Disease‐Associated Visual Image Degradation and Spherical Refractive Errors in Children

Emmetropization is the reduction in neonatal refractive errors that occurs after birth. Ocular disease may affect this process. We aimed to determine the relative frequency of ocular conditions causing vision impairment in the pediatric population and characterize the refractive anomalies present. We also compared the causes of vision impairment in children today to those between 1974 and 1981. Causes of vision impairment and refractive data of 872 children attending a pediatric low-vision clinic from 1985 to 2002 were retrospectively collated. As a result of associated impairments, refractive data were not available for 59 children. An analysis was made of the causes of vision impairment, the distribution of refractive errors in children with vision impairment, and the average type of refractive error for the most commonly seen conditions. We found that cortical or cerebral vision impairment (CVI) was the most common condition causing vision impairment, accounting for 27.6% of cases. This was followed by albinism (10.6%), retinopathy of prematurity (ROP; 7.0%), optic atrophy (6.2%), and optic nerve hypoplasia (5.3%). Vision impairment was associated with ametropia; fewer than 25% of the children had refractive errors < or = +/-1 D. The refractive error frequency plots (for 0 to 2-, 6 to 8-, and 12 to 14-year age bands) had a Gaussian distribution indicating that the emmetropization process was abnormal. The mean spherical equivalent refractive error of the children (n = 813) was +0.78 +/- 6.00 D with 0.94 +/- 1.24 D of astigmatism and 0.92 +/- 2.15 D of anisometropia. Most conditions causing vision impairment such as albinism were associated with low amounts of hyperopia. Moderate myopia was observed in children with ROP. The relative frequency of ocular conditions causing vision impairment in children has changed since the 1970s. Children with vision impairment often have an associated ametropia suggesting that the emmetropization system is also impaired.

To describe the distribution of refractive errors by age and sex among schoolchildren in Soacha, Colombia. This was an observational cross-sectional study conducted in five urban public schools in the municipality of Soacha. A total of 1161 school-aged and pre-adolescent children, aged 5-12y were examined during the school year 2021-2022. Examinations included visual acuity and static refraction. Spherical equivalent (SE) was analysed as follows: myopia SE≤-0.50 D and uncorrected visual acuity of 20/25 or worse; high myopia SE≤-6.00 D; hyperopia SE≥+1.00 D (≥7y) or SE≥+2.00 D (5-6y); significant hyperopia SE≥+3.00 D. Astigmatism was defined as a cylinder in at least one eye ≥1.00 D (≥7y) or ≥1.75 D (5-6y). If at least one eye was ametropic, children were classified according to the refractive error found. Of the 1139 schoolchildren included, 50.6% were male, 58.8% were aged between 5 and 9y, and 12.1% were already using optical correction. The most common refractive error was astigmatism (31.1%), followed by myopia (20.8%) and hyperopia (13.1%). There was no significant relationship between refractive error and sex. There was a significant increase in astigmatism (P<0.001) and myopia (P<0.0001) with age. Astigmatism is the most common refractive error in children in an urban area of Colombia. Emmetropia decreased and myopia increased with age.

The long-term outcome of the refractive error in hypermetropic children

Retrospective clinical data from 496 eyes of 256 children attending a low vision clinic were analyzed to determine the relation between different classes of disease that involve visual image degradation and astigmatism. Control data comprised refractions from 79 normal vision children. Children were classified into groups according to the category of disease (14 groups) and the reported age-of-onset of their visual disability (0 to 13 years, 5 groups). The mean astigmatism for all groups of children with low vision was larger than that of the normals and in most cases the difference was significant at the 95% level. Astigmatism was highest in children with albinism, retinitis pigmentosa, and idiopathic nystagmus. Increased prevalence of astigmatism compared to normals was noted in children having their onset of low vision as late as 13 years of age. In the low vision subjects with-the-rule astigmatism occurred more frequently than oblique or against-the-rule astigmatism and oblique astigmatism more frequently than against-the-rule astigmatism.

PurposeTo compare the patterns of longitudinal refractive error development during the first 3.5 years in children with severe retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB) or laser photocoagulation.MethodsThis prospective cohort study enrolled extremely preterm infants (birth weight < 1000 g, gestational age 23–27 weeks) with type 1 ROP from multiple hospitals in Dallas between 1999 and 2017; IVB group (N = 22); laser group (N = 26). Cycloplegic retinoscopy was conducted from 0.04 years corrected age and every 0.5 to 1.0 years thereafter until 3.5 years old. Right eye spherical equivalent (SEQ) and astigmatism, anisometropia, and better-eye visual acuity were analyzed over time.ResultsIn all children, both eyes were treated with the same modality. At the final visit, the prevalence of myopia (SEQ ≤ −1D) was 82.7% in the laser group and 47.7% in the IVB group (P < 0.05) with a mean SEQ of −8.0D ± 5.8D in the laser group versus −2.3D ± 4.2D in the IVB group (P < 0.001). Longitudinal SEQ were best fit with a bilinear model. Before one year, the rate of SEQ change was −5.0D/year in the laser group, but only −3.5D/year in the IVB group (T = −5.14, P < 0.001); after one year, there was a significant flattening of these slopes (T = 6.23, P < 0.001). Anisometropia in the IVB group was significantly less than in the laser group (P < 0.05). Final visual acuity in both groups was similar at 0.47 logMAR (∼ 20/60).ConclusionsChildren with severe ROP treated with IVB developed less myopic refractive error than those treated with laser largely because of a slower rate of refractive change during the first year of life.Translational RelevanceThese findings may inform decisions regarding ROP treatment timing and modality.

Various studies have explored the relationship between visual impairment and poverty. This study aims to enrich understanding on the relationship between poverty and visual disability in the Indonesian context. This study uses data from Wave 5 of the Indonesian Family Life Survey (IFLS), focused on individuals aged 25 and above in 2014. The method used in this study consists of descriptive analysis and logistic regression. This study found that there is no relationship between poverty and visual impairment. The empirical result shows that people who experienced visual disability tend to have a lower probability of being poor in 2014 compared to people without visual disability. Poor persons also have lower probability to be visually disabled in 2014. This finding tends to be slightly different from previous research which showed the bidirectional relationship between poverty and visual disability. This difference might be due to the indicator of visual disability used in this study. Based on the IFLS data, people with visual disability come from a non-poor family so that they were able to perform medical check up, including eye health check. The results of this study indicate that a person with visual disability is capable of performing various activities, including productive activities. They are also able to work and create income. Thus, there is the possibility that they do not experience severe visual disability

Purpose: To identify factors which affect mesopic pupil diameter in refractive surgery patients.Setting: This retrospective study was performed at the 1st Ophthalmology Clinic in Ankara Ataturk Training and Research Hospital, Ankara, Turkey.Methods: Medical records of 412 refractive surgery candidates who applied between 2006 and 2008 were reviewed. Detailed ophthalmological examination data were obtained from medical records. Pupil size measurements were performed with a COAS Ocular Wavefront analyzer in mesopic conditions. Relationship between mesopic pupil diameter and age, sex, spherical refractive error (D), magnitude of astigmatism (D), type of astigmatism, spherical equivalent, and average keratometry were analyzed by means of univariate and multivariate regression analyses.Results: Mean mesopic pupil diameter was 6.19 ± 0.88 mm. Mean pupil diameter (mean ± standard deviation) was 5.70 ± 1.01 in hypermetropia, 6.04 ± 0.79 mm in mixed astigmatism, and 6.33 ± 0.82 mm in myopia. The difference in mean mesopic pupil diameters between myopes and hypermetropes was statistically significant (p = 0.001). However, differences with regard to mean pupil diameters between myopes and mixed astigmatism (p = 0.660) and between hypermetropes and mixed astigmatism (p = 0.109) were not significant. Mean pupil diameter was 6.00 ± 0.99 mm in against the rule astigmatism, 5.96 ± 0.84 mm in oblique astigmatism, and 6.27 ± 0.84 mm in with the rule astigmatism. Mean mesopic pupil diameter in with the rule astigmatism group was higher than oblique astigmatism group. Spherical refractive error (r = -0.213, p = 0.001), cylindrical refractive error (0.197, p = 0.001), and age (r = −0.341, p = 0.001) showed correlation with pupil diameter.Conclusions: This study showed that age and magnitude of both spherical and cylindrical refractive error are the most determinative factors on mesopic pupil size.

ObjectivesThis study aimed to assess parents’ awareness of and perspectives on childhood refractive errors in Saudi Arabia.MethodsThis cross-sectional study was conducted between October and November 2020 in public schools across different regions of Saudi Arabia. Data were collected using an online questionnaire that assessed parents’ knowledge and perceptions of childhood refractive errors and spectacle wear.ResultsA total of 358 parents from different regions of Saudi Arabia completed the questionnaire and were obtained in this study (response rate: 85%). Approximately one third (38.3%) of the parents reported that they had never heard of refractive errors and one-third (33.8%) mentioned that uncorrected refractive errors did not lead to visual impairment. The majority (74.0%) cited using eyeglasses as an effective way to manage childhood refractive errors. Two-thirds (63.7%) stated that they did not receive any information about paediatric eye care. Better knowledge was associated with a higher educational level, female gender and older age (P <0.001, P = 0.008 and P = 0.024, respectively). Regarding parents’ perspective on spectacle wear, 13.7% felt that using eyeglasses affected their children’s chances of learning. However, 82.7% supposed that eyeglasses did not affect their children’s employment opportunities. Almost a quarter of the sample (22.1%) thought that using eyeglasses would decrease the eye’s power, resulting in childhood visual impairment.ConclusionThe level of awareness and perceptions regarding childhood refractive errors and spectacle wear was low among parents. Therefore, a policy is needed to improve the awareness and perception of the key stakeholders in this issue, including parents and teachers.

10.1016/j.yoph.2015.04.062

To estimate the rate of uncorrected refractive error and the associations with gender, age, ethnicity and place of residence. Population-based study. Secondary school students in the Central Division of Fiji. All 58 secondary schools in the Central Division of Fiji were invited to participate and one class per year level at each participating school was randomly selected for screening. Visual acuity was tested using a logMAR chart and pinhole. Outcomes of screening included normal vision, corrected refractive error, uncorrected refractive error (VA <6/12 and improvement to ≥ 6/12 with pinhole (myopia) or hyperopia (tested with +2.00-D lens) and low vision (corrected VA <6/18). Prevalence of uncorrected refractive error. The participation rate of schools was 91% with 8201 students aged 12-20 years; 8021 students had normal vision; 180 had impaired vision (166 refractive error and 14 low vision). The rate of refractive error was 2.0% (95% CI: 1.7-2.3). Indian students were nearly 6 times more likely (OR: 5.89; 95% CI: 4.17-8.34; P < 0.001) to have refractive error than Fijians. The rate of uncorrected refractive error was 0.9% (95% CI: 0.7-1.1) in Fijian students (OR: 2.89; 95% CI: 1.37-6.10; P = 0.01) and those living in rural areas (OR: 3.28; 95% CI: 1.32-8.16; P = 0.01) were more likely to have uncorrected refractive error. The rate decreased by 20% (95% CI: 4.0-33.0) with each year of increasing age. The prevalence of uncorrected refractive error in children is relatively low in Fiji with higher rates in Fijian and rural children.

<i>Purpose: </i>To determine the frequency of refractive errors in squinting eyes of children from 4 to 16 years presenting at tertiary care hospital. <i>Study Design:</i> A descriptive cross-sectional prospective study was done. <i>Place and Duration: </i>The study was conducted in Paedriatic Ophthalmology, Hayatabad Medical Complex, Peshawar. The duration of the study was 15^th Sep to 15^th Oct, 2021. <i>Materials and Methods: </i>Sample size was 146 keeping 41.45% proportion of refractive errors in children with squinting eyes, 95% confidence interval and 8% margin of error under WHO sample size calculations. Non-probability consecutive sampling was done. <i>Result: </i>Mean age was 8.57±2.66 years. Male were 89 (61.0%) and female were 57 (39.0%). Refractive error was present in 56 (38.4%), including 9 myopic, 32 hyperrmetropic, and 15 astigmatic children, and was absent in 90 (61.6%) patients. 57 positive parent refractive error patients, 21 (36.8%) showed refractive errors. However, In 89 patients without parent refractive errors, 35 (39.3%) showed refractive errors, p value 0.763. Early use of electric equipment against the refractive error showed that of total 56 patients with early use of electric equipment, 24 (42.9%) showed refractive errors. In 90 patient without the early use of electric equipment, 32 (35.6%) showed refractive errors There was no association of gender, age, parent refractive errors or early usage of electric equipment with the refractive errors. <i>Conclusion: </i>Prevalence of refractive errors is high in patient with strabismus. There is no association of age, gender, parent refractive errors or early usage of electric equipment in the occurrence of refractive errors. Further studies are recommended for confirmation of these.

Aim. To analyze the impact of early ametropia detection on clinical and economic treatment aspects. Patients and methods. Retrospectively, quality of ophthalmological care in 60 children aged 6 - 8 with ametropia and strabismus was analyzed. All children were divided into three groups depending on age, refractive error and year at which treatment was initiated. In group 1 (30 children), refractive error and strabismus were diagnosed at the first year of life. In group 2 (18 children), refractive error and strabismus were diagnosed at the age of 1 - 3 years. In group 3 (12 children), glasses were prescribed at the age of 3 - 7 years. Retrospective analysis of primary medical records of enrolled patients was performed. All diagnostic and treatment methods that were applied as well as treatment results performed at the age of 6 - 8 were considered. The study of economic aspects considered the rates of ophthalmological examinations and pleoptic and orthoptic treatment courses as well as need in surgery. Direct medical costs were calculated for mediumterm prospects (3 - 5 years). Results. Early detection of refractive errors prevents amblyopia, binocular vision impairment, and strabismus. Uncorrected refractive errors in children are characterized by high economic and social burden (i.e., the higher is the age at which refractive error was revealed, the higher treatment costs are). Ametropia diagnosis in children requires special skills, hence, dilated eye exam must be performed by pediatric ophthalmologist but not by an orthoptist. Early diagnosis of refractive errors and strabismus provides accurate glass correction and timely therapy thus reducing treatment costs. Conclusions. In terms of clinical and economic efficacy, optimal age of refractive error detection is less than 1 year. Increase in diagnostic costs is compensated by good clinical outcomes and decrease in costs of managing complications and non-medical costs associated with reduced quality of life of patients and their families.

Aim: To study the prevalence of various types of Uncorrected Refractive errors in a paediatric age group (7-15 years) attending a tertiary care centre. Materials and Methods: A hospital based cross sectional study was carried out to evaluate proportion of various types of uncorrected refractive errors in age group of 7–15yrs. in a tertiary eye care centre for a period of 3 months. Total of 4000 children were screened for presence of refractive error after taking informed consent from their parents. Children were then grouped into different types of refractive errors based on the results of cycloplegic refraction. Results: Out 4000 children, the most common age with refractive error was 10-12 years followed by 13-15 years and the commonest refractive error was astigmatism (55%) followed by myopia (34%). The most common presenting symptom was headache followed by visual disturbance. Significant family history was noted among group with prevalence of positive family history in 17% of study group. Discussion & amp, Conclusion: Astigmatism & Myopia is the commonest types of refractive error in children that was consistent with other Indian studies. Study suggests the significance of early school based screen to reduce the burden of childhood ocular morbidity because of uncorrected refractive error. Keywords: Uncorrected refractive error, Childhood blindness, Assam, Scenario.

Study of Correlation between Macular Thickness, Retina Nerve Fiber Layer Thickness and Axial Length according to Refractive Errors in Children

PurposeCorrection of refractive error in children is important for visual and educational development. The aim of this questionnaire‐based study was to explore paediatric refractive correction by optometrists in England.MethodsAn online questionnaire was piloted and distributed to optometrists in England. The questionnaire asked about respondents' characteristics (such as type of practice), management of refractive error in 1‐ and 3‐year‐old children and sources of information used as a basis for decisions on prescribing refractive error in children.ResultsTwo hundred and ninety‐three questionnaires were returned, although only 139 (47%) were fully completed. In an average month, about half of respondents examined no children between 0 and 2 years of age, and about half examined no more than five children aged 3–4 years. A significant proportion indicated they would refer children aged 1 or 3 years with refractive error and no other signs or symptoms into the hospital eye service. Almost a quarter would prescribe in full or in part an isometropic refractive correction of +2.00 D for a 3‐year‐old (within the normal range) with no other signs or symptoms, suggesting a degree of unnecessary prescribing. Almost all would act in cases of clinically significant refractive error. Respondents made similar use of their colleagues, optometric or postgraduate/continuing education, professional guidance and peer‐reviewed research as sources of evidence on which to base decisions about prescribing for paediatric refractive errors. Most reported ‘never’ or ‘rarely’ using Cochrane reviews.ConclusionsThese results suggest optometrists often defer management of paediatric refractive error to the hospital eye service, with implications in terms of underutilisation of community optometric expertise and burden on the National Health Service. In some cases, the results indicate a mismatch between respondents' reported management and existing guidance/guidelines on paediatric prescribing.