Introduction
Myopia is one of the most common cause of visual loss in the world, and its incidence appears to be rising.1 Genetic predisposition as well as environmental risk factors may influence the likelihood of acquiring myopia. Premature and low-birth-weight babies are more likely to get myopia in older stages of life, and a child's nutrition and height can also influence myopia development. There are considerable racial inconsistencies in the prevalence of myopia. On the basis of genetics, ethnicity and racial difference, prevalence of myopia can be explained. Close work an early age, as seen by a higher prevalence of myopia among the better education, educational levels of the parents and the individual, higher IQ, and socioeconomicity are all suspected environmental influences.
Myopia is thought to be caused due to increase in the axial (anterior-posterior) length of eye caused by close-up labour, according to several theories. According to studies, certain vocations that involve a lot of close-up work, such as microscopy, stitching, and carpet weaving, have higher prevalence of myopia. People with myopia, on the other hand, are more likely to favour occupations that require close labour, especially if their vision was not corrected in early years of life.
The rise in the number of myopic people in advancing age group can be related to the rise in near tasks like computer work, video games, and watching television. The disparity in myopia prevalence seen between the rural and urban populations in Indian studies also speaks to the same. 2
Myopia prevalence in the Indian population ranges from 2.77 percent to 7.4 percent.3, 4 According to a World Health Organization (WHO)-NPCB survey conducted in 1989, 1.49 percent of the Indian population is blind, with refractive defects accounting for 7.35 percent.5 Even though the total prevalence of blindness was lowered to 1.1 percent, the proportion of blindness owing to refractive error grew to 19.7% in the NPCB-National Blindness Survey. 6, 7
Myopia is a major public health problem in India, particularly among the city population, due to any number of non-corrected refractive defects. The National Programme for the Control of Blindness has given it attention.
Unfortunately, despite the fact that this well designed, mainly federally funded school vision screening programme has been very victorious in many states, a large number of school age children remain non-identified, and not meeting need for refractive error correction in children appears to be important. Not corrected refractive errors cause learning difficulties and poor academic performance, ultimately affecting the child's psychosocial development. Detection and evaluation of youngsters, who are introverted and exhibit little interest in socialising and engagement, requires sensitivity and skill.2
Materials and Methods
This study was undertaken at Dr. Br Ambedkar Medical College and Hospital. 764 children up to 16 yrs. were screened for type and amount of ametropia with special emphasis on observing type and amount of myopia and its clinical presentation. It was a cross sectional hospital based study. Children upto 16 yrs. with refractive error were included in this study. Children > 16 yrs. children with history of eye trauma/ eye surgery were excluded from study.
Patients' names, ages, sex, address, and socioeconomic position were all recorded as part of their demographic profile. History of the patients were gathered, and main symptoms was listed in three categories in chronological order:
Ocular complaints: Tiredness/ pain in the eyes, recurring redness, and squint
Visual complaints: difficulties reading / vision problems at a distance or up close
Referred complaints include a headache, nausea or vomiting, and a history of nausea or vomiting.
Refractive error in siblings/parents, cerebral palsy/Down's syndrome, was also noted in the family. Personal history, as well as any noteworthy prenatal, perinatal, or postnatal history, were taken into consideration. Visual acuity was measured, and a thorough ocular examination was performed using a slit lamp examination and indirect ophthalmoscope to search for any problems.
Retinoscopy was done to determine type and extent of myopia, fundus examination were used to determine if there was any posterior segment involvement due to mydriasis. Atropine 1 percent eye ointment/homatropine 0.5 percent eye drops / tropicamide eye drops were utilised by the cycloplegic.
Results
Table 1
Prevalence of Ametropia in children
|
S.No. |
No. of pediatric patient |
No. of ametropic children |
No. of myopic patients |
|
1 |
764 |
307 |
126 |
Ametropia was reported to be present in 40.24 percent of children. Myopia was identified in 41.05 percent of the 307 ametropic children. The prevalence of childhood myopia was 16.5 percent in a hospital-based study. The male:female kid ratio was 53:47, and nearly 2/3rd of population (63.61 percent) lived below the poverty line. Children from urban areas made up 59.18 percent of the total.Table 1
Table 2
Clinical features of ametropic children attending eye OPD (n=307)
It is seen that ametropic children presented with different clinical features. Headache is the most commonly presented clinical feature, accounts for 82.19%.Table 2
Table 3
Age and degree of myopia in children with myopia
As per the table more prevalence was observed in 7-12 and 13-16 years.Table 3
Table 4
Distribution of degree of myopia
|
Degree of myopia |
No. of eyes |
% |
|
<-2 d |
117 |
19.02% |
|
-2 to -6d |
131 |
21.21% |
|
>-6d |
5 |
0.8% |
|
total |
253 |
|
To moderate type of Myopia was more common than severe one.Table 4
Table 5
Myopic Astigmatism
Out of total eyes examined myopic astigmatism of < -2 D with the rule was observed in 78% males and 3 90% females.Table 5
Table 6
Family History of Refractive Error in Pediatric Ametropic Eyes (n=615)
Family history was present in 18.53% parents and 12.92% siblings in myopic patients.Table 6
Around 7.80 % of male and 8.29 % of female child were also having Anisometropia while Amblyopia was present in 0.88% of total eyes examined. Around 3.90% cases with myopia <-2 D, 2.11 % with-2D to -6D, and 0.32% with >-6D had exophoria. 0.08 % eyes with myopia <-2 D, 0.16% with -2 Dto -6 D and 0.08% with >-6 D had exotropia.
Discussion
Myopia, has been related to a variety of significant eye diseases, including myopic retinopathy, rhegmatogenous retinal detachment, myopic glaucomatous optic neuropathy, exudative myopic macular degeneration, haemorrhages and tears.
The purpose of the study was to find out how common myopia is in Indian schools and what variables contribute to it. In some Asian populations, myopia prevalence has been reported to be as high as 70-90 percent, with Taiwan reporting an 84 percent prevalence among 16-18 year old high school students. 8, 9
Myopia was found to be present in 4.79 percent of school pupils in Chandigarh in the first survey undertaken in India in the 1970s by Jain et al. In comparison to the rural population, it was higher in city population (6.9%). (2.77 percent). 10 Murthy et al.11 investigated the prevalence of refractive error and accompanying visual disability in school-aged children aged 5 to 15 in a New Delhi metropolitan community, finding a prevalence of 7.4% myopia.
The commonly reported risk factor of myopia is working near a computer, and various observations confirm this notion. In recent years, environmental variables like a more competitive school system have further added to the risk factor. Furthermore, environmental factors including as education, occupation, and personal income have been linked to the occurrence of myopia.
Because students in higher classes spend more time studying, a link between myopia with age and the rising prevalence of myopia with increased studying offers more support to the close work theory in myopia development. In this study, 18.53 percent of myopic cases had a parent with ametropia and 12.92 percent had a sibling with ametropia. 12, 13
Conclusion
For the prevention of myopia onset or progression, there is no well accepted or universally recommended treatment.
Myopia is regarded as a major public health problem in India, particularly in the city population, due to increased number of non corrected refractive defects. The National Programme for the Control of Blindness has given it top attention. The Government of India fully funds the school vision-screening programme, and impoverished students receive free spectacles. By 2020, the initiative aims to eliminate refractive error-related blindness by offering refractive error services at the primary level, with competent paramedical ophthalmic assistants available in vision centres for every 50,000 people.
Unfortunately, despite this fact that this well designed, federally funded school vision screening programme has been very victorious in many states, a large number of school-aged children remain not identified, and the non met need for refractive error correction in children appears to be more. Uncorrected refractive errors cause learning difficulties and poor academic performance, ultimately impacting the child's psychosocial development. The detection and evaluation of these youngsters, who are introverted and exhibit little interest in socialising and engagement, requires sensitivity and skill.
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