The aim of this study was to investigate the agreement between cycloplegic and non-cycloplegic autorefraction with an open-field auto refractor in a school vision screening set up, and to define a threshold for myopia that agrees with the standard cycloplegic refraction threshold. The study was conducted as part of the Sankara Nethralaya Tamil Nadu Essilor Myopia (STEM) study, which investigated the prevalence, incidence, and risk factors for myopia among children in South India. Children from two schools aged 5 to 15 years, with no ocular abnormalities and whose parents gave informed consent for cycloplegic refraction were included in the study. All the children underwent visual acuity assessment (Pocket Vision Screener, Elite school of Optometry, India), followed by non-cycloplegic and cycloplegic (1% tropicamide) open-field autorefraction (Grand Seiko, WAM-5500). A total of 387 children were included in the study, of whom 201 were boys. The mean (SD) age of the children was 12.2 (±2.1) years. Overall, the mean difference between cycloplegic and non-cycloplegic spherical equivalent (SE) open-field autorefraction measures was 0.34 D (limits of agreement (LOA), 1.06 D to −0.38 D). For myopes, the mean difference between cycloplegic and non-cycloplegic SE was 0.13 D (LOA, 0.63D to −0.36D). The prevalence of myopia was 12% (95% CI, 8% to 15%) using the threshold of cycloplegic SE ≤ −0.50 D, and was 14% (95% CI, 11% to 17%) with SE ≤ −0.50 D using non-cycloplegic refraction. When myopia was defined as SE of ≤−0.75 D under non-cycloplegic conditions, there was no difference between cycloplegic and non-cycloplegic open-field autorefraction prevalence estimates (12%; 95% CI, 8% to 15%; p = 1.00). Overall, non-cycloplegic refraction underestimates hyperopia and overestimates myopia; but for subjects with myopia, this difference is minimal and not clinically significant. A threshold of SE ≤ −0.75 D agrees well for the estimation of myopia prevalence among children when using non-cycloplegic refraction and is comparable with the standard definition of cycloplegic myopic refraction of SE ≤ −0.50 D.
Purpose: The aim was to determine the characteristics of near work-induced transient myopia (NITM) in asymptomatic Indian subjects and the influence of target size and contrast. Methods: Two studies were conducted: First, 24 myopes and 24 emmetropes viewed four targets (N8 and N12 with 50 and 90 per cent contrasts) placed at 0.2 m for five minutes. The refractive status was assessed objectively, before and after carrying out the near task, with the Grand Seiko WAM-5500 open-field autorefractor under monocular viewing conditions. Second, a different group of 24 myopes and 24 emmetropes viewed a N12 target with 90 per cent contrast for 60 minutes with pre-and post-refractive state measurements repeated as above. NITM was defined as the difference between pre-task and post-task distance refraction. Results: In the first study, myopes demonstrated an initial post-task myopic shift of 0.21 D, whereas emmetropes demonstrated a small hyperopic shift of 0.07 D (p < 0.001). The myopes demonstrated a decay time constant of 6.07 seconds. There was no effect of target size or contrast on the magnitude of the NITM or the decay time constant (p > 0.05). In the second study, myopes showed a NITM of 0.31 D, which was significantly greater than emmetropes (p < 0.001). The myopes demonstrated a decay time constant of 8.16 seconds. Conclusion: The magnitude of the NITM was higher in myopes compared to emmetropes for both five minute and 60 minute viewing time. The NITM decayed slightly faster than that found in previous literature for some other ethnic groups. Potential reasons for these findings are discussed.
To report the baseline prevalence of myopia among school children in Tamil Nadu, South India from a prospective cohort study. Methods: Children between the ages of 5 and 16 years from 11 schools in two districts of Tamil Nadu underwent vision screening. All children underwent visual acuity assessment using a Pocket Vision Screener followed by non-cycloplegic open-field autorefraction (Grand Seiko WAM-5500). Myopia was defined as a spherical equivalent (SE) refraction of ≤−0.75 D and high myopia was defined as SE ≤ −6.00 D. Distribution of refraction, biometry and factors associated with prevalence of myopia were the outcome measures.Results: A total of 14,699 children completed vision screening, with 2% (357) of them having ocular abnormalities other than refractive errors or poor vision despite spectacle correction. The remaining 14,342 children (7557 boys; 52.69%) had a mean age of 10.2 (Standard Deviation [SD] 2.8) years. A total of 2502 had myopia in at least one eye, a prevalence of 17.5% (95% CI: 14.7-20.5%), and 74 (0.5%; 95% CI: 0.3-0.9%) had high myopia. Myopia prevalence increased with age (p < 0.001), but sex was not associated with myopia prevalence (p = 0.24). Mean axial length (AL; 23.08 (SD = 0.91) mm) and mean anterior chamber depth (ACD; 3.45 (SD = 0.27) mm) positively correlated with age (p < 0.001). The mean flat (K1; 43.37 (SD = 1.49) D) and steep (K2; 44.50 (SD = 1.58) D) corneal curvatures showed negative correlation with age (p = 0.02 and p < 0.001, respectively). In the multivariable logistic regression, older age and urban school location had higher odds for prevalence of myopia. Conclusion:The baseline prevalence of myopia among 5-to 16-year-old children in South India is larger than that found in previous studies, indicating that myopia is becoming a major public health problem in this country.
PurposeTo compare the axial length measurements obtained by a new swept source optical coherence tomography based biometer-ARGOS with partial coherence interferometry based biometer -IOL master in school children between the ages of 11–17.MethodsA prospective, cross-sectional, device comparison study was conducted in a school vision screening program comparing the axial length (AL) and corneal curvature (K) measurements obtained by two biometers- ARGOS and IOL master. Children with 6/9 vision or better, without any ocular abnormalities were included in the study. Two trained optometrists performed the measurements and were masked for the outcome measures.ResultsThe sample size was 188 with a mean(SD) age of 13.88±1.69 years, of which 101 were boys. The mean (SD) AL was 23.94± 1.01 mm with Argos and 23.83 ± 1.03 mm with IOL Master (paired t-test, p>0.05). The mean K was 43.62D±1.59 with Argos and 43.64D±1.61 with IOL master (paired t-test, p>0.05). There was a strong positive correlation between the biometers for AL (r = 1.00, p<0.0001) and K (r = 0.99, p<0.0001). The mean difference in axial length between the two biometers was 0.11± 0.04 mm and the limits of agreement were between -0.02 to -0.19. The mean difference in corneal curvature was 0.02±0.15D and the limits of agreement were between -0.28 to 0.32D.ConclusionAxial length measurements using SS-OCT and PCI based biometers were in agreement and comparable among children between the ages of 11 to 17.
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