Age-Specific Prevalence of Visual Impairment and Refractive Error in Children Aged 3–10 Years in Shanghai, China

We assessed changes in age-specific prevalence of refractive error at the time of starting school, by comparing preschool and school age cohorts in Shanghai, China. A cross-sectional study was done in Jiading District, Shanghai during November and December 2013. We randomly selected 7 kindergartens...

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Published in:	Investigative ophthalmology & visual science Vol. 57; no. 14; p. 6188
Main Authors:	Ma, Yingyan, Qu, Xiaomei, Zhu, Xiaofeng, Xu, Xun, Zhu, Jianfeng, Sankaridurg, Padmaja, Lin, Senlin, Lu, Lina, Zhao, Rong, Wang, Ling, Shi, Huijing, Tan, Hui, You, Xiaofang, Yuan, Hong, Sun, Sifei, Wang, Mingjin, He, Xiangui, Zou, Haidong, Congdon, Nathan
Format:	Journal Article
Language:	English
Published:	United States 01.11.2016
Subjects:	Age Distribution Age Factors Child Child, Preschool China - epidemiology Cross-Sectional Studies Female Humans Male Prevalence Prognosis Refraction, Ocular - physiology Refractive Errors - epidemiology Refractive Errors - physiopathology Refractive Errors - rehabilitation Risk Factors Vision Tests Visual Acuity Visually Impaired Persons
ISSN:	1552-5783, 1552-5783
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Abstract	We assessed changes in age-specific prevalence of refractive error at the time of starting school, by comparing preschool and school age cohorts in Shanghai, China. A cross-sectional study was done in Jiading District, Shanghai during November and December 2013. We randomly selected 7 kindergartens and 7 primary schools, with probability proportionate to size. Chinese children (n = 8398) aged 3 to 10 years were enumerated, and 8267 (98.4%) were included. Children underwent distance visual acuity assessment and refraction measurement by cycloplegic autorefraction and subjective refraction. The prevalence of uncorrected visual acuity (UCVA), presenting visual acuity, and best-corrected visual acuity in the better eye of ≤20/40 was 19.8%, 15.5%, and 1.7%, respectively. Among those with UCVA ≤ 20/40, 93.2% could achieve visual acuity of ≥20/32 with refraction. Only 28.7% (n = 465) of children with UCVA in the better eye of ≤20/40 wore glasses. Prevalence of myopia (spherical equivalent ≤-0.5 diopters [D] in at least one eye) increased from 1.78% in 3-year-olds to 52.2% in 10-year-olds, while prevalence of hyperopia (spherical equivalent ≥+2.0 D) decreased from 17.8% among 3-year-olds to 2.6% by 10 years of age. After adjusting for age, attending elite "high-level" school was statistically associated with greater myopia prevalence. The prevalence of myopia was lower or comparable to that reported in other populations from age 3 to 5 years, but increased dramatically after 6 years, consistent with a strong environmental role of schooling on myopia development.
AbstractList	We assessed changes in age-specific prevalence of refractive error at the time of starting school, by comparing preschool and school age cohorts in Shanghai, China.PURPOSEWe assessed changes in age-specific prevalence of refractive error at the time of starting school, by comparing preschool and school age cohorts in Shanghai, China.A cross-sectional study was done in Jiading District, Shanghai during November and December 2013. We randomly selected 7 kindergartens and 7 primary schools, with probability proportionate to size. Chinese children (n = 8398) aged 3 to 10 years were enumerated, and 8267 (98.4%) were included. Children underwent distance visual acuity assessment and refraction measurement by cycloplegic autorefraction and subjective refraction.METHODSA cross-sectional study was done in Jiading District, Shanghai during November and December 2013. We randomly selected 7 kindergartens and 7 primary schools, with probability proportionate to size. Chinese children (n = 8398) aged 3 to 10 years were enumerated, and 8267 (98.4%) were included. Children underwent distance visual acuity assessment and refraction measurement by cycloplegic autorefraction and subjective refraction.The prevalence of uncorrected visual acuity (UCVA), presenting visual acuity, and best-corrected visual acuity in the better eye of ≤20/40 was 19.8%, 15.5%, and 1.7%, respectively. Among those with UCVA ≤ 20/40, 93.2% could achieve visual acuity of ≥20/32 with refraction. Only 28.7% (n = 465) of children with UCVA in the better eye of ≤20/40 wore glasses. Prevalence of myopia (spherical equivalent ≤-0.5 diopters [D] in at least one eye) increased from 1.78% in 3-year-olds to 52.2% in 10-year-olds, while prevalence of hyperopia (spherical equivalent ≥+2.0 D) decreased from 17.8% among 3-year-olds to 2.6% by 10 years of age. After adjusting for age, attending elite "high-level" school was statistically associated with greater myopia prevalence.RESULTSThe prevalence of uncorrected visual acuity (UCVA), presenting visual acuity, and best-corrected visual acuity in the better eye of ≤20/40 was 19.8%, 15.5%, and 1.7%, respectively. Among those with UCVA ≤ 20/40, 93.2% could achieve visual acuity of ≥20/32 with refraction. Only 28.7% (n = 465) of children with UCVA in the better eye of ≤20/40 wore glasses. Prevalence of myopia (spherical equivalent ≤-0.5 diopters [D] in at least one eye) increased from 1.78% in 3-year-olds to 52.2% in 10-year-olds, while prevalence of hyperopia (spherical equivalent ≥+2.0 D) decreased from 17.8% among 3-year-olds to 2.6% by 10 years of age. After adjusting for age, attending elite "high-level" school was statistically associated with greater myopia prevalence.The prevalence of myopia was lower or comparable to that reported in other populations from age 3 to 5 years, but increased dramatically after 6 years, consistent with a strong environmental role of schooling on myopia development.CONCLUSIONSThe prevalence of myopia was lower or comparable to that reported in other populations from age 3 to 5 years, but increased dramatically after 6 years, consistent with a strong environmental role of schooling on myopia development. We assessed changes in age-specific prevalence of refractive error at the time of starting school, by comparing preschool and school age cohorts in Shanghai, China. A cross-sectional study was done in Jiading District, Shanghai during November and December 2013. We randomly selected 7 kindergartens and 7 primary schools, with probability proportionate to size. Chinese children (n = 8398) aged 3 to 10 years were enumerated, and 8267 (98.4%) were included. Children underwent distance visual acuity assessment and refraction measurement by cycloplegic autorefraction and subjective refraction. The prevalence of uncorrected visual acuity (UCVA), presenting visual acuity, and best-corrected visual acuity in the better eye of ≤20/40 was 19.8%, 15.5%, and 1.7%, respectively. Among those with UCVA ≤ 20/40, 93.2% could achieve visual acuity of ≥20/32 with refraction. Only 28.7% (n = 465) of children with UCVA in the better eye of ≤20/40 wore glasses. Prevalence of myopia (spherical equivalent ≤-0.5 diopters [D] in at least one eye) increased from 1.78% in 3-year-olds to 52.2% in 10-year-olds, while prevalence of hyperopia (spherical equivalent ≥+2.0 D) decreased from 17.8% among 3-year-olds to 2.6% by 10 years of age. After adjusting for age, attending elite "high-level" school was statistically associated with greater myopia prevalence. The prevalence of myopia was lower or comparable to that reported in other populations from age 3 to 5 years, but increased dramatically after 6 years, consistent with a strong environmental role of schooling on myopia development.
Author	Lu, Lina Zhu, Xiaofeng Zhao, Rong Shi, Huijing Xu, Xun Qu, Xiaomei Zhu, Jianfeng Tan, Hui You, Xiaofang Ma, Yingyan Wang, Ling Sun, Sifei Congdon, Nathan Yuan, Hong Zou, Haidong Sankaridurg, Padmaja Lin, Senlin He, Xiangui Wang, Mingjin
Author_xml	– sequence: 1 givenname: Yingyan surname: Ma fullname: Ma, Yingyan organization: Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China 2Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 2 givenname: Xiaomei surname: Qu fullname: Qu, Xiaomei organization: Eye & ENT Hospital, Fudan University, Shanghai, China – sequence: 3 givenname: Xiaofeng surname: Zhu fullname: Zhu, Xiaofeng organization: Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 4 givenname: Xun surname: Xu fullname: Xu, Xun organization: Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 5 givenname: Jianfeng surname: Zhu fullname: Zhu, Jianfeng organization: Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China – sequence: 6 givenname: Padmaja surname: Sankaridurg fullname: Sankaridurg, Padmaja organization: Brien Holden Vision Institute, Rupert Myers Building, Kensington, New South Wales, Sydney, Australia – sequence: 7 givenname: Senlin surname: Lin fullname: Lin, Senlin organization: Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China 5School of Public Health, Fudan University, Shanghai, China – sequence: 8 givenname: Lina surname: Lu fullname: Lu, Lina organization: Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China – sequence: 9 givenname: Rong surname: Zhao fullname: Zhao, Rong organization: Shanghai Shen Kang Hospital Development Center, Shanghai, China – sequence: 10 givenname: Ling surname: Wang fullname: Wang, Ling organization: Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China – sequence: 11 givenname: Huijing surname: Shi fullname: Shi, Huijing organization: Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China – sequence: 12 givenname: Hui surname: Tan fullname: Tan, Hui organization: Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China – sequence: 13 givenname: Xiaofang surname: You fullname: You, Xiaofang organization: Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China – sequence: 14 givenname: Hong surname: Yuan fullname: Yuan, Hong organization: Jiading Center for Disease Prevention and Control, Shanghai, China – sequence: 15 givenname: Sifei surname: Sun fullname: Sun, Sifei organization: Jiading Center for Disease Prevention and Control, Shanghai, China – sequence: 16 givenname: Mingjin surname: Wang fullname: Wang, Mingjin organization: Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China – sequence: 17 givenname: Xiangui surname: He fullname: He, Xiangui organization: Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China 7Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China – sequence: 18 givenname: Haidong surname: Zou fullname: Zou, Haidong organization: Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China 2Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China – sequence: 19 givenname: Nathan surname: Congdon fullname: Congdon, Nathan organization: TREE Centre, Centre for Public Health, Queen's University Belfast, Northern Ireland, United Kingdom 10Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China 11Orbis International, New York, New York, United States
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SubjectTerms	Age Distribution Age Factors Child Child, Preschool China - epidemiology Cross-Sectional Studies Female Humans Male Prevalence Prognosis Refraction, Ocular - physiology Refractive Errors - epidemiology Refractive Errors - physiopathology Refractive Errors - rehabilitation Risk Factors Vision Tests Visual Acuity Visually Impaired Persons
Title	Age-Specific Prevalence of Visual Impairment and Refractive Error in Children Aged 3–10 Years in Shanghai, China
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