Indian Journal of Community Messcine Vol. XXV, No.4, Oct-Dec, 2000 PREVALENCE OF REFRACTIVE ERRORS IN SCHOOL CHILDREN (12-17 YEARS) OF AHMEDABAD CITY Sonam Sethi, G.P. Kartha Dept. of Preventive & Social Medicine, B,J. Medical College, Ahmedabad Abstract: Research question: What isthe prevalence of Refractive Errors in ‘Objective: To study the pre Suidy design: Cross-sectional Setting: Schools of Ahmedabad city schoolchildren (12-17 years) of Ahmedabad City? lence of refractive erors in schoolchildren (12-17 years) of Ahmedabad city by age, Sex, class and type Participants: School children aged 12-17 years studying in 7th to 12th cass ‘Study period: September 1997 to March 1998, ‘Sample size: 1647 schoo! children which included 828 males and Study variables: Refractive errs by age, sex, class and type Statistical analysis: Chi square test, proportions. 819 females, Results: 25.32% of the students were found to be having refractive errors. Of these 47% were females and $3% were males. The distribution of refractive erors was: Myopia - 63,38, Hypermetropia 11.2% and astigmatism 20.4%. ‘Conclusions: These data support the assumption that vision screening of school children in develop ig countries could be useful in detccting correctable causes of decreased vision especially refractive errors and in minimising long term visual disability Key words: Prevalence, Refractive errors, Myopia, Hypermetropia, School children, Age, Sex, Class Introduction: Refractive errr is an optic defect, intrinsic o the eye which prevents light from being brought to a single point focus onthe retina, thus reducing normal vision. Diagnosis and treatment of refractive errors is relatively simple and is fone of the easiest way to reduce impaired vision. Ye, in India refractive errr is the second major cause for patients to consult ophthalmologists Refractive errors constitute a sizeable proportion of ‘any large eye OPD in our country. The overall incidence has been reported to vary between 21% and 25% of the patients attending eye OPD in India’. About 13% of Indian Population isin the age group of 10-15 years. Poor vision in childhood affects performance in school or at work and has a negative influence on the futute life of the child. Moreover, planning of a youth's career is very much dependent on the visual acuity, especially in jobs for navy, rilitary, railways and aviation’. This warrants early detection and treatment of refractive errors to prevent permanent disability Population based data concerning prevalence of refractive errors in children are not readily available for India. There have been reports of refractive errors for populations of other countries, but very little has been reported for India population ‘The present study was carried out in the schools of Ahmedabad city. Students of the age group 12-17 years ‘were chosen because refractive errors are most prevalent in this age group, occurring in as high as 20% of children by 16 years of age’ ‘This study presents the prevalence of refractive errors by age, sex, class, type and socio-economic status among. school children of Ahmedabad city. The mean age of onset of refractive errors was computed. This information may be used for planning appropriate eye care programme for the high risk groups in order to reduce the burden of visual impairment in the population, Material and Methods: Ahmedabad is metropolitan city. There are approximately 260 schools in the city. For the study purpose, Naranpura, Ramdevnagar, Memnagar and ‘Vastrapur were chosen and the schools were selected randomly. Students in the age group 12-17 years studying in classes 7th-12th were included in the study. Assuming a 20% prevalence of refractive errors based on a pilot study, the sample size was calculated to be 1526 for this cross-sectional study. However, 1714 students were selected, ofthese 67 students remained absent during study period and could not be examined. Students of 10th, 11th, and 12th classes were busy preparing for their examinations so their number was less 181The students were~ examined in their respective classes, The screening’ was done in the following way. From 6 metre distance the student was shown the E-card ‘with four E's of standard size (69 of Saellen's chat) For cach eye the child had to indicate the direction of open end of E. By simply rotating the card the sequence could be changed. The child either indicated the direction correctly (eye sight good) or incorrectly (eye sight not good). In case of a doubt the eye sight was recorded as not good. Children whose eye sight was not good ie. who had a visual acquity of less than 6/9 were sent for subjective refraction Subjective refraction was done till best corected visual acquity was achieved. Cycloplegic refraction was advised for students in whom best corrected visual acquity could not be achieved. Those having organic defects in eye such as, comeal opacity, opacity of the lens, choroid and retinal disorders were excluded. It must be mentioned that students ‘were screened only for distant vision. Therefore, number of hhypermetropics was far less than myopics. Results: Indian Joumal of Community Medicine Vol. XXV, No 4, et -Dee., 2000 ‘Table II: Class-wise distribution of students with and without refractive errors. Class Refractive errors Total Yes(%) No(#) 7 1343.3) 441062) 575 8 9120.7) 3479.3) 438 9 1277.1) 342(72.9) 469 10 39(43.8) 5056.2) 89 Ww 1236.4) 21(63.6) 33 Re 14326) 29(67.4) 3 Total a7 1230 1647 ‘Number of ammetropic of 10th to 12th standard were significantly higher (d value = 3.96, p<0.0S) than the ‘Ammetropic students of 7h to 9th standard, thereby showing that ammetropia is related to number of years of schooling ‘Table ITT: Age-wise distribution of students with and without refractive errors. ‘Age Refractive errors Total Age, sex and class distribution: ro) Note ‘Amongst 1647 students who were examined, 828 —y 267) 7803.3) eT) ‘were males and 819 were females. The age of the students 12.—==—195(24.5) 386(75.5) sn ranged from 11 to 17 years. The mean age was 13.22 years, 13 «111@22.3) 382075) 493 ‘median and mode age was 13 years. 14 101259) 288(74.1) 389 Table I: Sex-wise distribution of students with and tw ere ween ° ~arithout refractive errors. 0 4(40.0) (60.0) 10 Sex Refractive erors Toval a7 1230 1647 Yes) No) ‘The refractive errors increased with age Males 2126.7) 607(73.3) Table IV: Age of onset of refractive errors. Females 196(23.9) 623(76.1) ‘Age of onset No of cases Percentage 3 4 14 Toul 47 1230 6 4 14 7 8 28 In the study 417 students (25.32%) were found to 8 12 42 have refractive errors. Of these 196(47%) were females and Yo % ne 221(53%) were males. There was no significant difference jy 31 1B4 between refractive errors amongst males and females, ("= 12, 6 235 B 49 177 1.34, p>0.25), ; - 4 14 5a ‘Out of 417 students with refractive errors. myopia 15 8 29 was found in 265(63.5%), hypermetropia in 47(11.2%)and 16 1 04 astigmatism in 85(20.4%) cases, a 1 04 Total 27 100 FRatactve eros in schoo chikren 182 SothiS otalIndian Journal of Community Medicine Vol. XXV, No.4, Oct-Dec.. 2000, i was found that 277(66.4%) were aware of their refractive errors, whereas, 140(33.6%) were unaware of the problem, The mean age of onset of refractive errors in these ceases was 11.2242.07 years and the median and mode age was 12 years. Discussion: In the present study, prevalence of refractive errors ‘was found to be 25.3% which included 63.5% myopia, 11.2% hypermetropia and 20.4% astigmatism. ‘These results are similar to the study carried out by Laatkainen’. The prevalence of refractive errors varies depending on the population under study. particularly with regard to the age groups under consideration, Inthe present study, population consisted of age group 11-17 years. It is during this period, the children are at risk of developing refractive errors, because they are actively growing and subjected to the strain of near work due to demanding academic schedules, Such a population is likely have more ‘number of myopics. Refractive errors did not differ significantly between ‘males and females’. However, in other studies" refractive ‘errors were found more commonly in girls than in boys, probably related to their ate of growth, Girls attain puberty ‘earlier on an average and reach their final body weight 1-2 ‘years earlier than the boys. ‘Sperduto* showed that myopic prevalence rises with ‘educational level. The present study also showed that the number of students with refractive errors increased as the students move to higher classes, implying thereby that a significant relationship exists between refractive error and educational level. Conclusion: ‘The data support the assumption that vision screening. Cf school children in developing countries could be useful jin detecting correctable causes of decreased vision especially refractive errors and in minimising long term ‘The present study shows thatthe adolescent age group forms the high risk group for refractive errors and most of the children are unaware of refractive errors. Due emphasis Rafractve errors in schoolchildren 163 ‘must, therefore, be laid upon the screening for refractive errors inthis age group. Moreover, attention should be paid to visual hygiene. While reading illumination should be ‘200d and adequately arranged. Posture should be easy and natural. Clarity and print should be carefully supervised. An undue ocular fatigue should be avoided. Students should have as many outdoor hours as possible. Students need to be educated about signs and symptoms of refractive errors. Pre-school and school screening for detection of refractive errors should be carried out on periodic basis. Acknowledgements: I wish to acknowledge the guidance of Dr. V.S. Rawal, Head of the Department PSM for his constant support and encouragement. [also than WHO for providing {information and software like EP16 for the computer aided analysis of observations. References: 1. Limburg H: Cost effective screening of school for refractive errors, W.H. Fourm 1995, 16, 173-8. Goswami A, Ahmead E, Shaha PL, Roy IS: An epidemiological pattern of cases of refractive errors, JIMA 1979, 72(10), 227-8. Mukherjee R, Seal SC: An epidemiological study of refractive errors among school children in Calcutta, JIMA 1973, 73(9-10), 159-64. Krause VLF, Krause Kaisa, Rantakallo Paule: Some differences in refractive errors upto age of 15, Acta ‘ophthamol 1982, 60, 917-26. Blindness & visual impairment in Gujarat, State “ophthalmic cell, Govt. of Gujarat, 1986-89, ‘Tay MT et al: Myopic and educational attainment in 421116 young Singaporean males, Ann Acad Med, Singapore, 1992, 21(6): 785-91 Venkatramana K, Naduvilam T: Visual impairment in school children in Southern India, Ind. Jou. of Ophthalmol, 1997, 129-34. Elkinton AR, Khan PT: Refractive Errors, BMJ, 1988; 297: 192-5. ‘Seti S otal