Refractive Error, Visual Acuity and Causes of Vision Loss in Children in Shandong, China. The Shandong Children Eye Study

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Abstract

Purpose

To examine the prevalence of refractive errors and prevalence and causes of vision loss among preschool and school children in East China.

Methods

Using a random cluster sampling in a cross-sectional school-based study design, children with an age of 4–18 years were selected from kindergartens, primary schools, and junior and senior high schools in the rural Guanxian County and the city of Weihai. All children underwent a complete ocular examination including measurement of uncorrected (UCVA) and best corrected visual acuity (BCVA) and auto-refractometry under cycloplegia. Myopia was defined as refractive error of ≤−0.5 diopters (D), high myopia as ≤−6.0D, and amblyopia as BCVA ≤20/32 without any obvious reason for vision reduction and with strabismus or refractive errors as potential reasons.

Results

Out of 6364 eligible children, 6026 (94.7%) children participated. Prevalence of myopia (overall: 36.9±0.6%;95% confidence interval (CI):36.0,38.0) increased ( P<0.001) from 1.7±1.2% (95%CI:0.0,4.0) in the 4-years olds to 84.6±3.2% (95%CI:78.0,91.0) in 17-years olds. Myopia was associated with older age (OR:1.56;95%CI:1.52,1.60; P<0.001), female gender (OR:1.22;95%CI:1.08,1.39; P = 0.002) and urban region (OR:2.88;95%CI:2.53,3.29; P<0.001). Prevalence of high myopia (2.0±0.2%) increased from 0.7±0.3% (95%CI:0.1,1.3) in 10-years olds to 13.9±3.0 (95%CI:7.8,19.9) in 17-years olds. It was associated with older age (OR:1.50;95%CI:1.41,1.60;P<0.001) and urban region (OR:3.11;95%CI:2.08,4.66); P<0.001). Astigmatism (≥0.75D) (36.3±0.6%;95%CI:35.0,38.0) was associated with older age ( P<0.001;OR:1.06;95%CI:1.04,1.09), more myopic refractive error ( P<0.001;OR:0.94;95%CI:0.91,0.97) and urban region ( P<0.001;OR:1.47;95%CI:1.31,1.64). BCVA was ≤20/40 in the better eye in 19 (0.32%) children. UCVA ≤20/40 in at least one eye was found in 2046 (34.05%) children, with undercorrected refractive error as cause in 1975 (32.9%) children. Amblyopia (BCVA ≤20/32) was detected in 44 (0.7%) children (11 children with bilateral amblyopia).

Conclusions

In coastal East China, about 14% of the 17-years olds were highly myopic, and 80% were myopic. Prevalence of myopia increased with older age, female gender and urban region. About 0.7% of pre-school children and school children were amblyopic.

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Most cited references 37

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Causes of blindness and visual impairment in urban and rural areas in Beijing: the Beijing Eye Study.

Liang Xu, Yaxing Wang, Yibin Li … (2006)

To evaluate the causes of visual impairment and blindness in adult Chinese in an urban and rural region of Beijing, China. Population-based prevalence survey. From a rural region and an urban region of Greater Beijing, 4439 of 5324 > or=40-year-old invited subjects participated in the study (response rate, 83.4%). Using the World Health Organization (WHO) standard and the United States standard, blindness was defined as best-corrected visual acuity (BCVA) in the better-seeing eye of or =20/400, and of or =2/20, respectively. Determination of BCVA, pneumotonometry, frequency doubling perimetry, evaluation of photographs of the fundus and lens, and clinical examination. Causes of visual impairment and blindness. Visual acuity measurements were available for 8816 eyes of 4409 subjects (99.3%). Using the WHO standard and the U.S. standard, 49 (1.1%) subjects and 95 (2.2%) subjects, respectively, had low vision, and 13 (0.3%) subjects and 15 (0.3%) subjects, respectively, were blind by definition. Taking the whole study population, the most frequent cause of low vision/blindness was cataract (36.7%/38.5%), followed by degenerative myopia (32.7%/7.7%), glaucoma (14.3%/7.7%), corneal opacity (6.1%/15.4%), and other optic nerve damage (2.0%/7.7%). Age-related macular degeneration (AMD) (2.0%/7.7%) and diabetic retinopathy (0%/7.7%) were responsible for a minority of cases. In subjects 40 to 49 years old, the most frequent cause of low vision and blindness was degenerative myopia. In the 50- to 59-year age group, the most frequent cause was cataract, followed by degenerative myopia. In the 60- to 69-year-old subjects and the > or =70-year group, the most frequent cause of low vision and blindness was cataract, followed by degenerative myopia and glaucoma. The most frequent cause of low vision and blindness in adult Chinese is cataract, followed by degenerative myopia and glaucomatous optic neuropathy, with degenerative myopia dominating in younger groups and cataract dominating in elder groups. In contrast to studies in Western countries, AMD and diabetic retinopathy appear to play a minor role as a cause of visual impairment in elderly Chinese.

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Prevalence of myopia and its association with body stature and educational level in 19-year-old male conscripts in seoul, South Korea.

Hirohiko Kakizaki, Donghyun Jee, Brian J. Lee … (2011)

To examine prevalence of refractive errors and its associated factors, such as body stature and educational level, among 19-year-old males in Seoul, Korea. A population-based cross-sectional study was performed in male subjects (n = 23,616; age = 19 years) who were normally resident in Seoul for male compulsory conscripts during the study period (2010). Refractive examination was performed with cycloplegia. Height, weight, and educational level were examined. Myopia was defined as a spherical equivalent less than -0.5 diopters (D) and high myopia less than -6.0 D. The association of myopia with body stature and educational level was analyzed using logistic regression analysis. The prevalence of myopia in 19-year-old males in Seoul was 96.5%. The prevalence of high myopia was 21.61%. Body stature was not significantly associated with myopia. Four- to 6-year university students (odds ratio [OR] 1.69; P < 0.001) and 2 to 3-year college students (OR 1.68; P < 0.001) showed significantly higher risk for myopia than those with lower academic achievement (< high school graduation). The 19-year-old male population in Seoul, Korea, demonstrated a very high myopic prevalence. Myopic refractive error was associated with academic achievement, not with body stature.

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Refractive error in children in an urban population in New Delhi.

L Sanga, Damodar Bachani, Neha A Gupta … (2002)

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

Steven Barnes: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 23 December 2013

Volume: 8

Issue: 12

Electronic Location Identifier: e82763

Affiliations

[1 ]Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

[2 ]Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

[3 ]School of Public Health, Shandong University, Jinan, Shandong, China

[4 ]The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China

[5 ]Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany

Dalhousie University, Canada

Author notes

* E-mail: hongshengbi@ 123456126.com (HSB); jost.jonas@ 123456medma.ma.uni-heidelberg.de (JBJ)

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

Conceived and designed the experiments: JFW HSB SMW YYH HW WS TLL XRW JBJ. Performed the experiments: JFW HSB SMW YYH HW WS TLL XRW. Analyzed the data: JFW HSB SMW YYH HW WS TLL XRW JBJ. Contributed reagents/materials/analysis tools: HSB. Wrote the paper: JFW HSB SMW YYH HW WS TLL XRW JBJ.

Article

Publisher ID: PONE-D-13-31868

DOI: 10.1371/journal.pone.0082763

PMC ID: 3871613

PubMed ID: 24376575

SO-VID: 9f2c8d55-d84d-48d7-b1b2-4df5609d76d2

License:

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

Date received : 5 August 2013

Date accepted : 5 November 2013

Page count

Pages: 12

Funding

This study was supported by Shandong Science & Technology Department (2011GGB14097, 2011GGH21835, 2012YD18081), Shandong Health Department (2011HD014), Jinan Science & Technology Bureau (201102061). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Refractive Error, Visual Acuity and Causes of Vision Loss in Children in Shandong, China. The Shandong Children Eye Study

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Most cited references 37

Causes of blindness and visual impairment in urban and rural areas in Beijing: the Beijing Eye Study.

Prevalence of myopia and its association with body stature and educational level in 19-year-old male conscripts in seoul, South Korea.

Refractive error in children in an urban population in New Delhi.

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