Purpose This cross-sectional report includes ocular component data as a function of age, gender, and ethnicity from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Methods The ocular components of 4881 school-aged children were examined using cycloplegic autorefraction (refractive error), keratometry (corneal curvature), ultrasonography (axial dimensions), and videophakometry (lens curvature). Results The average age (± SD) was 8.8 ± 2.3 years, and 2458 were girls (50.4%). Sixteen percent were African American, 14.8% were Asian, 22.9% were Hispanic, 11.6% were Native American, and 34.9% were White. More myopic/less hyperopic refractive error was associated with greater age, especially in Asians, less in Whites and African Americans. Corneal power varied slightly with age, with girls showing a greater mean corneal power. Native-American children had greater corneal toricity with a markedly flatter horizontal corneal power. Anterior chambers were deeper with age, and boys had deeper anterior chambers. Native-American children had the shallowest anterior chambers and Whites the deepest. Girls had higher Gullstrand and calculated lens powers than boys. Boys had longer vitreous chambers and axial lengths, and both were deeper with age. Native Americans had the longest vitreous chambers and Whites the shortest. Conclusions Most ocular components showed little clinically meaningful variation by ethnicity. The shallower anterior chambers and deeper vitreous chambers of Native-American children appeared to be offset by flatter corneas. The relatively deeper anterior chamber and shallower vitreous chambers of White children appeared to be offset by steeper corneas. Asian children had more myopic spherical equivalent refractive errors, but for a given refractive error the ocular parameters of Asian children were moderate in value compared to those of other ethnic groups. Asian children may develop longer, myopic eyes more often than other ethnic groups, but the eyes of Asian emmetropes do not appear to be innately longer.

Purpose To investigate factors associated with spectacle wear in a group of primarily Native-American children provided spectacles free of charge through a school-based vision program. Methods Spectacle wear was studied in 247 participants provided two pairs of spectacles the previous year. Univariate and multivariate logistic regression models assessed whether gender, race, parental education levels, family income, uncorrected distance visual acuity, refractive error, or the children’s attitudes and beliefs about their vision and spectacles were associated with spectacle wear. Results Two-thirds of the participants (165/247) were not wearing their spectacles at their annual exam. The most common reasons given for non-wear were lost (44.9%) or broken (35.3%) spectacles. A one diopter increase in myopic spherical equivalent was associated with more than a 2-fold increase in the odds of wearing spectacles (Odds Ratio [OR]=2.5, 95% CI = 1.7, 3.7). Among non-myopic participants, increasing amounts of astigmatism in the better- and worse-seeing eye were associated with an increased likelihood of spectacle wear (p-values ≤ 0.02). In multivariate analysis, only poorer uncorrected acuity in the better-seeing eye (p < 0.001) and shorter acceptance time (p = 0.007) were found to be significantly associated with spectacle wear. For each line of poorer uncorrected acuity in the better-seeing eye, the likelihood that the participant was wearing spectacles increased by 60% (adjusted OR] = 1.6, 95% CI = 1.4, 1.8). Not surprisingly, participants who reported never getting used to their spectacles were less likely to be wearing spectacles than those who reported getting used to wearing glasses in a few days (adjusted OR = 5.7, 95% CI = 1.9, 17.5). Conclusions Despite being provided with two pairs of spectacles, loss and breakage were the most commonly reported reasons for not wearing spectacles. The best predictive factor for determining whether participants were wearing spectacles was their uncorrected acuity.

As in non-Native American populations, Tohono O'odham infants show a high prevalence of astigmatism, which decreases in the second year of life. However, the prevalence of high astigmatism in Tohono O'odham children increases by age 2 to <3 years to a level near that seen in infancy and remains at that level until at least age 8 years. Longitudinal data are needed to determine whether the increase in high astigmatism after infancy occurs in infants who had astigmatism as infants or is due to the development of high astigmatism in children who did not show astigmatism during infancy.

Purpose-To evaluate the accuracy of the Welch Allyn SureSight in noncycloplegic measurements of astigmatism as compared to cycloplegic Retinomax K+ autorefractor measurements of astigmatism in children from a Native American population with a high prevalence of high astigmatism.Methods-Data are reported for 825 3-to 7-year-old children with no ocular abnormalities. Each child had a Retinomax K+ cycloplegic measurement of right eye astigmatism with a confidence rating ≥8 and 3 attempts to obtain a SureSight measurement on the right eye.Results-SureSight measurement success rates did not differ significantly across age or measurement confidence rating (<6 vs ≥6). Ninety-six percent of children had at least 1 measurement (any confidence), and 89% had at least 1 measurement with confidence at the manufacturer's recommended value (≥6). Overall, the SureSight tended to overestimate astigmatism. If the SureSight measurement had any dioptric value (0.00 D to 3.00 D), astigmatism of 2.00 D or less was likely to be present. If the SureSight showed astigmatism beyond the instrument's dioptric range (>3.00 D), Retinomax K+ measurements indicated that >2.00 D of astigmatism was present in 136 of 157 (86.6%). In cooperative children for whom the SureSight would not give a reading, 32 of 34 (94%) had >3.00 D of astigmatism. Conclusions-TheSureSight does not provide an accurate, quantitative measure of amount of astigmatism. However, it does allow accurate categorization of amount of astigmatism as ≤2.00 D, >2.00 D, or >3.00 D, and it has high measurement success rate in young children.Handheld autorefractors have the potential to be useful tools for measurement of refractive error in infants, toddlers, and preschoolers in both screening and research settings. However, when used without cycloplegia, autorefractors tend to have high variability across subjects in accuracy of sphere measurements in children, 1-5 thus eliminating the feasibility of simply applying a single factor to correct for the overestimation of myopia/underestimation of hyperopia that occurs in the absence of cycloplegia. Ste. 108, Tucson, AZ 85711 (emharvey@u.arizona.edu).. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.The authors have no financial interest in any of the tests used in this study. In contrast, while some studies report significant differences between cycloplegic and noncycloplegic measures of astigmatism, these differences tend to be of minimal clinical significance. 1-8 Therefore, non-cycloplegic autorefraction may be useful in measuring astigmatism in infants and toddlers, in both screening...

The prevalence and mean amount of corneal astigmatism were higher than reported in non-Native American populations. Mean astigmatism increased from 1.43 D in 1-year-olds to nearly 2.00 D by school age.