Abstract
Purpose :
Although globally uncorrected refractive error is reported to be the most common cause of visual impairment in school-age children, little is known about the extent of uncorrected refractive error in Israel. Schoolchildren in Israel receive vision screening in first grade, approximately age 6. However, the efficacy of this is unclear. We investigated the prevalence of uncorrected refractive error in schoolchildren in Jerusalem.
Methods :
Healthy boys ages 6-12 were recruited to participate in various research studies, all which first included a parental questionnaire to exclude children with amblyopia, strabismus and hyperopia. A full eye exam was then performed. Habitual visual acuity was measured including with glasses if the children presented with them, and cycloplegic autorefraction was measured (VX130 Luneau). Habitual visual acuity ≤20/40 was considered as visual impairment. Refractive error classifications were based on cycloplegic refraction. Amblyopia was defined as best corrected visual acuity ≤20/40 in at least one eye, astigmatism as ≤-0.75 D, myopia as spherical equivalent refraction ≤−0.50 D and hyperopia as ≥+0.50 D. Descriptive statistics were used to calculate the prevalence of amblyopia and each refractive error.
Results :
Altogether, 205 boys (average age 8.8 ± 1.7) met the ocular history criteria in the parental questionnaire. Overall, 2% of the entire cohort presented with amblyopia. The prevalence of visual impairment at initial presentation was 28% (N=57), with 21.4% (N=44) and 6.3% (N=13) for both eyes and one eye, respectively. This is despite the fact that 32% (N=18) of these children presented with glasses. Refractive error was the cause of the visual impairment in 93% (N=53) of the children, while the rest (7%, N=4) were diagnosed with amblyopia. Visual impairment was caused by myopia or hyperopia in 83% (N=44) and 17% (N=9), respectively. In addition, 38% (N=20) of the children with visual impairment had astigmatism.
Conclusions :
A high prevalence of uncorrected refractive error was observed. Many children had amblyopia and hyperopia despite a priori exclusion of children with these conditions. This suggests that many parents are unaware of their children’s visual and refractive statuses, even for children who already have glasses. Furthermore, vision screening in first grade is not sufficient to insure good vision in school.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.