Astigmatism among schoolchildren in Mumbai, India: a large, population-based study
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 2 (2024),
1 September 2024
,
Page 57-62
https://doi.org/10.51329/mehdioptometry198
Abstract
Background: Astigmatism is a common refractive error. If left untreated, it may result in blurred or distorted vision. We determined the prevalence of astigmatism in schoolchildren aged 6–16 years in Mumbai, India.Methods: A cross-sectional study was conducted using a stratified cluster random sampling method. We included primary and secondary schoolchildren aged 6–16 years. All children underwent a comprehensive eye examination. Astigmatism was characterized as having a diopter cylinder (DC) power of 0.50 or more in at least one eye, and for prevalence estimation, we reported the number of children with astigmatism. Astigmatism severity was defined as mild (less than or equal to - 1.50 DC), moderate (- 1.50 DC to - 2.50 DC), and severe (> - 2.50 DC). Based on the axis orientation, astigmatism was categorized as with-the-rule, against-the-rule, and oblique.
Results: A total of 3151 schoolchildren with a mean (standard deviation) age of 12.1 (2.9) years were screened; boys and girls accounted for 49.22% and 50.78%, respectively. Age groups of 6–9, 10–13, and 14–16 years accounted for 51.35%, 28.53%, and 20.12%, respectively. The overall prevalence of astigmatism was 11.46%, with no significant difference between sexes (P > 0.05). The prevalences of astigmatism in the groups aged 6–9-, 10–13-, and 14–16 years were 5.24%, 3.49%, and 2.73%, respectively. Prevalence differed significantly among age groups (P < 0.05), with a trend of decreasing prevalence with increasing age. No significant association was found between age and severity of astigmatism (P > 0.05). The prevalences of mild, moderate, and severe astigmatism were 6.51%, 3.11%, and 1.84%, respectively. Mild astigmatism was significantly more prevalent than moderate (P < 0.05) or severe astigmatism (P < 0.05). The prevalence of astigmatism differed significantly among the three orientations of axis (P < 0.001). The prevalences were 9.20%, 1.68%, and 0.57% for with-the-rule, against-the-rule, and oblique astigmatism, respectively. We found a statistically significant difference in the prevalences of astigmatism based on the axis orientation between boys and girls (P < 0.05) and between age groups (P < 0.001), with a decreasing trend observed with increasing age.
Conclusions: We found a prevalence of 11.46% for astigmatism among schoolchildren aged 6–16 years in Mumbai, India. There was a decreasing trend in prevalence with increasing age, with no difference between sexes. The prevalence was the highest for mild astigmatism, followed by moderate and severe astigmatism. Prevalence differed significantly based on the axis orientation among the three subtypes, age groups, and between the two sexes, with a decreasing trend with increasing age. With-the-rule astigmatism was the most common, followed by against-the-rule astigmatism; oblique astigmatism was the least common.
Keywords:
- ocular refraction
- optometrist
- ophthalmologist
- children
- child
- frequency
- prevalence
- vision screening
References
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15. Hashemi H, Asharlous A, Khabazkhoob M, Yekta A, Emamian MH, Fotouhi A. The profile of astigmatism in 6-12-year-old children in Iran. J Optom. 2021 Jan-Mar;14(1):58-68. doi: 10.1016/j.optom.2020.03.004. Epub 2020 Apr 25. PMID: 32345571; PMCID: PMC7752993.
16. Krishnamurthy S, Rangavittal S, Chandrasekar A, Narayanan A. Distribution of Astigmatism among School Children Who Fail Vision Screening in South India. Ophthalmic Epidemiol. 2023 Jun;30(3):276-285. doi: 10.1080/09286586.2022.2088804. Epub 2022 Jun 20. PMID: 35723007.
17. Elfil M, Negida A. Sampling methods in Clinical Research; an Educational Review. Emerg (Tehran). 2017;5(1):e52. Epub 2017 Jan 14. PMID: 28286859; PMCID: PMC5325924.
18. Aluyi-Osa G, Musa MJ, Zeppieri M. Jackson Cross Cylinder. 2023 May 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 36508527.
19. Kaur K, Gurnani B. Subjective Refraction Techniques. 2023 Jun 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 35593807.
20. Momeni-Moghaddam H, Goss DA. Comparison of four different binocular balancing techniques. Clin Exp Optom. 2014 Sep;97(5):422-5. doi: 10.1111/cxo.12198. PMID: 25138746.
21. Broadway DC. How to test for a relative afferent pupillary defect (RAPD). Community Eye Health. 2012;25(79-80):58-9. PMID: 23520419; PMCID: PMC3588138.
22. Belliveau AP, Somani AN, Dossani RH. Pupillary Light Reflex. 2023 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30725865.
23. Scheiman M, Gallaway M, Frantz KA, Peters RJ, Hatch S, Cuff M, Mitchell GL. Nearpoint of convergence: test procedure, target selection, and normative data. Optom Vis Sci. 2003 Mar;80(3):214-25. doi: 10.1097/00006324-200303000-00011. PMID: 12637833.
24. Parkinson J, Linthorne N, Matchett T. Subjective measurement of the near point of accommodation in pre/early literates. Am Orthopt J. 2001;51:75-83. doi: 10.3368/aoj.51.1.75. PMID: 21149034.
25. Elamurugan V, Shankaralingappa P, Aarthy G, Kasturi N, Babu RK. Assessment of stereopsis in pediatric and adolescent spectacle-corrected refractive error - A cross-sectional study. Indian J Ophthalmol. 2022 Feb;70(2):604-608. doi: 10.4103/ijo.IJO_997_21. PMID: 35086245; PMCID: PMC9024002.
26. Alduhayan R, Almustanyir A. Comparison of Two Printed Pseudoisochromatic Tests for Color Vision Assessment. Optom Vis Sci. 2023 Dec 1;100(12):840-846. doi: 10.1097/OPX.0000000000002087. Epub 2023 Nov 27. PMID: 38019937.
27. Guirao A, Williams DR. A method to predict refractive errors from wave aberration data. Optom Vis Sci. 2003 Jan;80(1):36-42. doi: 10.1097/00006324-200301000-00006. PMID: 12553542.
28. Sheeladevi S, Seelam B, Nukella PB, Modi A, Ali R, Keay L. Prevalence of refractive errors in children in India: a systematic review. Clin Exp Optom. 2018 Jul;101(4):495-503. doi: 10.1111/cxo.12689. Epub 2018 Apr 22. PMID: 29682791.
29. Wang J, Cheng QE, Fu X, Zhang R, Meng J, Gu F, Li J, Ying GS. Astigmatism in school students of eastern China: prevalence, type, severity and associated risk factors. BMC Ophthalmol. 2020 Apr 19;20(1):155. doi: 10.1186/s12886-020-01425-w. PMID: 32306963; PMCID: PMC7168812.
30. Huang J, Maguire MG, Ciner E, Kulp MT, Cyert LA, Quinn GE, Orel-Bixler D, Moore B, Ying GS; Vision in Preschoolers (VIP) Study Group. Risk factors for astigmatism in the Vision in Preschoolers Study. Optom Vis Sci. 2014 May;91(5):514-21. doi: 10.1097/OPX.0000000000000242. PMID: 24727825; PMCID: PMC4004377.
31. Wen G, Tarczy-Hornoch K, McKean-Cowdin R, Cotter SA, Borchert M, Lin J, Kim J, Varma R; Multi-Ethnic Pediatric Eye Disease Study Group. Prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white and Asian children: multi-ethnic pediatric eye disease study. Ophthalmology. 2013 Oct;120(10):2109-16. doi: 10.1016/j.ophtha.2013.06.039. Epub 2013 Aug 14. PMID: 23953098; PMCID: PMC3902090.
32. Shih YF, Hsiao CK, Tung YL, Lin LL, Chen CJ, Hung PT. The prevalence of astigmatism in Taiwan schoolchildren. Optom Vis Sci. 2004 Feb;81(2):94-8. doi: 10.1097/00006324-200402000-00007. PMID: 15127928.
33. Fotouhi A, Hashemi H, Yekta AA, Mohammad K, Khoob MK. Characteristics of astigmatism in a population of schoolchildren, Dezful, Iran. Optom Vis Sci. 2011 Sep;88(9):1054-9. doi: 10.1097/OPX.0b013e318221727d. PMID: 21623251.
34. Wang Y, Li L, Tang XL, Guo GL, Chen MW, Cha LL, Liao JY, Zou YC. Characteristics of astigmatism in school-age children aged 5 to 13 years in northeast Sichuan: a cross-sectional school-based study. Transl Pediatr. 2024 Jul 31;13(7):1130-1140. doi: 10.21037/tp-24-70. Epub 2024 Jul 29. PMID: 39144422; PMCID: PMC11319998.
35. Tong L, Saw SM, Carkeet A, Chan WY, Wu HM, Tan D. Prevalence rates and epidemiological risk factors for astigmatism in Singapore school children. Optom Vis Sci. 2002 Sep;79(9):606-13. doi: 10.1097/00006324-200209000-00012. PMID: 12322931
2. Zhang J, Wu Y, Sharma B, Gupta R, Jawla S, Bullimore MA. Epidemiology and Burden of Astigmatism: A Systematic Literature Review. Optom Vis Sci. 2023 Mar 1;100(3):218-231. doi: 10.1097/OPX.0000000000001998. Epub 2023 Feb 7. PMID: 36749017; PMCID: PMC10045990.
3. Mohammadi SF, Khorrami-Nejad M, Hamidirad M. Posterior corneal astigmatism: a review article. Clin Optom (Auckl). 2019 Aug 12;11:85-96. doi: 10.2147/OPTO.S210721. PMID: 31496856; PMCID: PMC6697663.
4. Read SA, Collins MJ, Carney LG. A review of astigmatism and its possible genesis. Clin Exp Optom. 2007 Jan;90(1):5-19. doi: 10.1111/j.1444-0938.2007.00112.x. PMID: 17177660.
5. Morlet N, Minassian D, Dart J. Astigmatism and the analysis of its surgical correction. Br J Ophthalmol. 2001 Sep;85(9):1127-38. doi: 10.1136/bjo.85.9.1127. PMID: 11520769; PMCID: PMC1724117.
6. Read SA, Vincent SJ, Collins MJ. The visual and functional impacts of astigmatism and its clinical management. Ophthalmic Physiol Opt. 2014 May;34(3):267-94. doi: 10.1111/opo.12128. Epub 2014 Mar 18. PMID: 24635572.
7. Shankar S, Bobier WR. Corneal and lenticular components of total astigmatism in a preschool sample. Optom Vis Sci. 2004 Jul;81(7):536-42. doi: 10.1097/00006324-200407000-00015. PMID: 15252353.
8. Black AA, Wood JM, Colorado LH, Collins MJ. The impact of uncorrected astigmatism on night driving performance. Ophthalmic Physiol Opt. 2019 Sep;39(5):350-357. doi: 10.1111/opo.12634. Epub 2019 Aug 4. PMID: 31378990.
9. Ren Q, Yang B, Liu L, Cho P. Orthokeratology in adults and factors affecting success: Study design and preliminary results. Cont Lens Anterior Eye. 2020 Dec;43(6):595-601. doi: 10.1016/j.clae.2020.03.016. Epub 2020 May 1. PMID: 32371038.
10. Dobson V, Harvey EM, Clifford-Donaldson CE, Green TK, Miller JM. Amblyopia in astigmatic infants and toddlers. Optom Vis Sci. 2010 May;87(5):330-6. doi: 10.1097/OPX.0b013e3181d951c8. PMID: 20351602; PMCID: PMC2886599.
11. Harvey EM. Development and treatment of astigmatism-related amblyopia. Optom Vis Sci. 2009 Jun;86(6):634-9. doi: 10.1097/OPX.0b013e3181a6165f. PMID: 19430327; PMCID: PMC2706277.
12. Wang Y, Mu J, Yang Y, Li X, Qin H, Mulati B, Wang Z, Gong W, Zhao Y, Gao Y. Prevalence and risk factors for astigmatism in 7 to 19-year-old students in Xinjiang, China: a cross-sectional study. BMC Ophthalmol. 2024 Mar 13;24(1):116. doi: 10.1186/s12886-024-03382-0. PMID: 38481203; PMCID: PMC10935971.
13. Hashemi H, Fotouhi A, Yekta A, Pakzad R, Ostadimoghaddam H, Khabazkhoob M. Global and regional estimates of prevalence of refractive errors: Systematic review and meta-analysis. J Curr Ophthalmol. 2017 Sep 27;30(1):3-22. doi: 10.1016/j.joco.2017.08.009. PMID: 29564404; PMCID: PMC5859285.
14. Yang Z, Lu Z, Shen Y, Chu T, Pan X, Wang C, Wang J. Prevalence of and factors associated with astigmatism in preschool children in Wuxi City, China. BMC Ophthalmol. 2022 Apr 1;22(1):146. doi: 10.1186/s12886-022-02358-2. PMID: 35365119; PMCID: PMC8976382.
15. Hashemi H, Asharlous A, Khabazkhoob M, Yekta A, Emamian MH, Fotouhi A. The profile of astigmatism in 6-12-year-old children in Iran. J Optom. 2021 Jan-Mar;14(1):58-68. doi: 10.1016/j.optom.2020.03.004. Epub 2020 Apr 25. PMID: 32345571; PMCID: PMC7752993.
16. Krishnamurthy S, Rangavittal S, Chandrasekar A, Narayanan A. Distribution of Astigmatism among School Children Who Fail Vision Screening in South India. Ophthalmic Epidemiol. 2023 Jun;30(3):276-285. doi: 10.1080/09286586.2022.2088804. Epub 2022 Jun 20. PMID: 35723007.
17. Elfil M, Negida A. Sampling methods in Clinical Research; an Educational Review. Emerg (Tehran). 2017;5(1):e52. Epub 2017 Jan 14. PMID: 28286859; PMCID: PMC5325924.
18. Aluyi-Osa G, Musa MJ, Zeppieri M. Jackson Cross Cylinder. 2023 May 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 36508527.
19. Kaur K, Gurnani B. Subjective Refraction Techniques. 2023 Jun 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 35593807.
20. Momeni-Moghaddam H, Goss DA. Comparison of four different binocular balancing techniques. Clin Exp Optom. 2014 Sep;97(5):422-5. doi: 10.1111/cxo.12198. PMID: 25138746.
21. Broadway DC. How to test for a relative afferent pupillary defect (RAPD). Community Eye Health. 2012;25(79-80):58-9. PMID: 23520419; PMCID: PMC3588138.
22. Belliveau AP, Somani AN, Dossani RH. Pupillary Light Reflex. 2023 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30725865.
23. Scheiman M, Gallaway M, Frantz KA, Peters RJ, Hatch S, Cuff M, Mitchell GL. Nearpoint of convergence: test procedure, target selection, and normative data. Optom Vis Sci. 2003 Mar;80(3):214-25. doi: 10.1097/00006324-200303000-00011. PMID: 12637833.
24. Parkinson J, Linthorne N, Matchett T. Subjective measurement of the near point of accommodation in pre/early literates. Am Orthopt J. 2001;51:75-83. doi: 10.3368/aoj.51.1.75. PMID: 21149034.
25. Elamurugan V, Shankaralingappa P, Aarthy G, Kasturi N, Babu RK. Assessment of stereopsis in pediatric and adolescent spectacle-corrected refractive error - A cross-sectional study. Indian J Ophthalmol. 2022 Feb;70(2):604-608. doi: 10.4103/ijo.IJO_997_21. PMID: 35086245; PMCID: PMC9024002.
26. Alduhayan R, Almustanyir A. Comparison of Two Printed Pseudoisochromatic Tests for Color Vision Assessment. Optom Vis Sci. 2023 Dec 1;100(12):840-846. doi: 10.1097/OPX.0000000000002087. Epub 2023 Nov 27. PMID: 38019937.
27. Guirao A, Williams DR. A method to predict refractive errors from wave aberration data. Optom Vis Sci. 2003 Jan;80(1):36-42. doi: 10.1097/00006324-200301000-00006. PMID: 12553542.
28. Sheeladevi S, Seelam B, Nukella PB, Modi A, Ali R, Keay L. Prevalence of refractive errors in children in India: a systematic review. Clin Exp Optom. 2018 Jul;101(4):495-503. doi: 10.1111/cxo.12689. Epub 2018 Apr 22. PMID: 29682791.
29. Wang J, Cheng QE, Fu X, Zhang R, Meng J, Gu F, Li J, Ying GS. Astigmatism in school students of eastern China: prevalence, type, severity and associated risk factors. BMC Ophthalmol. 2020 Apr 19;20(1):155. doi: 10.1186/s12886-020-01425-w. PMID: 32306963; PMCID: PMC7168812.
30. Huang J, Maguire MG, Ciner E, Kulp MT, Cyert LA, Quinn GE, Orel-Bixler D, Moore B, Ying GS; Vision in Preschoolers (VIP) Study Group. Risk factors for astigmatism in the Vision in Preschoolers Study. Optom Vis Sci. 2014 May;91(5):514-21. doi: 10.1097/OPX.0000000000000242. PMID: 24727825; PMCID: PMC4004377.
31. Wen G, Tarczy-Hornoch K, McKean-Cowdin R, Cotter SA, Borchert M, Lin J, Kim J, Varma R; Multi-Ethnic Pediatric Eye Disease Study Group. Prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white and Asian children: multi-ethnic pediatric eye disease study. Ophthalmology. 2013 Oct;120(10):2109-16. doi: 10.1016/j.ophtha.2013.06.039. Epub 2013 Aug 14. PMID: 23953098; PMCID: PMC3902090.
32. Shih YF, Hsiao CK, Tung YL, Lin LL, Chen CJ, Hung PT. The prevalence of astigmatism in Taiwan schoolchildren. Optom Vis Sci. 2004 Feb;81(2):94-8. doi: 10.1097/00006324-200402000-00007. PMID: 15127928.
33. Fotouhi A, Hashemi H, Yekta AA, Mohammad K, Khoob MK. Characteristics of astigmatism in a population of schoolchildren, Dezful, Iran. Optom Vis Sci. 2011 Sep;88(9):1054-9. doi: 10.1097/OPX.0b013e318221727d. PMID: 21623251.
34. Wang Y, Li L, Tang XL, Guo GL, Chen MW, Cha LL, Liao JY, Zou YC. Characteristics of astigmatism in school-age children aged 5 to 13 years in northeast Sichuan: a cross-sectional school-based study. Transl Pediatr. 2024 Jul 31;13(7):1130-1140. doi: 10.21037/tp-24-70. Epub 2024 Jul 29. PMID: 39144422; PMCID: PMC11319998.
35. Tong L, Saw SM, Carkeet A, Chan WY, Wu HM, Tan D. Prevalence rates and epidemiological risk factors for astigmatism in Singapore school children. Optom Vis Sci. 2002 Sep;79(9):606-13. doi: 10.1097/00006324-200209000-00012. PMID: 12322931
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