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      Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children

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          Abstract

          Background

          Studies show great variability in the prevalence of hyperopia among children. This study aimed to synthesize the existing knowledge about hyperopia prevalence and its associated factors in school children and to explore the reasons for this variability.

          Methods

          This systematic review followed PRISMA guidelines. Searching several international databases, the review included population- or school-based studies assessing hyperopia through cycloplegic autorefraction or cycloplegic retinoscopy. Meta-analysis of hyperopia prevalence was performed following MOOSE guidelines and using the random effects model.

          Results

          The review included 40 cross-sectional studies. The prevalence of hyperopia ranged from 8.4% at age six, 2-3% from 9 to 14 years and approximately 1% at 15 years. With regard to associated factors, age has an inverse association with hyperopia. The frequency of hyperopia is higher among White children and those who live in rural areas. There is no consensus about the association between hyperopia and gender, family income and parental schooling.

          Conclusion

          Future studies should use standardized methods to classify hyperopia and sufficient sample size when evaluating age-specific prevalence. Furthermore, it is necessary to deepen the understanding about the interactions among hyperopic refractive error and accommodative and binocular functions as a way of identifying groups of hyperopic children at risk of developing visual, academic and even cognitive function sequelae.

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          Most cited references60

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          Role of near work in myopia: findings in a sample of Australian school children.

          To examine the association of time spent in near work and reading with spherical equivalent refraction (SER) in a population-based sample of 12-year-old Australian schoolchildren. Data on the time spent in near-work or outdoor activities per week and estimates for the duration of continuous reading and reading distances, were collected in questionnaires (2353 participants, 75.3% response) in the Sydney Myopia Study between 2004 and 2005; 2339 children underwent a comprehensive eye examination, including cycloplegia. Longer time spent on reading for pleasure and reports of close reading distance ( 30 minutes) independently increased the odds of having myopia in this sample of children. Although myopia was not significantly associated with time spent in near work after adjustment for other factors, there were significant independent associations with close reading distance and continuous reading. These associations may indicate that the intensity rather than the total duration of near work is an important factor.
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            Parental myopia, near work, school achievement, and children's refractive error.

            To quantify the degree of association between juvenile myopia and parental myopia, near work, and school achievement. Refractive error, parental refractive status, current level of near activities (assumed working distance-weighted hours per week spent studying, reading for pleasure, watching television, playing video games or working on the computer), hours per week spent playing sports, and level of school achievement (scores on the Iowa Tests of Basic Skills [ITBS]) were assessed in 366 eighth grade children who participated in the Orinda Longitudinal Study of Myopia in 1991 to 1996. Children with myopia were more likely to have parents with myopia; to spend significantly more time studying, more time reading, and less time playing sports; and to score higher on the ITBS Reading and Total Language subtests than emmetropic children (chi(2) and Wilcoxon rank-sum tests; P < 0.024). Multivariate logistic regression models showed no substantial confounding effects between parental myopia, near work, sports activity, and school achievement, suggesting that each factor has an independent association with myopia. The multivariate odds ratio (95% confidence interval) for two compared with no parents with myopia was 6.40 (2.17-18.87) and was 1.020 (1.008-1.032) for each diopter-hour per week of near work. Interactions between parental myopia and near work were not significant (P = 0.67), indicating no increase in the risk associated with near work with an increasing number of parents with myopia. Heredity was the most important factor associated with juvenile myopia, with smaller independent contributions from more near work, higher school achievement, and less time in sports activity. There was no evidence that children inherit a myopigenic environment or a susceptibility to the effects of near work from their parents.
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              Refractive error in children in an urban population in New Delhi.

              To assess the prevalence of refractive error and related visual impairment in school-aged children in an urban population in New Delhi, India. Random selection of geographically defined clusters was used to identify a sample of children 5 to 15 years of age. From December 2000 through March 2001, children in 22 selected clusters were enumerated through a door-to-door survey and examined at a local facility. The examination included visual acuity measurements, ocular motility evaluation, retinoscopy and autorefraction under cycloplegia, and examination of the anterior segment, media, and fundus. Myopia was defined as spherical equivalent refractive error of at least -0.50 D and hyperopia as +2.00 D or more. Children with reduced vision and a sample of those with normal vision underwent independent replicate examinations for quality assurance in four of the clusters. A total of 7008 children from 3426 households were enumerated, and 6447 (92.0%) examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 6.4%, 4.9%, and 0.81%, respectively. Refractive error was the cause in 81.7% of eyes with vision impairment, amblyopia in 4.4%, retinal disorders in 4.7%, other causes in 3.3%, and unexplained causes in the remaining 5.9%. There was an age-related shift in refractive error from hyperopia in young children (15.6% in 5-year-olds) toward myopia in older children (10.8% in 15-year-olds). Overall, hyperopia was present in 7.7% of children and myopia in 7.4%. Hyperopia was associated with female gender. Myopia was more common in children of fathers with higher levels of education. Reduced vision because of uncorrected refractive error is a major public health problem in urban school-aged children in India. Cost-effective strategies are needed to eliminate this easily treated cause of vision impairment.
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                Author and article information

                Contributors
                vicastagno@hotmail.com
                anaclaudia.fassa@gmail.com
                mvcarret@hotmail.com
                mapvilela@gmail.com
                rodrigodalke@gmail.com
                Journal
                BMC Ophthalmol
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central (London )
                1471-2415
                23 December 2014
                23 December 2014
                2014
                : 14
                : 163
                Affiliations
                [ ]Department of Specialized Medicine – Ophthalmology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Centro, 96020-220 Pelotas, RS Brazil
                [ ]Department of Social Medicine, Rua Marechal Deodoro, 1160, Centro, 96020-220 Pelotas, RS Brazil
                [ ]Department of Social Medicine, Federal University of Pelotas, Avenida Duque de Caxias, 250, Fragata, 96001-970 Pelotas, RS Brazil
                Article
                549
                10.1186/1471-2415-14-163
                4391667
                25539893
                1afe7ed7-3669-4eb6-9d1a-07e887d69524
                © Castagno et al.; licensee BioMed Central. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 September 2013
                : 17 December 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                Ophthalmology & Optometry
                children,cross-sectional studies,hyperopia,longitudinal studies,prevalence

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