Refraction in the Pediatric Eye Examination

Accurate determination of refractive error is one of the most critical components of a pediatric eye examination. According to the National Eye Institute, refractive errors are the most common causes of correctable reduced vision in children. Children with uncorrected refractive error are more likely to have developmental delays, visual-related academic problems, and poor social skills or interactions. In addition to difficulty seeing, uncorrected refractive errors can contribute to developmental deficits of accommodation, binocular vision, and certain forms of strabismus, amblyopia, and perceptual function. The author provides the clinician an in-depth guide on how to determine the refractive error in pediatric patients. The chapter focuses on the specific techniques, advantages and disadvantages, equipment required, and step-by-step procedures for performing retinoscopy, objective refraction, and subjective refraction on children.

Global disease burden of uncorrected refractive error among adolescents from 1990 to 2019

Background To estimate the global disease burden of uncorrected refractive error (URE) among adolescents and assess the contributions of various risk factors to disability-adjusted life-years (DALYs) due to URE. Methods Global, regional and country-level DALY numbers and rates due to URE among adolescents were acquired from the Global Burden of Disease Study 2019 database. Human Development Index (HDI), Socio-Demographic Index (SDI) and other country-level data were obtained from other open databases as potential indicators. Regression analysis was used to evaluate associations between DALY rates among adolescents and potential predictors. Results Global DALYs due to URE among adolescents rose by 8% between 1990 and 2019 but moderately decreased by 4.8% during this period after adjusting for population size. Female adolescents showed higher DALY rates. DALY rates sharply increased from 5 to 9 years of age, then rose more slowly, reaching a plateau before 20 years of age. Country-level DALY rates in 2019 were positively associated with HDI, SDI, and urbanization rates but negatively correlated with primary school dropout rates. Higher disease burden of adolescents visually impaired from URE was associated with lower primary school dropout rates (β = − 0.257, 95% CI − 0.376 to − 0.138, P < 0.001) and higher urbanization rates (β = 0.257, 95% CI 0.067 to 0.256, P = 0.001). Conclusions Higher socioeconomic status, urbanization rates and education levels are associated with a heavier disease burden of URE among adolescents. The findings of this study can provide a reference for policy making on resource allocation for URE prevention and control in teenagers.

Improving Access to Refractive Services in Adults: A Health Examination Center-Based Model

Purpose: To assess the potential of a health examination center-based screening model in improving service for uncorrected refractive error.Methods: Individuals aged ≥18 years undergoing the routine physical examinations at a tertiary hospital in the northeast China were invited. Presenting visual acuity, noncycloplegic autorefraction, noncontact tonometry, fundus photography, and slit-lamp examination were performed. Refractive error was defined as having spherical equivalent ≤ -0.75 D or ≥ +1 D and uncorrected refractive error was considered as refractive error combined with presenting visual acuity &lt; 6/12 in the better eye. Costs for the screening were assessed.Results: A total of 5,284 participants (61 ± 14 years) were included. The overall prevalence of myopia and hyperopia was 38.7% (95% CI, 37.4–40.0%) and 23.5% (95% CI, 22.3–24.6%), respectively. The prevalence of uncorrected refractive error was 7.85% (95% CI, 7.13–8.58%). Women (p &lt; 0.001 and p = 0.003), those with age ≥ 70 years (p &lt; 0.001 and p = 0.003), and myopia (p &lt; 0.001 and p &lt; 0.001) were at higher risk of uncorrected refractive error and uncorrected refractive error-related visual impairment. Spectacle coverage rate was 70.6% (95% CI, 68.2–73.0%). The cost to identify a single case of refractive error and uncorrected refractive error was US$3.2 and US$25.2, respectively.Conclusion: The prevalence of uncorrected refractive error is high in the urban Chinese adults. Health examination center-based refractive error screening is able to provide an efficient and low-cost model to improve the refractive services in China.

Parents’ Awareness of and Perspectives on Childhood Refractive Error and Spectacle Wear in Saudi Arabia

Objectives: This study aimed to assess parents’ awareness of and perspectives on childhood refractive error in Saudi Arabia. Methods: This cross-sectional study included parents from different regions of Saudi Arabia was conducted between October and November 2020 and included 358 parents. Data were collected using an online questionnaire that involved questions to assess parents’ knowledge and perceptions of childhood refractive error and spectacle wear. Results: A total of 358 completed questionnaires were obtained in this study with a response rate of 85%. Almost 38.3% of parents reported that they had never heard of refractive error. One-third (33.7%) mentioned that uncorrected refractive error did not lead to visual impairment. The majority (74.0%) cited using eyeglasses as an effective way to manage childhood refractive error. Two-thirds (63.7%) stated that they did not receive any information about paediatric eye care. Better knowledge was associated with having a higher educational level, being female, and having an older age (p˂0.001, p=0.008, and p=0.024 respectively). Regarding parents' perspective on spectacle wear, almost 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. Approximately 22.1% thought that using eyeglasses would decrease the eyes power resulting in childhood visual impairment. Conclusion: The level of awareness and perceptions of childhood refractive error and spectacle wear was low among parents. Therefore, a policy is needed to improve the awareness and perception of key stakeholders such as parents and teachers. In turn such an improvement could play a crucial role in addressing the poor knowledge and bad perception of treatment for childhood refractive error. Keywords: Childhood visual impairment; spectacle wear; parental attitudes; refractive error; paediatric eye care; psychological effect; vision care; Spectacle compliance.

Rapid assessment of prevalence of blindness and cataract surgery in Kabul province, Afghanistan

ObjectiveTo estimate prevalence and causes of blindness and vision impairment and assess cataract surgical coverage and quality of cataract surgery in Kabul.Methods and analysisA total of 3751 adults aged 50 years and above were recruited from 77 randomly selected clusters. Each participant underwent presenting and pinhole visual acuity assessment and lens examination. Those with pinhole visual acuity <6/12 in either eye had a dilated fundus examination to determine the cause of reduced vision. Those with apparent lens opacity were interviewed on barriers to cataract surgery.ResultsThe age-adjusted and sex-adjusted prevalence of blindness was 2.4% (95% CI: 1.8% to 3.0%). Prevalence of severe, moderate and mild vision impairment was 2.2% (95% CI: 1.7% to 2.7%), 6.9% (95% CI: 6.0% to 7.9%) and 8.7% (95% CI: 7.5% to 9.8%), respectively. Cataract was the main cause of blindness (36.8%), severe (54.4%) and moderate (46.1%) vision impairment. Uncorrected refractive error was the leading cause of mild vision impairment (20.3%). Age-related macular degeneration was the second leading cause of blindness (23.0%). In people with a presenting visual acuity of <3/60, cataract surgical coverage was 89.7%, and effective cataract surgical coverage was 67.8%. The major barriers to uptake of the available cataract surgical services were the need for surgery was not felt (23.7%) and cost (22.0%).ConclusionKabul province has a high prevalence of blindness, largely due to cataract and age-related macular generation. The quality of cataract surgery is also lagging in terms of good visual outcomes. This calls for immediate efforts to improving the reach and quality of existing eye services and readiness to respond to the increasing burden of posterior eye disease.

Magnitude and causes of visual impairment amongst school children in the Bono Region of Ghana

Background: Information on the visual health of school children can assist in developing strategies to reduce preventable causes of visual impairment (VI) and maintain good vision.Aim: This study aimed to determine the magnitude and causes of VI amongst basic school children aged 6–16 years in the Bono Region of Ghana.Setting: The study site included five basic schools in 12 administrative districts of the Bono Region of Ghana.Methods: A multistage random sampling technique was used to enrol 645 participants from five selected public schools.Results: Overall, 1.4% of the sample had some form of VI that was worse than mild or no VI, and ocular conditions were present amongst 45.1% of the participants. Uncorrected refractive error (URE) was found amongst 9.8% of the study participants (n = 63) and was an important cause of VI. Other ocular conditions detected in the sample included allergic conjunctivitis (n = 174), cataract (n = 2) and keratoconus (n = 2). Overall, 632 (98.0%) participants recorded a visual acuity (VA) of 20/20 – 20/60, 11 (1.7%) participants had a VA of 20/60 – 20/200, 1 (0.15%) participant had a VA of 20/200 – 10/200 and 1 (0.15%) participant had a VA of 10/200.Conclusion: The presence of ocular conditions was high amongst the study participants (45.1%). However, the prevalence of VI was found to be low (1.4%) with URE being the most common cause. This study supports the need to intensify awareness of ocular conditions and/or VI in basic schools through regular vision health screening and education.

Prevalence of Refractive Errors among Children in Saudi Arabia: A Systemic Review

Introduction: The aim of this review was to estimate the prevalence of refractive errors (RE) and uncorrected refractive error (URE) in school-aged children of 4 to 14 years of age in Saudi Arabia. Methods: An extensive search was performed for peer-reviewed studies with data from the Saudi population during the past 20 years. The Cochrane Library, Pubmed, and Embase databases were used. Two independent reviewers evaluated publications and extracted the data. The quality of the studies was evaluated based on a critical appraisal tool designed for systematic reviews. The pooled prevalence of refractive error, uncorrected refractive error and different types of refractive error were estimated by using the random-effects meta-analysis. Results and Discussion: Eight school-based studies were included in this review. Among the overall pooled population of 12,247childern, the estimated prevalence of refractive error was 17.5% (95% CI: 11.1- 25). In the five studies that reported uncorrected refractive error (N=10,198), the pooled prevalence was 16.8% (95% CI: 11.4 – 21.3). The overall prevalence of refractive errors was very similar among boys, 16.8 (95% CI: 10.8- 24.1), and girls, 17.7% (95% CI: 10.2 – 25.9). Myopia was the most prevalent refractive error and was present in 40.8% (95% CI: 16.1 – 69.9) followed by astigmatism 29.7% (95% CI: 6.1- 61.7) and hyperopia 28.3% (95% CI: 16.9 – 41.2). Conclusion: This review highlights the high prevalence of refractive errors and uncorrected refractive error among children in Saudi Arabia. More studies are required using standardised methods in different regions where there is a lack of information on UREs. It is recommended that vision screening programs of children for RE should be implemented at the community level and integrated into school health programmes in order to detect UREs and prevent amblyopia, which is one of the debilitating consequences of URE.

Global Disease Burden of Uncorrected Refractive Error Among Adolescents From 1990 to 2019

Background To estimate the global disease burden of uncorrected refractive error (URE) among adolescents and assess the contributions of various risk factors to disability-adjusted life-years (DALYs) due to URE.Methods Global, regional and country-level DALY numbers and rates due to URE among adolescents were acquired from the Global Burden of Disease Study 2019 database. Human Development Index (HDI), Socio-Demographic Index (SDI) and other country-level data were obtained from other open databases as potential indicators. Regression analysis was used to evaluate associations between DALY rates among adolescents and potential predictors.Results Global DALYs due to URE among adolescents rose by 8% between 1990 and 2019 but moderately decreased by 4.8% during this period after adjusting for population size. Female adolescents showed higher DALY rates. DALY rates sharply increased from 5 to 9 years of age, then rose more slowly, reaching a plateau before 20 years of age. Country-level DALY rates in 2019 were positively associated with HDI, SDI, and urbanization rates but negatively correlated with primary school dropout rates. Higher disease burden of adolescents visually impaired from URE was associated with lower primary school dropout rates (β=−0.257, 95% CI −0.376 to −0.138, P<0.001) and higher urbanization rates (β=0.257, 95% CI 0.067 to 0.256, P=0.001).Conclusions Higher socioeconomic status, urbanization rates and education levels are associated with a heavier disease burden of URE among adolescents. The findings of this study can provide a reference for policy making on resource allocation for URE prevention and control in teenagers.