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Rakhi Dandona, Lalit Dandona, Marmamula Srinivas, Prashant Sahare, Saggam Narsaiah, Sergio R. Muñoz, Gopal P. Pokharel, Leon B. Ellwein; Refractive Error in Children in a Rural Population in India. Invest. Ophthalmol. Vis. Sci. 2002;43(3):615-622.
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purpose. To assess the prevalence of refractive error and related visual
impairment in school-aged children in the rural population of the
Mahabubnagar district in the southern Indian state of Andhra Pradesh.
methods. Random selection of village-based clusters was used to identify a
sample of children 7 to 15 years of age. From April 2000 through
February 2001, children in the 25 selected clusters were enumerated in
a door-to-door survey and examined at a rural eye center in the
district. 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 seven clusters.
results. A total of 4414 children from 4876 households was enumerated, and 4074
(92.3%) were examined. The prevalence of uncorrected, baseline
(presenting), and best corrected visual acuity of 20/40 or worse in the
better eye was 2.7%, 2.6%, and 0.78%, respectively. Refractive error
was the cause in 61% of eyes with vision impairment, amblyopia in
12%, other causes in 15%, and unexplained causes in the remaining
13%. A gradual shift toward less-positive values of refractive error
occurred with increasing age in both boys and girls. Myopia in one or
both eyes was present in 4.1% of the children. Myopia risk was
associated with female gender and having a father with a higher level
of schooling. Higher risk of myopia in children of older age was of
borderline statistical significance (P = 0.069).
Hyperopia in at least one eye was present in 0.8% of children, with no
conclusions. Refractive error was the main cause of visual impairment in children
aged between 7 and 15 years in rural India. There was a benefit of
spectacles in 70% of those who had visual acuity of 20/40 or worse in
the better eye at baseline examination. Because visual impairment can
have a significant impact on a child’s life in terms of education and
development, it is important that effective strategies be developed to
eliminate this easily treated cause of visual
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