Indian Journal of Clinical and Experimental Ophthalmology

Print ISSN: 2395-1443

Online ISSN: 2395-1451

CODEN : IJCEKF

Indian Journal of Clinical and Experimental Ophthalmology (IJCEO) is open access, a peer-reviewed medical journal, published quarterly, online, and in print, by the Innovative Education and Scientific Research Foundation (IESRF) since 2015. To fulfil our aim of rapid dissemination of knowledge, we publish articles ‘Ahead of Print’ on acceptance. In addition, the journal allows free access (Open Access) to its content, which is likely to attract more readers and citations of articles published in IJCEO. Manuscripts must be prepared in more...

  • Article highlights
  • Article tables
  • Article images

Article statistics

Viewed: 360

PDF Downloaded: 256


Get Permission Fatima: Refractive errors in children attending ophthalmology clinic of a teaching institute in South India


Introduction

Refractive errors are one of the most common causes of visual impairment around the world and second leading cause of treatable blindness.1 When uncorrected, refractive errors can affect children adversely in the form of learning problems, poor performance at school lowered self-esteem, hampering of day to day activities and hence can affect future of the child. Childhood blindness and visual impairment are important and perhaps more devastating & disabling than adult onset blindness because a child spends twice the number of blind years than a person blind due to cataract.

Studies show that in India 6-7% of children in the age group of 10-15 years have refractive errors affecting their learning at school.2 This study aims to assess the prevalence of various refractive errors in children.

Materials and Methods

This is a hospital based prospective study which was done in children attending ophthalmology OPD of Shadan hospital, Shadan institute of medical sciences which is a teaching institute located in south India.

Study period

June 2021 to June 2022.

Sample size

173 children who fulfilled the inclusion and exclusion criteria were included in the study.

Ethical consideration

The study was done after getting clearance from the institutional ethics committee.

Inclusion criteria

Children aged between 5-12 years with defective vision.

Exclusion criteria

  1. Children <5years and >12 years

  2. Children with strabismus

  3. Children with nystagmus

Data collection

An informed written consent was obtained in every case, and patients with defective vision were subjected to the following tests.

Visual acuity was tested by snellen’s chart. Illiterate E and Lea symbol chart were used in pre school children. It was followed by autorefractometry and wet retinoscopy with the help of 1% cyclopentolate eye drops. The post mydriatic test was carried out on 3rd day of dilatation. The children were categorized into various refractive error subtypes depending on the power of lens that could correct the error. It was as follows:

Low hyperopia upto +2D, moderate hyperopia from +2D to +5D and high hypermetropia as >5D low myopia as <3D, moderate myopia as 3D-6D and high myopia as >6D.

A difference of 0 25D in between 2 principle meridians of the eye was considered astigmatism.

Statistical analysis

Data was entered in MS-excel and analysis was done using SPSS version 20.

Descriptive statistical analysis was done. Results on continuous measurement are represented as mean and standard deviation. Results on categorical measurements are presented as percentages.

Chi square test was used to find out the significance of study parameters on a categorical scale between 2 groups.

Paired t-test was used to find out the significance of study parameters on a continuous scale between 2 groups made under 2 different conditions.

Results

The present study analysed 173 children with refractive errors, aged 5-12 years without any other organic diseases of eye. It was done in the ophthalmology out patient department of Shadan hospital.

Distribution of children according to their age is presented in table 1. The majority of children that were examined were in the age group of 10-12 yrs (58.4%). The least number of children were in 5-7 yrs group (19.1%). Mean age was 9.62 years, with 95% CI of 9.31 to 9.94. The median was 10 years, with SD of 2.09. Minimum age was 5 yrs and maximum was 12 yrs.

Table 1

Age distribution of refractive errors

Age Group

Frequency

Percent

5-7years

33

19.1%

8-9 years

39

22.5%

10-12 years

101

58.4%

Total

173

100%

Table 2

Sex distribution of refractive errors

Sex

Frequency

Percent

Female

99

57.2%

Male

74

42.8%

Total

173

100%

Table 3 shows the sex distribution according to age of children, most of them being females in age group of 10-12yrs, accounting for 61.6% of the total children. The majority of males(54.1%) and females(61.6%) belonged to 10-12 years age group.

Table 3

Sex distribution of refractive errors according to age

Age group

Female

Male

Total

5-7 years

16

17

33

16.2%

23.0%

19.1%

8-9 years

22

17

39

22.%

23.%

22.5%

10-12 years

61

40

101

61.6%

54.1%

58.4%

[i] Chi square value= 1.455 p-value= 0.483 ; statistically not significant

Table 4 represents the frequency and percentage of various refractive errors in study group.the majority fell into myopia group (52%), next being hypermetropia (27.2%) and least, astigmatism accounting for 20.8% of the total refractive anomalies. Among the cases of astigmatism, majority(72.2%) belonged to myopic astigmatism group.

Table 4

Distribution of various refractive errors

Type

Frequency

Percentage

Astigmatism

36

20.8

Myopic

26

72.2

Hyperopic

4

11.1

Mixed

6

16.7

Myopia

90

52.0

Hypermetropia

47

27.2

Table 5 shows the distribution of refractive anomalies according to the sex of children with myopia and astigmatism showing predominance of females 57.6% and 21.2%, respectively and 35.1% males falling into hypermetropia.

Table 5

Distribution of various refractive errors by sex

Refractive error

Male (%)

Female(%)

Total(%)

Myopia

33(44.6)

57(57.6)

90(52.0)

Hypermetropia

26(35.1)

21(21.2)

47(27.2)

Astigmatism

15(20.3)

21(21.2)

36(20.8)

Total(%)

74(100)

99(100)

173(100)

[i] Chi square value = 4.411 p-value=0.110; statistically not significant

Table 6 shows distribution of refractive anomalies according to various age groups. Myopia was found to be more common in 10-12 years of age group accounting for 72.2% of all myopic children and 37.5% of all refractive errors with p-value of <0.01 which is statistically significant. Astigmatism was the least common in 5-7 (5;15.2%) and 8-9 (9;23.1%) age groups. Hypermetropia accounted for least number of refractive anomalies among 10-12 years group (14;13.9%).

Table 6

Distribution of refractive errors by age groups

Variable

Age group

Total (%)

5 to 7 (%)

8 to 9 (%)

10 to 12 (%)

Astigmatism

5(15.2)

9 (23.1)

22(21.8%)

36(20.8)

Myopia

6(18.2)

19(48.7)

65(64.4)

90(52.0)

Hypermetropia

22(66.7)

11(28.2)

14(13.9)

47(27.2)

[i] Chi square value = 36.499;   p-value<0.01; Statistically significant

It shows that highest parental association rate is present in myopia (55.5%).

Table 7

Parental association in various refractive errors

Refractive error

Parental association

Percentage

Myopia

39

57.4%

Hyperopia

14

20.6%

Astigmatism

15

22.1%

[i] Chi-square value = 2.481, p-value = 0.289 ; statistically not significant.

Mean refractive error was -1.047 with 95% CI of -1.32 to -0.77. The SD was - 2.57 with minimum value of -10.5 maximum value of 5.75 and median of -0.75.

Low myopia (<3D) was the most common (66;38.1%), with females contributing to most of them (42;24.2%). Least were children with high hypermetropia with only one male child.

Discussion

Screening and diagnosis of refractive abnormalities must be carried out in children from a very young age as when undetected and uncorrected they remain a significant cause of amblyopia and strabismus. It is important to timely determine the existence, amount and difference of refractive anomalies in both eyes in this vulnerable population.

Refraction of the eye changes through-out life. During the growth of the eye, the process of emmetropization normally occurs i.e., harmonization of refractive and axial parameters and formation of emmetropic relations within normal biological variation.

Refractive errors are among the leading causes of visual impairment worldwide and are responsible for high rates of low vision and blindness in certain areas. The refractive error study in children in China3 Chile4 and Nepal5 is the first multicountry population based assessment of refractive errors in children. The data reveals that there are significant and large geographic differences in the prevalence of refractive errors and that uncorrected refractive errors are very common.

Our study investigated the most common type of refractive error and its correlation with age and gender of the study population. In our study, myopia was found to be the most common refractive error (52.0%), followed by hyperopia (27.2%) and least number of cases were astigmatic (20.8%). Findings from some studies from different countries like China,3 Chile,4 Kenya,6 Malawi,7 India,8, 9, 10 and Nepal5 have shown similar results i.e.,myopia was the most common type of refractive error.

This consistent lower prevalence of hypermetropia in school going children is due to the emmetropization process of the eye and the children experience loss of hypermetropia after 6 to 8 yrs of age.11, 12

Ali in Pakistan reported a positive familial history of wearing spectacles at 57% and indicates a very strong relationship between refractive errors and hereditary or familial factors.13

Conclusions

Myopia was the most common type of refractive error and there is no statistical significance of the relation between sex and type of refractive error.

  1. Myopia is the most common refactive error in age group of 10-12 years and it is statistically significant.

  2. Myopia had a positive parental association in more than half of cases.

  3. Myopic astigmatism is the most common variety of astigmatic cases.

Limitations

This was a hospital based study and hence not representative of the real community and world scenario. School screening programmes and community screening has to be done in order to bring out the real picture.

Source of Funding

None.

Conflicts of Interest

None.

Acknowledgements

I am thankful to all the participants and the staff and administration of Shadan institute of Medical Sciences for extending support in my study.

References

1 

A Koroye-Egbe G Ovenseri-Ogbomo A Adio Refractive error status in Bayelsa state, NigeriaJ Niger Optom Assoc2010161116

2 

Government of India (2004), Annual report 2003-2004, ministry of health and family welfarehttps://nhm.gov.in/images/pdf/media/publication/Annual_Report-Mohfw.pdf

3 

J Zhao X Pan R Sui SR Munoz RD Sperduto LB Ellwein Refractive error study in children: results from Shunyi district, ChinaAm J Ophthalmol2000129442735

4 

E Maul S Barroso SR Munoz RD Sperduto LB Ellwein Refractive error study in children: results from La Florida, ChileAm J Ophthalmol2000129444554

5 

PP Goh Y Abqariyah GP Pokharel LB Ellwein Refractive error and visual impairment in School-Age Children in Gombak District, MalaysiaOphthalmology 2005112467885

6 

KJ Nzuki S Masinde Significant refractive error as seen in standard eight attending public schools in Langata DivisionJ East Afr Ophthalmol200612134

7 

V Msiska M Njuguna MM Kariuki Magnitude and pattern of significant refractive error in primary school children of Ntcheu, a rural district in MalawiEast Afr Ophthalmol20091511820

8 

S Matta P Matta V Gupta A Dev refractive error among adolescents attending Ophthalmology opdIndian J Community Med2006312114

9 

J Costa R Lindfield Prevalence of refractive errors in children age 11 to 15 years old and uptake of prescribed spectacles2009www.ishtm.ac.uk

10 

AS Padhye R Khandekar S Dharmadhikari K Dole P Gogate M Deshpande Prevalence of uncorrected refractive error and other eye problems among Urban and Rural school childrenMiddle East Afr J Ophthalmol20091626974

11 

AK Khurana Theory and practice of optics and refraction2nd EdElsevierIndia20086280

12 

R Dandona L Dandona M Srinivas P Sahare S Narsaiah SR Muñoz Refractive Error in Children in a Rural Population in IndiaInvest Ophthalmol Vis Sci200243361522

13 

A Ali I Ahmad S Ayud Prevalence of undetected refractive error among school children. EBiomedica20072396101



jats-html.xsl


This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Article type

Original Article


Article page

374-377


Authors Details

Kaneez Fatima*


Article History

Received : 29-08-2022

Accepted : 05-09-2022


Article Metrics


View Article As

 


Downlaod Files