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A. S. Pai, C. Samarawickrama, J. J. Wang, T. Y. Wong, R. Varma, K. A. Rose, G. Burlutsky, P. Mitchell, Sydney Paediatric Eye Disease Study; Prevalence and Associations of Low Vision in Preschool Children: The Sydney Paediatric Eye Disease Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5210.
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To investigate the prevalence and associations of low vision in a sample of preschool children.
2473 children, aged 6-72 months, were examined in the Sydney Paediatric Eye Disease Study (SPEDS) during 2007-9. Monocular visual acuity (VA) was attempted on all children, aged 30 months+, using the Electronic Visual Acuity system, and in a subset using the logarithm of the minimum angle of resolution chart. Low vision was defined as presenting VA worse than 20/50 in children aged less than 48 months and worse than 20/40 in those aged 48 to 72 months. Refraction was measured using Retinomax K-Plus 2, Canon RK-F1 autorefractor, or streak retinoscopy after adequate cycloplegia. Myopia was defined as spherical equivalent refraction (SER, sphere + ½ cylinder) ≤ -0.50 dioptres (D), hyperopia as SER ≥+2.00D, astigmatism as cylinder ≥ 1.00D, and anisometropia as SER difference ≥1.00D between eyes. Sociodemographic data was obtained from questionnaires.
Low vision in the worse eye was found in 8.35%, with an overall mean VA of 20/32 and mean SER 1.30D in our sample. A trend of improving mean VA from 20/32 to 20/25 with increasing age was observed (ptrend < 0.0001). However, low VA prevalence was similar across all 5 age groups (p=0.92). There was also no significant difference in prevalent low vision between girls and boys, across ethnicity subgroups, or socioeconomic levels (all p>0.05). After adjusting for age, gender and ethnicity, low vision in preschool children was found to be significantly associated with myopia (odds ratio with 95% confidence interval [OR] 4.71, 2.38-9.33), hyperopia (OR 2.58, 1.62-4.11), astigmatism (OR 7.71, 5.01-11.87), anisometropia (OR 4.20, 1.80-9.80), esotropia (OR 8.72, 2.28-33.37), suspected amblyopia (OR 63.52, 23.46-171.98), low birthweight <2500g (OR 2.80, 1.22-6.43) and prematurity ≤36 weeks (OR 2.25, 1.15-4.42).
This study suggests that 8% of Australian preschool children have low presenting vision. Significant ametropia, low birthweight, and prematurity were strongly associated with low vision, suggesting the importance to identify and monitor vision in such children and to correct refractive errors from an early age to ensure normal vision development.
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