31.12.9 Prevalence of Refractive Errors in Urban Area among School Boys

Original Article

 

Refractive Errors in Urban School Boys

Prevalence of Refractive Errors in Urban Area among School Boys

Zulfiqar Ali1, Nadia Nazir1, Soufia Farrukh1, Abdul Rehman2, Muhammad Javaid Iqbal3 and Imran Nazir4

ABSTRACT

Objective: To study the prevalence of refractive errors among school boys in urban area.

Study Design: A cross sectional study

Place and Duration of Study: This study was conducted at Ophthalmology, Bahawal Victoria Hospital, Quaid e Azam Medical College, Bahawalpur during November 2017.

Materials and Methods: The study population comprised of 462 students from class 6th to Class 10th. Ocular examination process was thoroughly explained to the study participants while all the study instruments/equipments were transported to school one day prior to the actual ocular examination. Standard “Snellen Chart” was used for screening of visual acuity. Children having visual acuity < 6/6 in any of the eye were further confirmed for refractive error with the use of pinhole. Objective refraction was made using auto-refractor and retinoscopy while confirmation was done applying subjective refraction.

Results: Among a total of 460 students, age range was between 9 to 18 years while the mean age +SD was recorded to be 14.3+1.8 years. History of glasses was noted among 58 (12.6%) students. There were 253 (55.0%) who had history of glasses in their parents. Findings of our study revealed frequency of refractive errors in 98 (21.3%) students. Among 98 children with refractive errors, myopia in 58 students (59.2%) was the commonest type of refractive error followed by astigmatism in 28 students (28.6%) and hypermetropia in 12 students (12.1%).

Conclusion: Myopia was the commonest type of refractive error in school going boys followed by Astigmatism and hypermetropia.

Key Words: Refractive errors, myopia, astigmatism, boys

Citation of article: Ali Z, Nazir N, Farrukh S, Rehman A, Iqbal MJ, Nazir I. Prevalence of Refractive Errors in Urban Area among School Boys. Med Forum 2020;31(12):40-43.

 

 

INTRODUCTION

Prevalence of blindness in pediatric population ranges between 0.3% to 1.5% per 1000 children in developing countries. Uncorrected refractive errors are known to be the commonest reason of visual impairment worldwide. WHO estimated around 285 million people to have visual impairments, out of which, around 40 million are having blindness while 250 million have low vision.2 Commonest causes for visual impairment are considered to be refractive errors followed by cataract seen in 43% and 33% cases respectively.3Researchers have proposed that more than90% causes of blindness are either preventable or treatable.4

 

 

1. Department of Ophthalmology / Peadiatric Medicine2 / Consultant Physician3 / Pharmacist4, Bahawal Victoria Hospital, Quaid e Azam Medical College, Bahawalpur.

 

 

Correspondence: Dr. Zulfiqar Ali, Assistant Professor of Ophthalmology, Bahawal Victoria Hospital, Quaid e Azam Medical College, Bahawalpur.

Contact No: 0300-9689475

Email: dr.zulfiqarali64@hotmail.com

 

 

Received:    May, 2020

Accepted:    September, 2020

Printed:        December, 2020

 

 

 

 

 

 

Among children, refractive errors are considered to be one of the commonest problems faced. In children and adults age groups, refractive errors present multiple issues like educational loss, economic hurdles, less productivity as well as impairment in quality of life.5,6Lack of services along with less affordability and poor access to healthcare services are some of the major issues linked to non-correction of refractive errors among pediatric age groups.7But, this does not mean that developed communities cannot have unidentified or uncorrected refractive errors in pediatric age groups.8 Untreated visual problems are of special interest among children as they affect educational achievements as well as put emotional burden on the parents and families. Vision problems can be addressed with help of various available options like eye glasses, medications or vision therapies. Children themselves have increased chances of developing social or emotional problems due to unidentified or untreated vision issues. Studies have shown variation in the prevalence of refractive errors among school going children.9,10 This study was planned to determine the prevalence of refractive errors among boys in an Urban school of District Bahawalpur.

MATERIALS AND METHODS

This cross sectional study was conducted in a boys school of Bahawalpur City. Boys from Class 6th to Class 10th were included during November 2017. Request was made to school administration and after getting the formal permission, ocular examination of the students was done in the school. Approval from “institutional ethical committee” was taken for this research. Informed consent was sought from all study participants.

Ocular examination process was thoroughly explained to the study participants while all the study instruments/equipments were transported to school one day prior to the actual ocular examination. Two ophthalmologists along with 2 optometrists did ocular examination and refraction. Standard “Snellen Chart” was used for screening of visual acuity. Children having visual acuity < 6/6 in any of the eye were further confirmed for refractive error with the use of pinhole. Objective refraction was made using auto-refractor and retinoscopy while confirmation was done applying subjective refraction.

A special proforma was made to record study data. SPSS version 26.0 was used for data handling and analysis. Study data was represented as frequency and percentages.

RESULTS

Among a total of 460 students, age ranged between 9 to 18 years while the mean age+SD was recorded to be 14.3+1.8 years. Table (1) is showing characteristics of study participants. Class 10th followed by 9thand 8th had the most number of students in the present study having 106 (23.0%), 102 (22.2%) and 94 (20.4%) students respectively. History of glasses was noted among 58 (12.6%) students. There were 253 (55.0%) who had history of glasses in their parents.

Table No.1: Characteristics of Students Participated

Characteristics

No. (%)

Class-wise Distribution

6th

82 (17.8%)

7th

76 (16.5%)

8th

94 (20.4%)

9th

102 (22.2%)

10th

106 (23.0%)

History of Glasses

Yes

58 (12.6%)

No

402 (87.4%)

History of Glasses among any of the Parents

Yes

253 (55.0%)

No

207 (45.0%)

Figure No.1: Prevalence of Refractive Errors among students (n=460)

Findings of our study revealed frequency of refractive errors in 98 (21.3%) students while remaining 362 (78.7%) had normal vision (Figure No.1). Figure (2) is showing distribution of students with refractive errors in terms of types of refractive errors. Among 98 children with refractive errors, myopia 58 (59.2%) was the commonest type of refractive error followed by astigmatism 28 (28.6%) and hypermetropia 12 (12.1%).

Figure No.2: Types of Refractive Errors (n=98)

DISCUSSION

Among children, refractive errors are associated with short-term as well as long term problems like loss in education, poor educational grades, loss of professional opportunities, economic difficulties as well as poor quality of life.5,6 Visual impairments caused by unaddressed refractive errors are considered to be a public health issue while correction of refractive errors adopting spectacles are known to be the best cost effective interventions. Researchers have shown that screening at mass levels among children of school going age can be a successful way of identifying and treating uncorrected refractive errors.11

In the present study, frequency of refractive errors was noted to be 21.3% among students. Our findings are showing a higher prevalence of refractive errors when compared to other local studies (8.9% and 10%).10,12 Studies from Malaysia13 noted prevalence of refractive errors among children to be 7.7% while researchers from Nepal14 and Iran15 noted that to be 8.6% and 3.5% respectively. A recent local study found prevalence of refractive errors to be 9.4% among children.16

In this study, among 98 children with refractive errors, myopia 58 (59.2%) was the commonest type of refractive error followed by astigmatism 28 (28.6%) and hypermetropia 12 (12.1%). Our findings are close to a recent local study from Faisalabad which showed that Myopia was the commonest type of refractive error observed among 51.5% children.17 Another local study revealed Myopia to form 42.1% of refractive errors among children.16Data from Ethiopia also showed that myopia was the most frequent type of refractive error among children.18 Our findings were somewhat different to a local study from LandiKotal where researchers noted hypermetropia to be the most frequent type of refractiveerror.12Data from Vietnam has also shown that myopia was the commonest cause of impaired vision among school goingchildren.19Some other researchers have also concluded that Myopia is the most frequent type of refractive error among children.20

The present study has some limitations as well. As this study was conducted among school going children, our findings cannot be generalized.As this study was conducted among male students. We were unable to find out any gender based differences regarding prevalence and types of refractive errors. High prevalence of refractive errors among school going children is alarming so the government and stakeholders should form alliance to plan regular screening programs for the timely identification and treatment of refractive errors among school going children. There screening programs can provide low cost assistance to children and their families who are suffering with refractive errors. Awareness programs and relevant educational activities can also be planned to increase awareness and knowledge about refractive errors among general population.

CONCLUSION

Prevalence of refractive errors was high among school going children. Myopia followed by Astigmatism was the commonest types of refractive errors. Regular screening programs for the early identification and treatment of refractive errors should be conducted.

Acknowledgement: The authors would like to thank Muhammad Aamir (Research Consultant, Bahawalpur) for his valuable assistance in statistical analysis of this research.

Author’s Contribution:

Concept & Design of Study:

Zulfiqar Ali

Drafting:

Nadia Nazir, Soufia Farrukh

Data Analysis:

Abdul Rehman, Muhammad Javaid Iqbal and Imran Nazir

Revisiting Critically:

Zulfiqar Ali, Nadia Nazir

Final Approval of version:

Zulfiqar Ali

Conflict of Interest: The study has no conflict of interest to declare by any author.

REFERENCES

1.      Pizzarello  L,  Abiose  A,  Ffytche  T,  Duerksen  R,  Thulasiraj R. Vision  2020:  The  right  to  sight:  Aglobal  initiative to  eliminateavoidable blindness. Arch Ophthalmol 2004;122(4):615-20.

2.      WHO Fact Sheet; Blindness and Visual Impairment 2013 [cited 2014 July.3]. Available from:http://www.iapb.org/vision-2020/global-facts.

3.      Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012; 96(5):614-8.

4.      Katibeh M, Pakravan  M, Yaseri M, Pakbin  M, Soleimanizad  R.  Prevalence and  causes of  visual  impairment  and blindness  in  central  Iran;  The  Yazd eye study. J Ophthalmic Vis Res 2015; 10:279-85.

5.      Sharma IP, Lepcha NT, Lhamo T, EllweinLB, Pokharel GP, Das T, et al. Visual impairment and refractive error in school children in Bhutan: The findings from the Bhutan School Sight Survey (BSSS 2019). PLoS ONE 2020;15(9):e0239117.

6.      OlatunjiLK, AbdulsalamLB, Lukman A, Abduljaleel A, Yusuf I. Academic Implications of Uncorrected Refractive Error: A Study of Sokoto Metropolitan Schoolchildren. Niger Med J 2019; 60(6):295-9.

7.      Ayanniyi A, Mahmoud AO, Olatunji FO. Causes and prevalence of ocular morbidity among primary school children in Ilorin, Nigeria. Niger J Clin Pract 2010;13:248–53.

8.      Vitale S, Cotch MF, Sperduto RD. Prevalence of visual impairment in the United States. J Am Med Assoc 2006;295(18):2158-63.

9.      Ali A, Ahamad I, Ayub S. Prevalence of undetected refractive errors among school children. Biomedica 2007;23:96-101.

10.  Alam H, Siddiqui MI, JafriSIA, Khan AS, Ahmed SI, Jafar M. Prevalence of refractive error in school children of Karachi. J Pak Med Assoc 2008; 58(6):322-5.

11.  Baltussen R, Naus J, Limburg H. Cost-effectiveness of screening and correcting refractive errors in school children in Africa, Asia, America and Europe. Health Policy 2009;89(2):201-15.

12.  Sethi MJ, Sethi S, Iqbal R. Frequency of Refractive Errors in Children Visiting Eye Out Patients Department Agency Headquarter Hospital Landi Kotal. Gomal J Med Sci 2009;7(2):114-7.

13.  Hashim SE, Tan HK, Wan-Hazabbah W, Ibrahim M. Prevalence of refractive error in malay primary school children in suburban area of Kota Bharu, Kelantan, Malaysia. Ann Acad Med Singap 2008;37(11):940-6.

14.  Pokharel A, Pokharel P, Das H, Adhikari S. The patterns of refractive errors among the school children of rural and urban settings in Nepal. Nepalese J Ophthalmol 2010;2(2):114-20.

15.  Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K. The prevalence of refractive errors among schoolchildren in Dezful, Iran. Br J Ophthalmol 2007;91(3):287-92.

16.  Abbas H, Awais M, Naimat K. Prevalence and pattern of refractive errors in school going children of Mangla Cantonment. Pak Armed Forces Med J 2019;69(5):1125-8.

17.  Iqbal F, Khalil I, Zahid M. Prevalence of refractive errors in school going children in district Faisalabad, Pakistan. Adv Ophthalmol Vis Syst 2020;10(1):4‒6.

18.  Kedir J, Girma A. Prevalence of Refractive Error and Visual Impairmentamong Rural School-Age Children of Goro District, GurageZone,Ethiopia. Ethiop J Health Sci 2014;24(4):353.

19.  Paudel P, Ramson P, Naduvilath T, Wilson D, Phuong HT, Ho SM, et al. Prevalence of vision impairmentand refractive error in school children in Ba Ria - Vung Tau province,Vietnam. Clin Exp Ophthalmol 2014;42(3):217−26.

20.  Mehari ZA, Yimer AW. Prevalence of refractive errors among school children in rural central Clin Exp Optom 2012;96(1):65−9.