Causes of Visual Impairment in African-American and Hispanic Preschool Children: The Multi-Ethnic Pediatric Eye Disease Study

Abstract

Purpose: : To determine the causes of Visual Impairment (VI) in African-American (AA) and Hispanic (Hisp) preschool children.

Methods: : A population-based sample of children 30 to 72 months of age underwent a comprehensive eye examination including assessments of visual acuity (VA), anterior and posterior segments, eye alignment and cycloplegic refraction. In cases of decreased VA, retesting with refractive correction was performed and the best result was considered as best-measured VA. Decreased VA was defined as VA worse than 20/40 in children >=48 months and worse than 20/50 in children 30-47 months. Frequency distributions of the causes of decreased VA are presented.

Results: : Presenting VA and best measured VA was obtained in 3207 and 3364 children, respectively. Decreased presenting VA in the worse eye was present in 137 AA and 169 Hisp children. A majority of these cases were attributable to an identifiable ophthalmic etiology [94 (69%) of AA and 114 (67%) of Hisp children]. Of the children with an attributable cause of presenting VI, a majority of the cases [69 (73%) in AA and 85 (75%) in Hisp children] were associated with significant uncorrected refractive error and resolved after retesting. The proportion of the decreased VA cases without an identifiable etiology decreased with increasing age (Chi square test, P<0.0001).Decreased best-measured VA in the worse eye was present in 52 AA and 64 Hisp children. A majority of these cases were attributable to an identifiable ophthalmic etiology [30 (58%) in AA and 37 (58%) in Hisp children]. Amblyopia was the most common cause [23 (77%) in AA and 29 (78%) in Hisp]. 96% of these cases of amblyopia were attributable to refractive error (anisometropia, bilateral ametropia, or refractive esotropia).

Conclusions: : AA and Hisp preschool children in Los Angeles County have a significant burden of visual impairment from uncorrected refractive error and amblyopia related to refractive error. Efforts to reduce visual impairment should be focused on these treatable causes.

Keywords: clinical (human) or epidemiologic studies: prevalence/incidence • visual acuity • low vision