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Prevalence and causes of visual impairment in Asian and non-Hispanic white preschool children: Multi-ethnic Pediatric Eye Disease Study.

ABSTRACT: 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.

SUBMITTER: Tarczy-Hornoch K

PROVIDER: S-EPMC4848010 | biostudies-literature | 2013 Jun

REPOSITORIES: biostudies-literature

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Prevalence and causes of visual impairment in Asian and non-Hispanic white preschool children: Multi-ethnic Pediatric Eye Disease Study.

Tarczy-Hornoch Kristina K Cotter Susan A SA Borchert Mark M McKean-Cowdin Roberta R Lin Jesse J Wen Ge G Kim Jeniffer J Varma Rohit R

Ophthalmology 20130403 6

<h4>Purpose</h4>To determine the prevalence and causes of decreased visual acuity (VA).<h4>Design</h4>Population-based cross-sectional study.<h4>Participants</h4>Multi-ethnic sample of children 30 to 72 months of age identified in Los Angeles.<h4>Methods</h4>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 pres ...[more]

PMID: 23561327

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Project description:To 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.Cross-sectional survey.A 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.A 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.The 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.Strabismus 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).The 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.The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Project description:PurposeTo determine the age-, gender-, and ethnicity-specific prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white (NHW) and Asian preschool children.DesignPopulation-based, cross-sectional study.ParticipantsA population-based sample of 1501 NHW children and 1507 Asian children aged 6-72 months from Los Angeles County and Riverside County, California.MethodsEligible children underwent an in-home and in-clinic interview and a comprehensive eye examination including cycloplegic autorefraction from 100 census tracts.Main outcome measuresThe proportion of children with myopia (spherical equivalent [SE] ?-1.00 diopter [D]), hyperopia (SE ? +2.00 D) and cylindrical refractive error ?1.50 D in the worse eye. The astigmatism type was defined as with-the-rule (WTR; +cylinder axis 90°±15°) and against-the-rule (ATR; + cylinder axis 180°±15°); all other orientations were considered oblique (OBL).ResultsThe prevalence of myopia, hyperopia, and astigmatism in NHW children was 1.20% (95% confidence interval [CI], 0.76%-1.89%), 25.65% (95% CI, 23.5%-27.9%), and 6.33% (95% CI, 5.21%-7.68%), respectively. The prevalence of WTR, ATR, and OBL astigmatism in NHW children was 4.33%, 1.00%, and 1.00%, respectively. Prevalence was lower with older age groups for astigmatism (P = 0.0002), but not for myopia (P = 0.82) or hyperopia (P = 0.31). In Asian children, the prevalence of myopia, hyperopia, and astigmatism was 3.98% (95% CI, 3.11%-5.09%), 13.47% (95% CI, 11.8%-15.3%), and 8.29% (95% CI, 7.01%-9.80%), respectively. The prevalence of WTR, ATR, and OBL astigmatism was 6.50%, 0.80%, and 1.00% respectively. The prevalence of hyperopia was higher in girls than boys (P = 0.0002), but no differences were found for myopia and astigmatism.ConclusionsHyperopia was the most common refractive error in both Asian and NHW children. However, compared with NHW children, myopia was relatively more prevalent, and hyperopia less prevalent, among Asian children. The prevalence of astigmatism was greatest in infants, and WTR astigmatism predominated at all ages. Myopia showed relatively stable prevalence across age groups, whereas hyperopia prevalence decreased after infancy and then increased again in older age groups; however, longitudinal studies are needed to evaluate refractive changes over time in individual children.Financial disclosure(s)The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Project description:ObjectiveTo investigate risk factors associated with unilateral or bilateral decreased visual acuity (VA) in preschool children.DesignPopulation-based, cross-sectional prevalence study.ParticipantsPopulation-based samples of 6504 children ages 30 to 72 months from California and Maryland.MethodsParticipants 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 measuresOdds 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.ResultsIn 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).ConclusionsAnisometropia 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.

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:BackgroundPopulation-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique.MethodsMalaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling 'E' Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed.ResultsA total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0-1.4%), 1.0% (95%CI: 0.8-1.2%) and 5.9% (5.3-6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively.ConclusionIncreased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.

Dataset Information

Prevalence and causes of visual impairment in Asian and non-Hispanic white preschool children: Multi-ethnic Pediatric Eye Disease Study.

Publications

Prevalence and causes of visual impairment in Asian and non-Hispanic white preschool children: Multi-ethnic Pediatric Eye Disease Study.

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