Paediatric Refractive Error among Hospital Attending Population in

the MaldivesRajendra Gyawali

Consultant optometrist, Male’ Eye Clinic MaldivesLecturer Optometrist, Asmara College of Health Sciences, Eritrea

Fathimath Nestha MohamedConsultant optometrist, Male’ Eye Clinic Maldives

Nabin Paudel Department of Optometry and Vision Science, University of Auckland, New Zealand

Rajendra GyawaliAsmara College of Health Sciences, Eritrea

Email: gyawali.rajendra@gmail.com

INTRODUCTION

• Uncorrected refractive error as a global public health problem – 12.8 M visually impaired children with prevalence of 0.97%

(WH0)

• Significant and large geographic differences in prevalence of refractive error in children(RESC)

• WHO blindness estimation Maldives 0.8% – Causes Cataract, refractive error and childhood blindness(V2020

MALDIVES)

INTRODUCTION

Maldives – Population of 319,000, – 1,190 coral islands (90,000 Km2)– Only 200 are inhabited– Capital Male’ (2/3rd population)

Eye Care – 6 regional hospital eye departments – Eye care services concentrated in

capital Male’– Lack of evidence based information

OBJECTIVES

Assess the prevalence of refractive errors among hospital attending children

Observe the association of different types of refractive errors with age and gender

METHODOLOGY

• Study design– Cross sectional hospital based

• Participants – All the consecutive children aged 5 to 15 years• Ophthalmology out patient department of IGMH from • April 2010 to September 2011.

– Exclusion: • Infectious anterior

segment disorders• Ocular injuries

CLINICAL EXAMINATION

• Distance Visual Acuity– Projected Snellen letter or a pictorial chart at 3 meter

• Refractions– Retinoscopy – Subjective refraction – Cycloplegic refraction in indicated cases

• Anterior and Posterior segment evaluation – Slit lamp examination – Fundus examination

DEFINITIONS

Myopia: >-0.50D Spherical equivalent (SE) error

Hyperopia: > +1.00D SE

Astigmatism: >0.75D or more in either eye.

Anisometropia: >1.0D difference of SE error in

between

two eyes.

RESULTS

4448 children – 7.6% of the estimated mid-year population for age group 5-15 years in

2010 (Maldives Year book 2011) Representative sample*

Age Group (years) Female % Male %

5-7 598 13.4 598 13.4

8-10* 295 6.6 370 8.3

11-13 704 15.8 558 12.6

14-15 722 16.3 603 13.6

Total 2319 52.1 2129 47.9

RESULTS

China (0.43%); Chile (3.3%); Nepal (0.44%); rural India (0.78%); urban India (0.81%); Iran (0.2%).

Causes: Amblyopia (41.6%), Retinal causes (35.1%), corneal disorders (12.9%), cataract (5.2%)

Spectacle coverage: 74.28%

Distribution of Uncorrected, Presenting and best corrected visual acuity in better eye (N=4436)

Visual acuity No. (%) with uncorrected VA No. (%) with presenting VA No. (%) with best corrected VA

6/6->6/9 3215 (72.48) 4107 (92.58) 4177 (94.16)

6/9->6/18 795 (17.92) 213 (4.80) 182 (4.10)

6/18->3/60 401 (9.04) 107 (2.41) 73 (1.65)

≤3/60 25 (0.56) 9 (0.21) 4 (0.09)2.62% 1.74%

1221 (27.5%)

REFRACTIVE ERROR Refractive Error

28.0% SE Myopia

21.3%SE Hyperopia

1.6% Astigmatism

*5.1%

-1.64D±2.5Male -1.66DFemale -1.62D

MYOPIA

– Pakistan (3.7%)– Nepal (1.2%), rural India (4.1%), Chile (6.8%),

urban India (7.4%) and Iran (4.3%) – China (16.2%), Hongkong (36.7%)

• ↑Age = ↑Myopia Prevalence (fluctuation) • Higher prevalence in male (all the age except for 7 years)

21.3%

HYPEROPIA

• 5.8% in Pakistan• Rural India (0.8%) and Nepal (1.4%) • China (3.5%), Iran (5.4%), Chile (7.7%) and

urban India (16.3%)

A higher prevalence of hyperopia was observed in children of lower age cohorts

1.6%

RESULTS

5 6 7 8 9 10 11 12 13 14 150

5

10

15

20

25

30

35Hyperopia Male

Hyperopia Female

Myopia Male

Myopia Female

Age (Years)

Prev

alen

ce (%

)

-0.71D -2.19D

-1.06D -2.22D

12.8%

18.1%

6.9% 1.2%

-0.85D -2.20D

ASTIGMATISM

• 17.6% of eyes• Iran (11.5%), China (15%) and Chile (19%); • Lower than Singapore (28.3%) • Higher than Nepal (2.2%), rural India (2.8%) and urban India (5.4%)

• WTR 86.9%; ATR 8.9%; OA 4.1% • No gender difference • WTR astigmatism decreased and ATR astigmatism increased with

age.

• Prevalence and amount was associated with younger age but not with the gender.

• 2.06DC at 5 years 0.86DC at 15 years

ANISOMETROPIA

• 3.3% of the children• Comparable with 3.8% in Iran • Less than Hong Kong (9.2%) and Australia (9.0%)

• Mean anisometropia 1.94±1.16D – No age (p=0.4) and gender (p=0.9) differences

• More in myopic children than hyperopic

CONCLUSION

• Refractive errors, myopia and astigmatism in particular, are common in school-age children in Maldives.

• Refractive error characteristics vary with age and gender

• Prevalence of all forms of visual impairment is considerably high

• Almost one fourth of the children who need spectacles are not wearing them

Thank You