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      Population prevalence of myopia, glasses wear and free glasses acceptance among minority versus Han schoolchildren in China

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          Abstract

          Aim

          To measure myopia, glasses wear and free glasses acceptance among minority and Han children in China.

          Methods

          Visual acuity testing and questionnaires assessing ethnicity, study time, and parental and teacher factors were administered to a population-based sample of 9–12 year old minority and Han children in Yunnan and Guangdong, and their teachers and parents. Refraction was performed on children with uncorrected visual acuity (VA) < = 6/12 in either eye, and acceptance of free glasses assessed.

          Main outcome measures

          Baseline myopia (uncorrected visual acuity < = 6/12 in > = 1 eye and spherical equivalent refractive power < = -0.5D in both eyes); baseline glasses wear; free glasses acceptance.

          Results

          Among 10,037 children (mean age 10.6 years, 52.3% boys), 800 (8.0%) were myopic, 4.04% among Yunnan Minority children (OR 0.47, 95%CI 0.33, 0.67, P<0.001), 6.48% in Yunnan Han (OR 0.65, 95%CI 0.45, 0.93, P = 0.019), 9.87% in Guangdong Han (Reference). Differences remained significant after adjusting for study time and parental glasses wear. Difference in baseline glasses ownership (Yunnan Minority 4.95%, Yunnan Han 6.15%, Guangdong Han 15.3%) was not significant after adjustment for VA. Yunnan minority children (71.0%) were more likely than Yunnan Han (59.6%) or Guangdong Han (36.8%) to accept free glasses. The difference was significant after adjustment only compared to Guangdong Han (OR 3.34, 95% CI 1.62, 6.90, P = 0.001).

          Conclusion

          Myopia is more common among Han children and in wealthier Guangdong. Baseline differences in glasses wear could be explained by student, teacher and parental factors. Yunnan Minority children were more likely to accept free glasses.

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          Most cited references27

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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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            Refractive Error Study in Children: results from Shunyi District, China.

            To assess the prevalence of refractive errors and vision impairment in school-age children in Shunyi District, northeast of Beijing, the Peoples Republic of China. Random selection of village-based clusters was used to identify a sample of children 5 to 15 years of age. Resident registration books were used to enumerate eligible children in the selected villages and identify their current school. Ophthalmic examinations were conducted in 132 schools on children from 29 clusters during May 1988 to July 1998, including visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and examination of the external eye, anterior segment, media, and fundus. Independent replicate measurements of all children with reduced vision and a sample of those with normal vision were done for quality assurance monitoring in three schools. A total of 6,134 children from 4,338 households were enumerated, and 5,884 children (95.9%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.5 (20/40) or worse in at least one eye was 12.8%, 10.9%, and 1.8%, respectively; 0.4% had best visual acuity 0.5 or worse in both eyes. Refractive error was the cause in 89.5% of the 1,236 eyes with reduced vision, amblyopia in 5%, other causes in 1.5%, with unexplained causes in the remaining 4%. Myopia -0.5 diopter or less in either eye was essentially absent in 5-year-old children, but increased to 36.7% in males and 55.0% in females by age 15. Over this same age range, hyperopia 2 diopters or greater decreased from 8.8% in males and 19.6% in females to less than 2% in both. Females had a significantly higher risk of both myopia and hyperopia. Reduced vision because of myopia is an important public health problem in school-age children in Shunyi District. More than 9% of children could benefit from prescription glasses. Further studies are needed to determine whether the upward trend in the prevalence of myopia continues far beyond age 15 and whether the development of myopia is changing for more recent birth cohorts.
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              Refractive error in children in a rural population in India.

              To assess the prevalence of refractive error and related visual impairment in school-aged children in the rural population of the Mahabubnagar district in the southern Indian state of Andhra Pradesh. Random selection of village-based clusters was used to identify a sample of children 7 to 15 years of age. From April 2000 through February 2001, children in the 25 selected clusters were enumerated in a door-to-door survey and examined at a rural eye center in the district. 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 seven clusters. A total of 4414 children from 4876 households was enumerated, and 4074 (92.3%) were examined. The prevalence of uncorrected, baseline (presenting), and best corrected visual acuity of 20/40 or worse in the better eye was 2.7%, 2.6%, and 0.78%, respectively. Refractive error was the cause in 61% of eyes with vision impairment, amblyopia in 12%, other causes in 15%, and unexplained causes in the remaining 13%. A gradual shift toward less-positive values of refractive error occurred with increasing age in both boys and girls. Myopia in one or both eyes was present in 4.1% of the children. Myopia risk was associated with female gender and having a father with a higher level of schooling. Higher risk of myopia in children of older age was of borderline statistical significance (P = 0.069). Hyperopia in at least one eye was present in 0.8% of children, with no significant predictors. Refractive error was the main cause of visual impairment in children aged between 7 and 15 years in rural India. There was a benefit of spectacles in 70% of those who had visual acuity of 20/40 or worse in the better eye at baseline examination. Because visual impairment can have a significant impact on a child's life in terms of education and development, it is important that effective strategies be developed to eliminate this easily treated cause of visual impairment.
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                Author and article information

                Contributors
                Role: InvestigationRole: Writing – review & editing
                Role: Investigation
                Role: Writing – original draft
                Role: ConceptualizationRole: Funding acquisitionRole: ValidationRole: VisualizationRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: Methodology
                Role: InvestigationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Investigation
                Role: ConceptualizationRole: InvestigationRole: Writing – review & editing
                Role: Investigation
                Role: Investigation
                Role: Investigation
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 April 2019
                2019
                : 14
                : 4
                : e0215660
                Affiliations
                [1 ] The Second People’s Hospital of Yunnan, Kunming, China
                [2 ] Centre for Public Health, Queen’s University Belfast, Belfast, Ireland, United Kingdom
                [3 ] State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, China
                [4 ] Orbis International, New York City, New York, United States of America
                [5 ] Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
                [6 ] Honghe First People’s Hospital, Honghe, Yunnan, China
                [7 ] Dehong People’s Hospital, Dehong, Yunnan, China
                [8 ] Jianchuan People’s Hospital, Jianchuan, Yunnan, China
                [9 ] Chuxiong People’s Hospital, Chuxiong, Yunnan, China
                [10 ] Lancang County First People’s Hospital, Lancang, Yunnan, China
                Faculty of Medicine, Cairo University, EGYPT
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-9866-3416
                Article
                PONE-D-18-29573
                10.1371/journal.pone.0215660
                6472783
                30998750
                599bf37b-f364-4870-8e44-a5dbd5f583ab
                © 2019 Hu et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 October 2018
                : 6 April 2019
                Page count
                Figures: 0, Tables: 5, Pages: 12
                Funding
                This work was supported by the United States Agency for International Development (USAID) Child Blindness Program; Orbis International; and the Fred Hollows Foundation. Prof Congdon is supported by the Chinese government’s Thousand Man Plan and the Ulverscroft Foundation (UK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
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                All relevant data are within the manuscript and its Supporting Information files.

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