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S. A. Cotter, J. Lin, K. Tarczy-Hornoch, M. Borchert, M. Torres, S. Azen, R. Varma, Multi-ethnic Pediatric Eye Disease Investigator Group; Prevalence of Astigmatism in Infants and Young Children: The Multi-Ethnic Pediatric Eye Disease Study. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3136.
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To determine age- and ethnicity-related astigmatism prevalence in 6-72 month old Hispanic and African-American children.
A population-based cohort of 6- to 72-month-old children underwent Retinomax autorefraction 30-60 minutes after cycloplegia with 1% cyclopentolate (0.5% if ≤12 months). Cycloplegic retinoscopy was used if autorefraction was unsuccessful and noncycloplegic retinoscopy was performed if drops were refused. The eye with the greater astigmatism was analyzed.
3024 Hispanic and 2993 African-American children were tested. Prevalence of astigmatism ≥1.5D in children aged 6-11,12-23, 24-35, 36-47, 48-59, and 60-72 months was: 40.0%, 16.6%, 15.1%, 14.0%, 14.2%, 11.4%, respectively in Hispanic children and 25.3%, 13.7%, 13.8%, 6.8%, 11.7%, and 10.9%, respectively in African-American children. There was a trend toward decreasing prevalence with age in both ethnic groups (p<0.0001, trend test). Prevalence of astigmatism ≥3D in the same age categories as above was 5.4%, 1.9%, 1.8%, 3.4%, 3.0%, 4.0% for Hispanic and 2.2%, 1.1%, 0.6%, 0.8%, 1.3%, 2.0% for African-American children, with no significant trend with age (p=0.51). Overall, astigmatism of ≥1.5D and ≥3D were more common in Hispanic compared to African-American children, even after adjusting for age (p<0.0001). The prevalence of astigmatism ≥1.5D was greater in Hispanic boys (18.5%) compared to girls (15%) (p=0.02, age-adjusted), but there was no difference between African-American genders (p=0.40). Among those with ≥1.5D astigmatism, prevalence of axis orientation was 83%, 4%, and 13% for with-the-rule, against-the-rule, and oblique in Hispanic and 61%, 18%, 21% in African-American children; with-the-rule astigmatism was predominant at all ages.
Astigmatism is more prevalent in Hispanic than in African-American infants and young children and decreases with age. Among Hispanic children, astigmatism is slightly more common in boys than in girls. With-the-rule astigmatism is predominant in both ethnic groups. Preschool refractive error screening may help identify persistent astigmatism in these populations.
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