Dataset Information

Risk factors for decreased visual acuity in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies.

ABSTRACT:

Objective

To investigate risk factors associated with unilateral or bilateral decreased visual acuity (VA) in preschool children.

Design

Population-based, cross-sectional prevalence study.

Participants

Population-based samples of 6504 children ages 30 to 72 months from California and Maryland.

Methods

Participants were preschool African-American, Hispanic, and non-Hispanic white children from Los Angeles, California, and Baltimore, Maryland. Data were obtained by a parental interview and a detailed ocular examination. Logistic regression models were used to evaluate the independent associations between demographic, behavioral, and clinical risk factors with unilateral and bilateral decreased VA.

Main outcome measures

Odds ratios (ORs) for various risk factors associated with interocular difference (IOD) in VA of ?2 lines with ?20/32 in the worse eye, or bilateral decreased VA <20/40 or <20/50 if <48 months of age.

Results

In multivariate logistic regression analysis, 2-line IOD with a VA of ?20/32 was independently associated with Hispanic ethnicity (OR, 2.05), esotropia (OR, 8.98), spherical equivalent (SE) anisometropia (ORs ranging between 1.5 and 39.7 for SE anisometropia ranging between 0.50 to <1.00 diopters [D] and ?2.00 D), and aniso-astigmatism in J0 or J45 (ORs ranging between 1.4 and ?5.3 for J0 or J45 differences ranging between 0.25 to <0.50 D and ?1.00 D). Bilateral decreased VA was independently associated with lack of health insurance (OR, 2.9), lower primary caregiver education (OR, 1.7), astigmatism (OR, 2.3 and 17.6 for astigmatism 1.00 to <2.00 D and ?2.00 D), and SE hyperopia ?4.00 D (OR, 10.8).

Conclusions

Anisometropia and esotropia are risk factors for IOD in VA. Astigmatism and high hyperopia are risk factors for bilateral decreased VA. Guidelines for the screening and management of decreased VA in preschool children should be considered in light of these risk associations.

Financial disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

SUBMITTER: Tarczy-Hornoch K

PROVIDER: S-EPMC3208077 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

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Publications

Risk factors for decreased visual acuity in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies.

Tarczy-Hornoch Kristina K Varma Rohit R Cotter Susan A SA McKean-Cowdin Roberta R Lin Jesse H JH Borchert Mark S MS Torres Mina M Wen Ge G Azen Stanley P SP Tielsch James M JM Friedman David S DS Repka Michael X MX Katz Joanne J Ibironke Josephine J Giordano Lydia L

Ophthalmology 20110819 11

<h4>Objective</h4>To investigate risk factors associated with unilateral or bilateral decreased visual acuity (VA) in preschool children.<h4>Design</h4>Population-based, cross-sectional prevalence study.<h4>Participants</h4>Population-based samples of 6504 children ages 30 to 72 months from California and Maryland.<h4>Methods</h4>Participants were preschool African-American, Hispanic, and non-Hispanic white children from Los Angeles, California, and Baltimore, Maryland. Data were obtained by a p ...[more]

PMID: 21856014

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Project description:ObjectiveTo evaluate risk factors for astigmatism in a population-based sample of preschool children.DesignPopulation-based cross-sectional study.ParticipantsPopulation-based samples of 9970 children ages 6 to 72 months from Los Angeles County, California, and Baltimore, Maryland.MethodsA cross-sectional study of children participating in the Multiethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study was completed. Data were obtained by clinical examination or by in-person interview. Odds ratios and 95% confidence intervals (CI) were calculated to evaluate potential associations between clinical, behavioral, or demographic factors and astigmatism.Main outcome measuresOdds ratios (ORs) for various risk factors associated with astigmatism.ResultsParticipants with myopia (≤-1.0 diopters) were 4.6 times as likely to have astigmatism (95% CI, 3.56-5.96) than those without refractive error, whereas participants with hyperopia (≥+2.00 diopters) were 1.6 times as likely (95% CI, 1.39-1.94). Children 6 to <12 months of age were approximately 3 times as likely to have astigmatism than children 5 to 6 years of age (95% CI, 2.28-3.73). Both Hispanic (OR, 2.38) and African-American (OR, 1.47) children were as likely to have astigmatism than non-Hispanic white children. Furthermore, children whose mothers smoked during pregnancy were 1.46 times (95% CI, 1.14-1.87) as likely to have astigmatism than children whose mothers did not smoke.ConclusionsIn addition to infancy, Hispanic and African-American race/ethnicity and correctable/modifiable risk factors such as myopia, hyperopia, and maternal smoking during pregnancy are associated with a higher risk of having astigmatism. Although the prevalence of smoking during pregnancy is typically low, this association may suggest etiologic pathways for future investigation.Financial disclosure(s)The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Project description:PurposeTo describe the risk factors associated with hyperopia and myopia among children 6 to 72 months of age.DesignPopulation-based cross-sectional study.ParticipantsPopulation-based samples of 9970 children 6 to 72 months of age from Los Angeles County, California, and Baltimore, Maryland.MethodsParticipants were preschool African-American, Hispanic, and non-Hispanic white children (n = 9770) from Los Angeles, California, and Baltimore, Maryland. Parental questionnaires and a comprehensive eye examination were administered. Demographic, behavioral, and clinical risk factors associated with hyperopia (≥2.00 diopters [D]) and myopia (≤-1.00 D) were determined.Main outcome measuresOdds ratios (ORs) for risk factors associated with myopia and hyperopia.ResultsCompared with non-Hispanic whites, African-American (OR, 6.0) and Hispanic (OR, 3.2) children were more likely to be myopic. Children 6 to 35 months of age were more likely to be myopic compared with those 60 to 72 months of age (OR, ≥1.7). Compared with African-American children, non-Hispanic white (OR, 1.63) and Hispanic (OR, 1.49) children were more likely to be hyperopic. Children whose parents had health insurance (OR, 1.5) and those with a history of maternal smoking during pregnancy (OR, 1.4) were more likely to have hyperopia. Astigmatism of 1.5 D or more at any axis was associated with myopia (OR, 4.37) and hyperopia (OR, 1.43).ConclusionsChildren in specific racial or ethnic groups and age groups are at higher risk of having myopia and hyperopia. Cessation of maternal smoking during pregnancy may reduce the risk of hyperopia in these children. Given that both myopia and hyperopia are risk factors for the development of amblyopia and strabismus, these risk factors should be considered when developing guidelines for screening and intervention in preschool children.Financial disclosure(s)The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Project description:ObjectiveTo investigate risk factors associated with esotropia or exotropia in infants and young children.DesignPopulation-based cross-sectional prevalence study.ParticipantsPopulation-based samples of 9970 children 6 to 72 months of age from California and Maryland.MethodsParticipants were preschool African-American, Hispanic, and non-Hispanic white children participating in the Multi-Ethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study. Data were obtained by parental interview and ocular examination. Odd ratios and 95% confidence intervals were calculated to evaluate the association of demographic, behavioral, and clinical risk factors with esotropia and exotropia.Main outcome measuresOdds ratios (ORs) for various risk factors associated with esotropia or exotropia diagnosis based on cover testing.ResultsIn multivariate logistic regression analysis, esotropia was associated independently with prematurity, maternal smoking during pregnancy, older preschool age (48-72 months), anisometropia, and hyperopia. There was a severity-dependent association of hyperopia with the prevalence of esotropia, with ORs increasing from 6.4 for 2.00 diopters (D) to less than 3.00 D of hyperopia, to 122.0 for 5.00 D or more of hyperopia. Exotropia was associated with prematurity, maternal smoking during pregnancy, family history of strabismus, female sex, astigmatism (OR, 2.5 for 1.50 to <2.50 D of astigmatism, and 5.9 for ?2.5 D of astigmatism), and anisoastigmatism in the J0 component (OR, ?2 for J0 anisoastigmatism of ?0.25 D).ConclusionsPrematurity and maternal smoking during pregnancy are associated with a higher risk of having esotropia and exotropia. Refractive error is associated in a severity-dependent manner to the prevalence of esotropia and exotropia. Because refractive error is correctable, these risk associations should be considered when developing guidelines for the screening and management of refractive error in infants and young children.Financial disclosure(s)The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Project description:To determine the prevalence and causes of decreased visual acuity (VA).Population-based cross-sectional study.Multi-ethnic sample of children 30 to 72 months of age identified in Los Angeles.All eligible children underwent a comprehensive ophthalmic evaluation including monocular VA testing, cover testing, cycloplegic autorefraction, fundus evaluation, and VA retesting with refractive correction. Decreased VA was defined as presenting or best-measured VA worse than 20/50 in children 30 to 47 months of age and worse than 20/40 for children 48 months of age and older. The prevalence and causes of decreased VA were determined, for both presenting and best-measured VA, in the better-seeing and the worse-seeing eyes.Prevalence and causes of decreased vision.Presenting VA was assessed in 1840 children and best-measured VA was assessed in 1886 children. Presenting VA was decreased in the worse eye of 4.2% of Asian children and of 3.6% of non-Hispanic white (NHW) children. Close to one-fourth of these cases had no identifiable cause, and 81% of these resolved on retesting. Decreased presenting VA in the worse eye with an identifiable ophthalmic cause was present in 3.4% of Asian children and in 2.6% of NHW children. Decreased presenting VA attributable to simple refractive error (myopia ? 0.5 diopters [D]; hyperopia ? 3.0 D; astigmatism ? 2.0 D or ? 1.5 D for children older than 36 months) was present in the worse eye of 2.3% of Asian children and of 1.4% of NHW children and in the better eye of 0.5% of Asian children and of 0.3% of NHW children. Decreased best-measured VA attributable to a cause was present in the worse eye of 1.2% of both Asian children and NHW children and in the better eye of 0.2% of Asian and of 0.3% of NHW children. Amblyopia related to refractive error was the most common cause, and was 10 times as common as ocular disease. Severe visual impairment was rare.Seventy percent of all decreased VA in Asian and NHW preschool children and more than 90% of decreased VA with an identifiable cause is related to refractive error--either uncorrected refractive error or amblyopia resulting from refractive error.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Project description:ObjectiveTo determine the age- and race-specific prevalence of amblyopia in Asian and non-Hispanic white children aged 30 to 72 months and of strabismus in children aged 6 to 72 months.DesignCross-sectional survey.ParticipantsA population-based, multiethnic sample of children aged 6 to 72 months was identified in Los Angeles and Riverside counties in California to evaluate the prevalence of ocular conditions.MethodsA comprehensive eye examination and in-clinic interview were conducted with 80% of eligible children. The examination included evaluation of ocular alignment, refractive error, and ocular structures in children aged 6 to 72 months, as well as a determination of optotype visual acuity (VA) in children aged 30 to 72 months.Main outcome measuresThe proportion of 6- to 72-month-old participants with strabismus and 30- to 72-month-olds with optotype VA deficits and amblyopia risk factors consistent with study definitions of amblyopia.ResultsStrabismus was found in 3.55% (95% confidence interval [CI], 2.68-4.60) of Asian children and 3.24% (95% CI, 2.40-4.26) of non-Hispanic white children, with a higher prevalence with each subsequent older age category from 6 to 72 months in both racial/ethnic groups (P=0.0003 and 0.02, respectively). Amblyopia was detected in 1.81% (95% CI, 1.06-2.89) of Asian and non-Hispanic white children; the prevalence of amblyopia was higher for each subsequent older age category among non-Hispanic white children (P=0.01) but showed no significant trend among Asian children (P=0.30).ConclusionsThe prevalence of strabismus was similar in Asian and non-Hispanic white children and was found to be higher among older children from 6 to 72 months. The prevalence of amblyopia was the same in Asian and non-Hispanic white children; prevalence seemed to be higher among older non-Hispanic white children but was relatively stable by age in Asian children. These findings may help clinicians to better understand the patterns of strabismus and amblyopia and potentially inform planning for preschool vision screening programs.Financial disclosure(s)The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Dataset Information

Risk factors for decreased visual acuity in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies.

Objective

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Financial disclosure(s)

Publications

Risk factors for decreased visual acuity in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies.

Similar Datasets

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