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Celia R. Nakanami, Adriana Berezovsky, Nivea N. Cavascan, Marcia R. Mitsuhiro, Rubens Belfort, Jr., Solange R. Salomao; Refractive Services Outcomes in Low-Income School Children in São Paulo City. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4221.
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To investigate refractive services outcomes in low-income school children using visual acuity (VA) measurements and need/usage of glasses.
A population-based study was performed in school children in São Paulo city during 2005. Cluster sampling was used to obtain a random sample of children aged 11-14 years from public schools (grades 5-8) in 3 districts. The examination included VA testing, ocular motility, external eye exam, anterior segment and media. Cycloplegic refraction and fundus exam were performed in those with visual impairment (VI) - uncorrected VA 20/40 or worse in either eye. Children were queried about previous usage of glasses. Presenting VA (PVA) with/without glasses, UCVA and best-corrected VA (BCVA) were measured at 4 m distance with logMAR chart-tumbling-E optotypes.
A total of 2441 were examined (86.4%) out of 2825 enumerated school children. For the need of glasses analysis 25 children with other VI causes were excluded, with 2416 cases included in the analysis, considering 102 (4.22%) with VI. Forty-seven children (1.95%) had UCVA of 20/40 or worse in either eye and PVA with glasses of 20/32 or better in both eyes (OU) showing that they need and wear appropriate correction. Inappropriate present optical correction was found in 9 (0.37%) cases with PVA with glasses <=20/40 in either eye and BCVA>=20/32 in OU. Fifty-one (2.11%) children who needed glasses were not wearing them (PVA without glasses<=20/40 and BCVA>=20/32). On the other hand, 80 (3.31%) cases had PVA with glasses >=20/25 and UCVA >= 20/32 showing use of glasses without VI. The remaining 2229 (92.26%) children had PVA without glasses of >=20/32 in either eye. Out of the 136 (5.63%) children wearing glasses 80 (58.85%) had no VI and no need for optical correction.
Unmet need for glasses was evident by the number of children with VI (53.9%) without appropriate refractive correction. Contrarily, a considerable group of children were wearing glasses without any VI. The outcomes demonstrate that better quality of refractive services in this population is desirable, reinforcing the need for specific eye care programs to improve access and affordability for glasses in school children.
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