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Refractive error and visual impairment in school-age children in Gombak District, Malaysia
Pik-Pin Goh1, Yahya Abqariyah, Gopal P Pokharel
1Department of Ophthalmology, Hospital Selayang, Selangor, Malaysia.
Insights
Refractive errors, primarily myopia, cause significant visual impairment in Gombak District school children. Many children needing glasses lack them, highlighting a need for eye health education and screening.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Visual impairment and refractive errors are significant concerns in school-aged populations.
- Early detection and correction are crucial for academic and social development.
Purpose of the Study:
- To determine the prevalence of refractive errors and visual impairment in school-aged children in Gombak District.
- To identify the primary causes of visual impairment in this demographic.
Main Methods:
- A population-based, cross-sectional survey was conducted.
- 4,634 children aged 7-15 years were randomly selected from 34 clusters.
- Comprehensive eye examinations included visual acuity, cycloplegic refraction, and ocular assessments.
Main Results:
- The prevalence of uncorrected visual impairment was 17.1%, with refractive error being the main cause (87.0%).
- Myopia prevalence increased with age, from 9.8% at age 7 to 34.4% at age 15.
- Myopia was more common in older children, females, those with higher parental education, and children of Chinese ethnicity.
Conclusions:
- Myopia is the leading cause of visual impairment in Gombak District school children.
- A substantial number of children requiring spectacles do not have them.
- Enhanced eye health education and vision screening programs are recommended.
Purpose:
To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city.
Design:
Population-based, cross-sectional survey.
Participants:
Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households.
Methods:
Random selection of geographically defined clusters was used to identify the study sample. Children in 34 clusters were enumerated through a door-to-door survey and examined in 140 schools between March and July 2003. The examination included visual acuity measurements; ocular motility evaluation; retinoscopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus.
Main Outcome Measures:
Distance visual acuity and cycloplegic refraction.
Results:
The examined population was 70.3% Malay, 16.5% Chinese, 8.9% Indian, and 4.3% of other ethnicity. The prevalence of uncorrected (unaided), presenting, and best-corrected visual impairment (visual acuity < or =20/40 in the better eye) was 17.1%, 10.1%, and 1.4%, respectively. More than half of those in need of corrective spectacles were without them. In eyes with reduced vision, refractive error was the cause in 87.0%, amblyopia in 2.0%, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected amblyopia. Myopia (spherical equivalent of at least -0.50 diopter [D] in either eye) measured with retinoscopy was present in 9.8% of children 7 years of age, increasing to 34.4% in 15-year-olds; and in 10.0% and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, higher parental education, and Chinese ethnicity. Hyperopia (> or =2.00 D) with retinoscopy varied from 3.8% in 7-year-olds, 5.0% with autorefraction, to less than 1% by age 15, with either measurement method. Hyperopia was associated with younger age and "other" ethnicity. Astigmatism (> or =0.75 D) was present in 15.7% of children with retinoscopy and in 21.3% with autorefraction.
Conclusions:
Visual impairment in school-age children in urban Gombak District is overwhelmingly caused by myopia, with a particularly high prevalence among children of Chinese ethnicity. Eye health education and screening may help address the unmet need for refractive correction.
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