadu that aimed to address the refractive needs of children (6–17 years) between July 2016 and June 2019. The study followed a three-phase protocol, which included visual acuity test, modified clinical test, color vision test, binocular vision assessment, objective and subjective refraction, dispensing spectacles, posterior segment evaluation using direct ophthalmoscopy, and referral to the base hospital. The demographics, clinical details, and ocular conditions (classified under 16 categories) were analyzed. Profiling and association of ocular conditions among different locations, types of schools, class grades, and gender were presented.Results:Data of 2,45,565 children were analyzed from 1,047 schools, of which 4,816 (1.96%) children were identified with ocular conditions other than refractive errors. The common reasons for referral were high myopia 901 (0.37%), strabismus 819 (0.33%), and amblyopia 691 (0.28%). Retinal problems (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.22–2.22, P = 0.001) and strabismus (OR: 1.41, 95% CI: 1.21–1.65, P < 0.001) were the conditions prevalent in the rural location. Cataract and related conditions (OR: 5.73, 95% CI: 4.10–8.01, P < 0.001) and retinal problems (OR: 4.76, 95% CI: 3.37–6.72, P < 0.001) were common in children studying in public schools. Of the 16 categories, 13 conditions were seen among primary school children. Vernal keratoconjunctivitis (OR: 3.64 95% CI: 2.12–6.23 P < 0.001) was common among males.Conclusion:The study profiled ocular conditions among school children. Most ocular conditions warrant prolonged care and specialty eye care services. Ensuring the availability of such services and follow-up after school eye screening would safeguard the visual development of these children.     

Prevalence of color vision deficiency among school-going boys in South India

Purpose:Impact of color vision deficiency (CVD) on activities at school and productivity at work and consequential psychosocial difficulties has been reported. Although early detection and awareness help in overcoming these difficulties, screening for CVD is not a part of the school eye-screening initiatives in many countries. This study aimed at reporting the prevalence of CVD among school-going boys in Kanchipuram district, South India.Methods:The study was carried out as part of a school eye-screening program (SES) conducted in Kanchipuram district, Tamil Nadu, India for children between 6 and 17 years. The SES followed a three-phased protocol, which also included screening for CVD for all the boys between 11 and 17 years. The boys underwent CVD screening with Dalton''s pseudo isochromatic plates (PIPs) followed by confirmation with Ishihara''s PIP. The data were analyzed and the proportion of CVD in boys among different class grades, type of schools, location of schools, blocks of the district, and other clinical characteristics are presented.Results:Totally 250,052 children were screened in 1047 schools of which 74986 (60.61%) were boys between 11 and 17 years (mean age: 13.75 ± 1.91). The overall prevalence of CVD was found to be 2.76% (n = 2073; 95% confidence interval [CI]: 2.65–2.88). CVD was associated with urban locations (3.17% odds ratio [OR]: 1.90 95%CI: 1.69–2.13 P < 0.05) and public schooling (2.87%) (OR: 1.29 95%CI: 1.17–1.43 P < 0.05). Boys with CVD were less likely to have vision impairment (P = 0.002) and myopia (P < 0.001) as compared with boys with normal color vision. There was no significant difference in the proportion of other ocular conditions between children with and without CVD (P > 0.05).Conclusion:The study shows a significant proportion of CVD among boys in Kanchipuram district, India and its association with various demographic and clinical characteristics. Identification of CVD and counseling the stakeholders earlier through school children screening is crucial.     

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

Purpose:Addressing childhood vision impairment (VI) is one of the main goals of the World Health Organization’s (WHO) combating blindness strategies. The primary aim of this study was to estimate the prevalence of VI, causes, and its risk factors in school children in Krishna district, Andhra Pradesh, India.Methods:Children aged 4–15 years were screened in schools using the 6/12 Snellen optotype by trained community eye health workers, and those who failed the test and those reported or found to have obvious eye conditions were referred to primary (VC), secondary (SC), or tertiary (TC) care centre appropriately, where they underwent a complete eye examination including cycloplegic refraction and fundus examination.Results:A total of 56,988 children were screened, of whom 51.18% were boys. The mean age was 9.69 ± 3.26 years (4–15 years). Overall, 2,802/56,988 (4.92%) children were referred to a VC, of which 632/56,988 (1.11%) required referral to SC/TC. PVA of <6/12 was found in 1.72% (95% confidence interval [CI]: 1.61–1.83). The prevalence of refractive error (corrected and uncorrected) was 2.38% (95% CI: 2.26–2.51) and myopia was 2.17% (95% CI: 2.05–2.29). In multivariable analysis, older children, those in urban schools, private schools, and children with a disability had an increased risk of VI and myopia. Additionally, the risk of myopia was higher among girls than boys. Of those referred and reached SC/TC, 73.64% were due to avoidable causes.Conclusion:Childhood VI prevalence was 1.72% in this region. Uncorrected refractive error (URE) was the major cause of VI in children. Older age, schools in urban locations, private schools, and the presence of disability were associated with the risk of VI among children.     

Visual impairment in children with multiple disabilities in schools for children with special needs in South India

Purpose:To understand/assess ocular and functional vision impairment in children with multiple disabilities with a functional vision assessment battery in addition to standard ophthalmic examinations in an outreach setting.Methods:Seven schools for children with special needs, 243 children in total, were screened for ocular disorders and functional vision impairment through school camps.Results:Among them, 37% had refractive errors needing spectacle correction. With standard ocular testing methods, the visual impairment was around 32%, but when functional vision was assessed, the functional vision impairment amounted to 70% in these children. The presence of functional vision impairment was found to be independent of the associated disability. Assessment of visual capacities such as visual closure, saccade pursuits, optic ataxia, and developmental milestones early on can help in suspecting the presence of CVIConclusion:Children with multiple disabilities are more at risk of functional vision impairment, which significantly impairs their ability to function in daily life. A complete functional vision assessment becomes essential to plan early intervention for these children. The significant proportion of vision impairment and functional vision loss in our study indicates the need for coordinated structured programs to address vision-related problems in children with multiple disabilities.     

Burden of ocular morbidities and color blindness among school-attending children in a foothill town of Uttarakhand State

Purpose:To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India.Methods:A cross-sectional study was conducted among school-going children of age group 6–16 years of standard I–XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value <0.05.Results:In total, 13,492 students (mean age 10.9 ± 2.7 years) with almost equal male to female ratio were screened. Overall prevalence of ocular morbidity was 23.2%, with refractive error (18.5%) on top, followed by color blindness (2.2%). The later was observed more among males (3.0%) as compared to females (1.4%) with significantly higher odds, OR = 2.3 (1.7–2.9) (P < 0.001).Conclusion:Refractive error has been the most common ocular morbidity, followed by color blindness. Earliest detection can prevent permanent disability and disappointment among youngsters when rejected from entering certain professions due to color vision defect.     

Eye care seeking behavior among rural adults in South India: Tamil Nadu Rural Eye Examination (TREE) Study Report 1

Purpose:To present the eye care seeking behavior among rural adults in South India.Methods:This cross-sectional study was conducted between 2019 and 2020 covering three blocks of the Thiruvannamalai district, Tamil Nadu, India. Door-to-door survey was performed to collect demographic information, status of literacy, occupation, and details of previous eye examination. Distance visual acuity was tested for individuals available in the house using a log MAR (logarithm of minimum angle of resonance) chart. Association between demographic details, details of previous eye examination, and status of vision was analyzed using logistic regression.Results:A data of 12,913 individuals were included for the analysis, of which 6460 (50.03%) were females. Of the total individuals, 2007 (15.54%) had undergone an eye examination previously. There were 1639 (28.50%) people who had a vision less than 0.2 log MAR in at least one eye. The odds of reported ‘previous eye examination’ were more among females [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.32–1.66, P < 0.001]; individuals aged above 60 years [OR: 11.46, 95% CI: 9.44–13.91, P < 0.001], between 40 and 60 years [OR: 10.43, 95% CI: 8.85–12.30, P < 0.001], and between 18 and 40 years [OR: 2.48, 95% CI: 2.16–2.84, P < 0.001]; illiterates (OR: 1.76, 95% CI: 1.45–2.15, P < 0.001); and farmers (OR: 1.32 95% CI: 1.12–1.55, P = 0.001).Conclusion:The study presents the utilization of eye care among rural South Indian adults. Almost 84.46% of individuals had not undergone any eye examination. Robust measures to promote eye care management would help in effective utilization of eye care services among rural adults.     

Vision centre helps reduce blindness and vision impairment. Proof of concept in a four-year longitudinal study in an urban area in India

Purpose:To estimate the prevalence of blindness and severe visual impairment (SVI) by using a door-to-door screening and vision center (VC) examination strategy in an urban area in western Maharashtra (Pune), India and repeat the exercise after 4 years to study its impact.Methods:Four trained community health workers measured the visual acuity and performed an external ocular examination in patients’ homes. People with vision <6/18 were requested to visit the VC for a comprehensive eye examination by an optometrist. An ophthalmologist examined people whose vision did not improve to 6/12. A home examination was done for people who did not visit the VC despite two requests. The same population was examined twice in an interval of 4 years.Results:In the study, 44,535 people in 2015–16 and 98.14% (n = 43,708) of them in 2018–19 were examined. Blindness (vision < 3/60 in better eye), and moderate-to-severe visual impairment (MSVI, vision 6/18–6/60 in better eye) were 0.26% and 1.3%, respectively, in the first cohort, and 0.16% and 1.1%, respectively, in the second cohort (P < 0.001). When the worse eye was considered, the prevalence of blindness reduced from 0.72% to 0.44%, SVI reduced from 0.1% to 0.07%, and MVI decreased from 1.7% to 1.49% between 2015 and 2019 (P < 0.001). Females (P < 0.001) and older individuals (P < 0.001) were more likely to have blindness or SVI. In the VC, 8211 people were examined in 4 years.Conclusion:The reduction of blindness and MSVI in the urban area of Pune can be partly ascribed to the presence of a VC and attendant screening in this locality.     

Comparison of Binocular Vision Parameters Pre- and Post-EPILASIK Laser Vision Correction Surgery for Myopia in a Pilot Study – Can Vision Therapy Augment Refractive Results?

Purpose:To analyze the changes in the binocular vision parameters after bilateral Epilasik laser vision correction surgery (LVCS).Setting:Medical Research Foundation, Tamil Nadu, India.Study design:Prospective cohort study.Methods:Subjects with a best corrected visual acuity of ≤ 0.0 Log MAR scale and refractive error: < 6.00DS of myopia, < 0.75D of astigmatism, and < 1D of anisometropia were included in the study. All subjects underwent a comprehensive eye examination, LVCS workup which included corneal topography, tomography, aberrometry, and dry eye assessment prior to binocular vision assessment. Complete Binocular vision assessment which included stereopsis, fusion for distance and near, near point of convergence, phoria measurement, vergence amplitudes and facility, accommodative amplitudes, response, and facility was performed with the best corrected vision prior to LVCS, one month and six months after the surgery.Results:Twenty-five subjects of age 23.8 ± 2.9 years were included. Age ranged from 20 to 32 years. Ten were female and 15 were male. The median spherical power was –2.00DS with an inter quartile range (IQR) of –1.50DS to –3.00DS for both eyes. The median cylindrical power was plano with IQR –0.50DC to –1.00DC for both eyes. There was a statistically significant decrease in monocular and binocular accommodative amplitudes (accounting for age-related changes) as well as positive fusional vergence recovery for near between baseline and one month after surgery (p < 0.05).Conclusion:Though subjects were asymptomatic post LVCS, still there is an indication that myopic LVCS could precipitate or aggravate an existing non-strabismic binocular vision anomaly. Comprehensive binocular vision assessment and appropriate management is recommended before and after LVCS.     

Global burden of paediatric vision impairment: a trend analysis from 1990 to 2017

ObjectiveTo assess the trend of paediatric visual impairment and its disparities by year, sex, age and national socioeconomic levels using disability-adjusted life years (DALYs).MethodsIt is a retrospective analysis of data from the Global Burden of Disease (GBD) 2017. Global and national DALY numbers and rates of vision impairment in three paediatric age groups of 1–4 (preschool children), 5–9 (school children) and 10–14 years (teenagers) years were obtained from the GBD 2017 database. The socioeconomic indices for 195 countries were derived from international open databases. Main outcome measures were comparison of DALYs due to paediatric vision impairment in different age groups by socioeconomic indicators in 2017 and analysis of the trend from 1990.ResultsThe global prevalence of distance and/or near vision impairment for 1–14 years was 2.8% (95% uncertainty interval (UI): 2.5–3.1) in 2017. The highest DALYs for distance and/or near vision impairment [number=589.93 thousands (95%UI: 367.71–933.29), rate = 92.72 (95%UI: 57.79–146.68)] were observed in teenagers. DALY rate of distance and/or near vision impairment was not associated with socioeconomic indicators, however, DALY rate of refractive disorders had positive correlation with national socioeconomic development. The global trends of DALY numbers in distance and/or near vision impairment as well as refractive and other causes remained stable from 1990 to 2015 (0.128 ≤ P ≤ 0.738), however, DALY rates had a statistically significant trend of reduction in all paediatric age groups (0.003 ≤ P ≤ 0.024).ConclusionThe global health burden of paediatric vision impairment decreased from 1990. Refractive, near vision impairment and other causes were associated with socioeconomic development.Subject terms: Eye abnormalities, Paediatrics     

Rationale,Design, and Demographic Characteristics of the Handan Offspring Myopia Study

Abstract

Purpose: The Handan Offspring Myopia Study (HOMS) aims to investigate the familial associations of myopia between parents and their offspring.

Methods: Children aged 6–18 years, residing in 6 villages where all people aged ≥30 years had participated in The Handan Eye Study in 2006–2007, were selected for the current eye study between March and June 2010. A mobile clinic was set up in the 6 villages for comprehensive eye examinations, including visual acuity, ocular biometry, cycloplegic autorefraction and retinal photography.

Results: Of 1238 eligible individuals, 878 children (70.2%; 52.6% male) from 541 families were recruited. Mean age of the children was 10.5?±?2.5 years. The prevalence of myopia (spherical equivalent refraction <?0.5 diopter) was 23.5% (males 16.8%, females 30.8%). The prevalence of low vision (presenting visual acuity ≥20/400 but <20/60) in the better eye was 7.1%. A higher number of females had low vision at the time of presentation (9.2%) compared to males (5.2%, p?=?0.02). The prevalence of low vision in the worse eye was 10.6% (males 6.7%, females 14.9%, p?<?0.001). The majority of visual impairment in the better-seeing (56/62, 90.3%) as well as the worse-seeing (84/93, 90.3%) eye was correctable.

Conclusions: The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China. Results from the HOMS will provide key information about the prevalence of refractive errors and eye diseases in rural Chinese children.     

A comparative clinical survey of the prevalence of refractive errors and eye diseases in urban and rural school children

Objective: To assess the prevalence of refractive error and common ocular diseases in school-aged children in urban and rural populations in and around Hyderabad, India.Design: Population-based, cross-sectional study. Participants: A total of 3314 school children, 1789 from urban areas and 1525 from rural areas.Methods: The examination included visual acuity measurements, retinoscopy and autorefraction under cycloplegia, examination of the anterior segment and external eye, and ocular motility evaluation.Results: In the urban group the prevalence of uncorrected presenting and best-corrected visual impairment (≤20/40 in the better eye) was 9.8%, which dropped to 7.1% with presenting vision and was further reduced to 1.1% with best-corrected visual acuity. Uncorrected visual acuity in the rural group was 6.6%, which dropped to 3.3% with presenting vision and was further reduced to 2.5% with best-corrected visual acuity. The prevalence of refractive error was greater (25.2%) in the urban than the rural group (8%). Myopia measured with autorefraction was observed in 51.4% of urban children and 16.7% in rural children. Increased literacy rate, duration of study hours, and older age of the child were found to have contributed more to the prevalence of myopia in the urban group. Hyperopia with autorefraction was found to be 3.3% in the urban and 3.1% in the rural group. Hyperopia was associated with younger age in the study group. Trachoma was the leading cause of ocular morbidity in the rural group (3.5%) compared with the urban group (0.16%). Night blindness was reported in 3.2% of children in the rural group and 0.33% in the urban group. Vitamin A deficiency, low socio-economic status, and poor personal and environmental hygienic practice were found to have a positive correlation with ocular morbidity among rural group children.Conclusions: Provision of health education, periodic visual screening programs, and primary eye care by trained health care personnel in the elementary schools will prevent the prevalence of refractive errors and common ocular diseases in school children.     

Causas de la baja visión en los niños: revisión sistemática

ObjectiveTo identify the ocular pathologies that are reported as causes of low vision in children.Material and methodsThe systematic search was carried out in Medline (PubMed), Embase and Lilacs. Observational studies with populations between 0-18 years of age, reporting visual acuity data between 20/60-20/400 and reporting the frequency of ocular pathologies were selected. Studies in which the diagnosis of the condition had not been verified by a professional, or which covered only cases of blindness, uncorrected refractive errors, or amblyopia, were excluded. The methodological quality of the articles was evaluated using the Joanna Briggs Institute instrument for prevalence studies.Results27 studies conducted in Asia (13 publications), Africa (6 studies), Oceania (4 studies), Europe and South America (2 studies each) were included. The most reported causes of low vision were: cataract, with prevalence between 0.8% and 27.2%; albinism with from 1.1% to 47%; nystagmus, with prevalence between 1.3% and 22%; retinal dystrophies between 3.5% and 50%; retinopathy of prematurity (ROP) with prevalence between 1.1% and 65.8%, optic atrophy between 0.2% and 17.6%, and glaucoma from 2.4% to 18.1%.ConclusionsCataract, albinism and nystagmus are the ocular pathologies most mentioned by studies as a cause of low vision in children, as well as retinal diseases such as ROP and optic nerve diseases such as atrophy. However, there are numerous eye conditions that can result in low vision in the pediatric population.     

Visual impairment and the prevalence of ocular pathology in homeless children and adults globally: a systematic review

BackgroundHomelessness is a global issue in developing and developed countries. This article is the first systematic review to explore its impact on visual health globally.MethodsA systematic literature search was conducted on OVID MEDLINE, EMBASE, and Cochrane CENTRAL. Peer-reviewed English-language studies with a focus on homeless children or adults that reported on ocular outcomes were included. Primary outcomes and secondary endpoints were reported via weighted averages. Primary outcomes between homeless children and homeless adults were compared using the Fisher exact test.ResultsThere were 5774 individuals across 23 full-text articles included in the review. For studies reporting primary outcomes, 36.8% of homeless individuals self-reported dissatisfaction with their vision, 26.8% self-reported a previous ocular pathology, 26.3% had uncorrected refractive error, 25.6% were functionally visually impaired, 9.2% had at least one previous eye surgery or procedure, and 4.0% had nonrefractive visual impairment. Upon screening, 25.1% of homeless individuals had some type of ocular pathology, which included cornea and external eye diseases (13.4%), glaucoma (7.4%), cataracts (6.3%), retinal diseases (5.3%), ocular motility disorders (4.7%), trauma (2.3%), neuro-ophthalmological conditions (1.7%), and oculoplastic conditions (0.7%). Homeless adults had significantly more visual impairment (p < 0.001), uncorrected refractive error (p < 0.001), ocular pathology (p < 0.001), cataracts (p < 0.001), retinal pathology (p < 0.001), and neuro-ophthalmological conditions (p < 0.001) relative to children.ConclusionsVisual impairment in homeless individuals is higher than the general population. Uncorrected refractive error is a leading cause of visual impairment in this population. Additionally, homeless adults have significantly more visual impairment and ocular pathology than homeless children. Future studies should also explore if these differences are consistent in developing countries and investigate ways to increase eye care access for homeless individuals.     

Association Between Color Vision Deficiency and Myopia in Chinese Children Over a Five-Year Period

PurposeTo explore the relationship of color vision deficiency with myopia progression and axial elongation in Chinese primary school children during a five-year cohort study.MethodsA total of 2849 grade 1 students (aged 7.1 ± 0.4 years) from 11 primary schools were enrolled and followed up for five years. Cycloplegic autorefraction and axial length were measured annually. Color vision testing was performed using Ishihara''s test and the City University color vision test.ResultsThe prevalence of color vision deficiency was 1.68%, with 2.81% in boys and 0.16% in girls. Color-deficient cases consisted of 91.6% deutan and 8.3% protan. Over the five years, the cumulative incidence of myopia was 35.4% (17/48) in the color-vision deficiency group, which was lower than the 56.7% (1017/1794) in the color normal group (P = 0.004). Over the five-year study period, the change in spherical equivalent refraction in the color vision–deficiency group (−1.81 D) was also significantly lower than that in the color normal group (−2.41 D) (P = 0.002).ConclusionsThe lower incidence and slower progression of myopia in children with color-vision deficiency over the five-year follow-up period suggest that color-deficient individuals are less susceptible to myopia onset and development.     

Myopia prevalence and ocular biometry: a cross-sectional study among minority versus Han schoolchildren in Xinjiang Uygur autonomous region,China

ObjectivesTo describe and compare the prevalence of refractive error and its associated ocular biometric parameters in a large multi-racial sample of schoolchildren from Xinjiang.MethodsA total of 67,102 school children of five ethnicity groups aged 6–23 years from 46 schools in Xinjiang participated in this study. The children underwent a comprehensive eye examination for vision screening, including uncorrected visual acuity and standardized refraction. Refractive error was determined by autorefractors and subjective refraction. Refraction was recorded in spherical equivalent (SE). The age- and sex- adjusted prevalence of myopia (SE ≤ −0.5 D), low myopia (−6 D < SE ≤ −0.5 D), high myopia (SE ≤ −6.0 D), astigmatism (cylinder < −0.5 D), and anisometropia (difference in SE between two eyes of 1.0 D) in the five ethnic groups were calculated. Ocular biometric parameters including axial length (AL) and corneal radius of curvature (CR) were measured by AL-scan optical biometer.ResultsThe age- and sex- adjusted prevalence of myopia in the Han, Hui, Uyghur, Kyrgyz and Kazakh were 65.8% (95% confidence interval [CI] 65.4, 66.3); 59.1% (95% CI 57.8, 60.4); 30.1% (95% CI 29.2, 30.9); 30.2 (95% CI 28.9, 31.4); and 30.0% (95% CI 27.6, 32.3), respectively. The Han and Hui children also had longer ALs (Han, 23.8; Hui, 23.6, Uyghur, 23.1; Kyrgyz, 23.1; Kazakh, 23.3 mm) and larger AL/CR (Han, 3.04; Hui, 3.00; Uyghur, 2.95; Kyrgyz, 2.96; Kazakh, 2.97) values than the other three minorities (P < 0.01). Overall, girls had shorter ALs, steeper corneas, and smaller AL/CR values than boys (P < 0.01).ConclusionsSignificant ethnic difference in the prevalence of myopia was observed in this study on school-aged children in Xinjiang (Han > Hui > Kyrgyz > Uyghur > Kazakh). This study among different ethnic groups in a multiethnic population is valuable for enriching the ethnical information resources for refractive errors and ocular biometry parameters, as well as facilitating further research on myopia-related diseases and risks.Subject terms: Epidemiology, Refractive errors