Prevalence of Myopia in children
up to 16 years observed in tertiary care eye centre of central India
Gupta R1,
Sharma B2, Anand
R3, Bawaria S4, Kursange S5
1Dr. Rachna Gupta, Associate Professor, 2Dr.
Bhavna Sharma,
Assistant
Professor, 3Dr. Reena Anand,
Director, 4Dr.
Shefali
Bawaria, Senior
Resident, Chhatisgarh, Institute of Medical Sciences, Bilaspur,
CG, 5Dr. Shubhangi Kursange, Resident,
From Regional Institute
of
Ophthalmology, Gandhi Medical College, Bhopal, India.
Address for correspondence:
Dr Rachna Gupta, Email: drrachnagupta2k@gmail.com
Abstract
Introduction:
Myopia is most
common cause of childhood visual disability. In large population it
remains undiagnosed. High myopia can be associated with major
ophthalmic diseases such as myopic retinopathy and exudative myopic
macular degeneration, myopic glaucomatous optic neuropathy and
rhegmatogeneous retinal detachment. Methods:
Study was conducted in Regional Institute Of Ophthalmology in
central India. Children up to age of 16 years included with special
emphasis on observing type and amount of myopia and it’s
clinical
presentation. After mydriasis eyes were examined by
retinoscopy
and indirect ophthalmoscopy. Results:
Prevelance
of childhood myopia in hospital based study was 16.5 % with male to
female ratio 53:47. Most of the children were belonging to urban
area(63.61%). Headache was most common complain for hospital visit.
Most common age group affected was 7-12 and 13-16 years. In 18.53% of
patients family history was present.
Conclusion:
Due to high magnitude of uncorrected Myopia it appears to be a public
health problem both in urban and rural areas. An uncorrected refractive
error leads to learning difficulties and reduced performances in
school, ultimately affecting the psycho-social development of the
child. For prevention Large-scale visual acuity screening programs must
be launched to detect low vision due to myopia early and an annual
check up to update the spectacle prescriptions.
Introduction
The term myopia was introduced from the habit which short-sighted
people frequently have of half-closing the lids when looking at distant
objects so that they may gain the advantages of a stenopic opening.
Myopia also known as near sightedness is one of the leading cause of
visual disability all over the world. In India little data is available
for prevelance of myopia but it is most common form of correctable
refractive error. Usually it clinically presents with blurred distant
vision, squeezing of eye and eye rubbing. Although school health
programme for eye screening can diagnose a large number of student but
only very few states are running this programme. School myopia occurs
between 5-15 years and stabilizes by the age of 20 years. Cause is
idiopathic most of the time. Asian Population has witnessed a major
increase in the frequency of myopia, with a prevalence of myopia of as
high as 80% in the 18-year-old teenagers [1-9]. Although frequency
varies with different ethnic groups and countries. The use of
corrective lenses suggests that correctable visual impairment is the
most common treatable chronic condition of childhood. Income, gender,
and race/ethnicity are associated with having corrective lenses. The
underlying causes and the impacts of these differences must be
understood to ensure optimal delivery of eye care. [10]
Myopia in school children in one of the Asian study was associated with
higher age, female gender, school type, parental myopia, higher
socioeconomic background, dim reading illumination, longer daily
studying duration, less rest during study, shorter duration of watching
television (or computer), higher self-reported protein intake, feeling
well about life and status, and feeling tired and dizzy [11]. Little
data is available to know Prevalence of Myopia in Indian population.
Although it varies between 2.77 % to 7.4 % [12,13]. According to the
World Health Organization (WHO)-NPCB survey in 1989, 1.49% population
in India is blind of which 7.35% is due to refractive errors [14]. The
proportion of blindness due to refractive error increased to 19.7% in
the NPCB-National Blindness Survey even though the overall prevalence
of blindness was reduced to 1.1% [15]. Another study by
Padhey AS
et al [16]. Prevelance of myopia is 3.16 % and 1.5 % respectively in
Urban and Rural India. Another Indian study has shown 4.74 % prevelance
in north india [17].
The prevalence of myopia has been reported to be as high as 70-90% in
some Asian population with Taiwan reporting a myopic prevalence of 84%
among 16-18 - years - old high school students. [18,19]. Psychological changes also develop in children particularly in case of
uncorrected myopia where they are growing in limited world. They
started avoiding outdoor sports and prone to introspection. Limitations
of intelligence and curtailment of interests leads to development of
backwardness and stupidity in children. Another study has reported that
preschoolers with uncorrected ametropia had significant reduction in
visual-motor function. As per compressive vision care in urban
communities: the pediatric outreach program, early identification and
treatment of abnormal visual conditions ensure that children have
maximal visual acuity and function. This study was attempted to measure
the prevalence of myopia leading to visual acuity of less than 6/12 in
either eye in children in central India and to evaluate factors
associated with myopia in children of less than 16 years.
Manuscript received: 06th
Aug 2013
Reviewed: 13th
Aug 2013
Author Corrected: 19th
Aug 2013
Accepted for Publication:
28th Aug 2013
Material
and methods
This study was undertaken at tertiary eye care centre of central India,
Regional Institute of Ophthalmology, Bhopal. 3056 children up
to
16 yrs were screened for type and amount of ametropia with special
emphasis on observing type and amount of myopia and its clinical
presentation. It was a cross sectional hospital based study.
Inclusion criteria: children
up to 16 yrs
Exclusion criteria:
children > 16 yrs, children with history of ocular trauma/
ocular surgery were excluded.
The demographic profile of patients was recorded in terms of name, age,
sex, address, socioeconomic status. Detailed history of patients was
taken and the chief complaints were noted in chronological order in
three categories-
1) Ocular complaints-heaviness/pain in eyes/recurrent redness
/deviation of eyes
2) Visual complaints- difficulty in reading /defective vision for
distance or near
3) Referred complaints- heaviness of head or headache, history of
nausea or vomiting
Family history of refractive error in siblings and parents, cerebral
palsy or Down’s syndrome and other relevant neurobehavioral
abnormalities were recorded. Personal history and any significant
antenatal, perinatal and postnatal history were noted. Visual acuity
was noted and detailed ocular examination with slit lamp and indirect
ophthalmoscope was performed to look for any ocular morbidity.
Assessment of refractive
error:
Retinoscopy was done to evaluate the type and amount of myopia and
fundus examination was done to evaluate any posterior segment
involvement under mydriasis .The cycloplegic used atropine 1% eye
ointment/homatropine 0.5% eye drop/cyclopentolate/tropicamide eye drops.
Results
Table No 1: Prevalence of
Ametropia in children attending eye OPD
|
S.No.
|
No of pediatric
pts
|
No of Ametropic
children
|
No of myopic pts
|
|
1
|
3056
|
1230
|
505
|
The prevalence of ametropia in children was found to be 40.24%.Out of
1230 ametropic children, myopia was found in 41.05% children.
Prevelance of childhood myopia in hospital based study was 16.5 % .
Male to female child ratio was 53: 47 and around two third (63.61%) of
the population were belonging to below poverty line (BPL) category.
59.18% of children were belonging to urban areas.
Table No 2: Clinical
Profile of Ametropic Children attending eye OPD (n=1230)
|
S.
no.
|
Complaints
|
No.
of cases
|
%
|
|
1
|
Goes
close to television
|
756
|
61.46
|
|
2
|
Unable
to see blackboard
|
923
|
75.04
|
|
3
|
Frequent
blinking/frequent rubbing of eyes
|
98
|
7.96
|
|
4
|
Redness
of eyes
|
98
|
7.96
|
|
5
|
Watering
|
603
|
49.02
|
|
6
|
Recurrent
swelling of lids
|
56
|
4.55
|
|
7
|
Eyeache
|
856
|
69.59
|
|
8
|
Headache
|
1011
|
82.19
|
|
9
|
Change
in palpebral aperture
|
84
|
6.8
|
|
10
|
Deviation
of eyes
|
23
|
1.86
|
|
11
|
Frequent
fall
|
2
|
0.16
|
|
12
|
Picked
up in school
|
213
|
17.31
|
It was found that ametropic children presented with varied clinical
profiles. Headache was the most common presentation, accounts for
82.19%.
Table No 3:
Age distribution and degree of myopia in children with myopia
|
Degree
of myopia diopter(D)
|
Age
groups in yrs
|
|
0-3
|
%
|
4-6
|
%
|
7-12
|
%
|
13-16
|
%
|
|
<
-2
|
-
|
-
|
30
|
1.21
|
220
|
8.94
|
218
|
8.86
|
|
-2
to -6
|
-
|
-
|
64
|
2.61
|
232
|
9.43
|
226
|
9.18
|
|
>-6
|
-
|
-
|
2
|
0.08
|
8
|
0.32
|
10
|
0.40
|
|
Total
no of eyes
|
-
|
-
|
96
|
3.90
|
460
|
18.69
|
454
|
18.45
|
As per the table maximum prevelance was observed in age group 7-12 and
13-16 years.
Table No. 4: Distribution
of degree of myopia
|
Degree of myopia
|
No of eyes
|
%
|
|
< -2 D
|
468
|
19.02%
|
|
-2 to -6 D
|
522
|
21.21%
|
|
>-6D
|
20
|
0.8%
|
|
Total
|
1010
|
|
Mild to moderate type of Myopia was more common than severe one.
Table No 5: Myopic
Astigmatism
|
Amount
of myopic
In
diopters (D)
|
Astigmatism
|
|
With
the rule
|
Against
the rule
|
Oblique
|
Bi-oblique
|
|
No.
of eyes
|
%
|
No.
of eyes
|
%
|
No.
of eyes
|
%
|
No.
of eyes
|
%
|
|
|
M
|
F
|
M
|
F
|
M
|
F
|
M
|
F
|
M
|
F
|
M
|
F
|
M
|
F
|
M
|
F
|
|
<-2
|
44
|
96
|
1.78
|
3.90
|
50
|
80
|
2.03
|
3.25
|
14
|
16
|
0.56
|
0.65
|
10
|
12
|
0.40
|
0.48
|
|
-2
to -6
|
58
|
62
|
2.35
|
2.52
|
48
|
38
|
1.95
|
1.54
|
14
|
16
|
0.56
|
0.65
|
4
|
6
|
0.16
|
0.24
|
|
>-6
|
2
|
2
|
0.08
|
0.08
|
4
|
6
|
0.16
|
0.24
|
-
|
2
|
-
|
0.08
|
-
|
-
|
-
|
-
|
|
Total
|
104
|
160
|
4.22
|
6.50
|
102
|
134
|
4.14
|
5.44
|
28
|
34
|
1.13
|
1.38
|
14
|
18
|
0.56
|
0.73
|
|
|
Out of total eyes examined myopic astigmatism of < -2 D with the
rule was observed in 1.78% males and 3.90% females.
Table No 6: Family
History of Refractive Error in Pediatric Ametropic Eyes (n=2460)
|
Type
of refractive error
|
Refractive
error in parents
|
%
|
Refractive
error in siblings
|
%
|
|
Myopia
|
228
|
18.53
|
159
|
12.92
|
|
Hypermetropia
|
96
|
7.80
|
112
|
9.10
|
|
Astigmatism
|
121
|
9.83
|
178
|
14.47
|
|
Total
no of eyes
|
445
|
36.16
|
449
|
36.49
|
Family history was present in 18.53% parents and 12.92% siblings in
myopic patients.
Around 7.80 % of male and 8.29 % of female child were also having
Anisometropia while Amblyopia was present in 0.88% of total eyes
examined. Around 3.90% cases with myopia <-2 D, 2.11 % with-2D
to
-6D , and 0.32% with >-6D had exophoria. 0.08 % eyes
with
myopia <-2 D, 0.16% with -2 Dto -6 D and 0.08% with >-6 D
had
exotropia.
Discussion
Myopia, in particular high myopia, can be associated with major
ophthalmic diseases such as myopic retinopathy , exudative myopic
macular degeneration, myopic glaucomatous optic neuropathy,
rhegmatogeneous retinal detachment, as tears and hemorrhages. In this
hospital based study we have noted that around 16.5 % of total children
had myopia. Other Indian studies has shown prevalence between 2.77 % to
7.4 %12, 13. One Indian study has shown prevalence of 3.16 % and 1.5 %
respectively in Urban and Rural India16. Another Indian study has shown
4.74 % prevalence in North india17. Higher prevalence in our study can
be explained because it was a hospital based study. Czepita et al.
noted that gender influences the occurrence of myopia and hyperopia in
school-going children of age ranging from 6 to18 years.20. In our study
53% were male child while 47 % were female. It may be associated with
gender bias in our community. Skewed male to female child ratio may
also be responsible. More number of patients in our study belongs to
below poverty line (BPL) group with odds ratio 1.5. It may be because
of less available medical facility for poor population. 59 % of our
children were from urban population. Higher prevalence of myopia in
urban population was also noted in other study from India. Dandona et
al.21 in Andra Pradesh Eye Diseases Study (AEPDS) study also noted that
urban location was a predictor of myopia, and children of urban area
had 2.5 times higher risk compared to rural children. Some of the study
from Toiwan22 and Oman23 has had similar results.
Near work is one of the most frequently cited risk factor for myopia,
and several observations support this hypothesis. Environmental factors
such as progressively more competitive education system may have had an
increasing impact in recent years. Moreover, environmental factors such
as educational level, occupation and individual income have been shown
to associate with the prevalence of myopia24, 25
A positive correlation between the prevalence of myopia with age and
the increasing prevalence of myopia with higher studies lends a strong
support to close work theory in myopia development because in higher
classes students tend to spend more time on studies. In this study
18.53 % myopic cases were having history of ametropia in parents and
12.92% in sibling. Other study had shown positive family history as a
risk factor for myopia26.
Conclusion
There
is no well-established or universally accepted treatment for the
prevention of myopia onset or progression. Due to high magnitude of
uncorrected Myopia it appears to be a public health problem both in
urban and rural areas. It has been given high priority under the
National Programme for Control of Blindness. The school
vision-screening programme is fully sponsored by the Government of
India and free spectacles are provided to poor children. The programme
is aimed to eliminate blindness due to refractive error by providing
refractive error services at primary level with the availability of
qualified paramedical ophthalmic assistants in the vision centre for
every 50,000 population by the year 2020.
Although it is well structured centre sponsored programme but most of
the states are not able to implement this programme. It leads to large
number of uncorrected refractive errors. An uncorrected refractive
error leads to learning difficulties and reduced performances in
school, ultimately affecting the psycho-social development of the
child. There is need that National blindness control programme should
be integrated with the Serve Shiksha Abhyaan (SSA) programme and there
should be mandatory school vision screening at regular interval in all
the schools. Large-scale visual acuity screening programs must be
launched to detect low vision due to myopia early and an annual checkup
to update the spectacle prescriptions. Public and school-based health
education programs may also be targeted at the very young. School
teacher should be involved for positive reinforcement of school
children for screening.
Funding: Nil
Conflict of interest: Nil
Permission from IRB:
Yes
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How to cite this article?
Gupta R, Sharma B, Anand R, Bawaria S, Kursange S. Prevalence of Myopia
in children up to 16 years of age observed in tertiary care eye centre
of central India. Int J Med Res Rev 2013;1(3):99-105.