Refractive Errors in 3–6 Year-Old Chinese Children: A Very Low Prevalence of Myopia?

Lan, Weizhong; Zhao, Feng; Lin, Lei; Li, Zhen; Zeng, Junwen; Yang, Zhikuan; Morgan, Ian G.

doi:10.1371/journal.pone.0078003

Cited by 76 publications

(78 citation statements)

References 32 publications

(38 reference statements)

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“…The problem is particularly acute for populations which are not of European origin, where much darker irises are the general rule, and where very accurate measurements are required. The literature in this area is far from systematic, but in general, we recommend the use of 1% cyclopentolate, and we note that in populations with darker irises such as the Chinese population, three or even four drops may be required to achieve satisfactory cycloplegia for most participants (Lan et al 2013).…”

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confidence: 91%

“…The literature in this area is far from systematic, but in general, we recommend the use of 1% cyclopentolate, and we note that in populations with darker irises such as the Chinese population, three or even four drops may be required to achieve satisfactory cycloplegia for most participants (Lan et al. ).…”

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confidence: 99%

“…Even for estimating the prevalence of myopia, cycloplegia may sometimes be essential. This situation occurs in paediatric populations, where the prevalence of myopia is very low (Giordano et al 2009;Dirani et al 2010;ME-PEDS Study Group 2010;Lan et al 2013;Wen et al 2013). Under these conditions, even small errors in the estimation of myopia can distort the study outcomes considerably, and under these conditions, particularly rigorous attention to cycloplegia is essential to ensure that a low prevalence of pseudomyopia is not confused with a low prevalence of genuine myopia.…”

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confidence: 99%

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Cycloplegic refraction is the gold standard for epidemiological studies

Morgan

Iribarren

Fotouhi

et al. 2015

Acta Ophthalmologica

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ABSTRACT. Many studies on children have shown that lack of cycloplegia is associated with slight overestimation of myopia and marked errors in estimates of the prevalence of emmetropia and hyperopia. Non-cycloplegic refraction is particularly problematic for studies of associations with risk factors. The consensus around the importance of cycloplegia in children left undefined at what age, if any, cycloplegia became unnecessary. It was often implicitly assumed that cycloplegia is not necessary beyond childhood or early adulthood, and thus, the protocol for the classical studies of refraction in older adults did not include cycloplegia. Now that population studies of refractive error are beginning to fill the gap between schoolchildren and older adults, whether cycloplegia is required for measuring refractive error in this age range, needs to be defined. Data from the Tehran Eye Study show that, without cycloplegia, there are errors in the estimation of myopia, emmetropia and hyperopia in the age range 20-50, just as in children. Similar results have been reported in an analysis of data from the Beaver Dam Offspring Eye Study. If the only important outcome measure of a particular study is the prevalence of myopia, then cycloplegia may not be crucial in some cases. But, without cycloplegia, measurements of other refractive categories as well as spherical equivalent are unreliable. In summary, the current evidence suggests that cycloplegic refraction should be considered as the gold standard for epidemiological studies of refraction, not only in children, but in adults up to the age of 50.

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confidence: 91%

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Cycloplegic refraction is the gold standard for epidemiological studies

Morgan

Iribarren

Fotouhi

et al. 2015

Acta Ophthalmologica

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132

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“…Observations from a number of population‐based studies in China,9, 10, 11, 12, 13, 14, 15, 27, 28, 29, 30, 31, 32 show that myopia prevalence varies based on location and age. For example, in children aged 10 years myopia prevalence can range anywhere from 9% to 53% 9, 12, 13, 15, 29, 30.…”

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Design and methodology of the Shanghai child and adolescent large‐scale eye study (SCALE)

Zhao

Sankaridurg

et al. 2017

Clinical Exper Ophthalmology

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ImportanceNearly half of children suffering vision impairment reside in China with myopia accounting for the vast majority.BackgroundTo describe the design and methodology of the Shanghai Child and Adolescent Large‐scale Eye Study (SCALE).DesignThe SCALE was a city wide, school‐based, prospective survey.ParticipantsChildren and adolescents aged 4–14 years from kindergarten (middle and senior), primary schools and junior high schools of all 17 districts and counties of the city of Shanghai, China were examined in 2012–2013.MethodsEach enrolled child underwent vision assessment (distance visual acuity; uncorrected and with corrective device if worn) and their parent/carer completed a questionnaire designed to elicit risk factors associated with myopia. Additionally, non‐cycloplegic autorefraction and ocular axial length was measured in a subset of the larger sample.Main Outcome MeasuresPrevalence and the associated factors of vision impairment, myopia and high myopia in Shanghai.ResultsIn 2012–2013, a total of 910 245 of the eligible 1 196 763 children and adolescents identified from census (76%, mean age 9.0 ± 2.7 years [4–14 years]) were enrolled with visual acuity screened in the city of Shanghai. Of these, 610 952 children (67% of the entire sample) underwent non‐cycloplegic autorefraction and 219 188 (24% of the entire sample) had both non‐cycloplegic autorefraction and axial length measurements.Conclusions and RelevanceThe study results will provide insights on the burden of vision impairment, myopia and high myopia in children and adolescents in a metropolitan area of China, and contribute to the policies and strategies to address and limit the burden.

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“…Limitations of past studies include using different types of cycloplegic medications (Sanfilippo et al 2014). Even fewer studies have focused on adult populations in China, where myopia is highly prevalent ), possibly reducing the need for cycloplegia (Fotouhi et al 2012), but among whom the presence of dark irides might conversely require a higher cycloplegic concentration (Lan et al 2013).…”

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confidence: 99%