No abstract

Purpose To determine the age-, gender- and ethnicity-specific prevalence of myopia, hyperopia and astigmatism in Non-Hispanic White (NHW) and Asian preschool children. Design Population-based cross-sectional study. Participants A population based sample of 1501 NHW children and 1507 Asian children aged 6-72 months from Los Angeles County and Riverside County, California. Methods Eligible children underwent an in-home and in-clinic interview and a comprehensive eye examination including cycloplegic auto-refraction from 100 census tracts. Main outcome measures The proportion of children with myopia (spherical equivalent (SE) <=−1.00 diopter (D)), hyperopia (SE >=+2.00) D and cylindrical refractive error >=1.50 D in the worse eye. The astigmatism type was defined as with-the-rule (WTR) (+cylinder axis 90° ± 15°) and against-the-rule (ATR) (+ cylinder axis 180° ± 15°); all other orientations were considered oblique (OBL). Results The prevalence of myopia, hyperopia and astigmatism in NHW children was 1.20% (95% Confidence Interval (CI) = 0.76-1.89%), 25.65% (95% CI= 23.5-27.9%), and 6.33% (95% CI = 5.21-7.68%), respectively. The prevalence of WTR, ATR and OBL astigmatism in NHW children was 4.33%, 1.00% and 1.00% respectively. Prevalence was lower with older age groups for astigmatism (p=0.0002), but not for myopia or hyperopia (p=0.82 and p=0.31, respectively). In Asian children, the prevalence of myopia, hyperopia and astigmatism was 3.98% (95% CI = 3.11-5.09%), 13.47% (95% CI= 11.8-15.3%) and 8.29% (95% CI=7.01-9.80%), respectively. The prevalence of WTR, ATR and OBL astigmatism was 6.50%, 0.80% and 1.00% respectively. The prevalence of hyperopia was higher in girls than boys (p=0.0002), but no significant differences were found for myopia and astigmatism. Conclusion Hyperopia was the most common refractive error in both Asian and NHW children. However, compared to NHW children, myopia was relatively more prevalent, and hyperopia less prevalent, in Asian children. The prevalence of astigmatism was highest in infants, and WTR astigmatism predominated at all ages. Myopia showed relatively stable prevalence across age groups, while hyperopia prevalence decreased after infancy and then increased again in older age groups; however, longitudinal studies are needed to evaluate refractive changes over time in individual children.

Objective To investigate risk factors associated with esotropia or exotropia in infants and young children. Design Population-based cross-sectional prevalence study. Participants Population-based samples of 9970 children ages 6 to 72 months from California and Maryland. Methods Participants were preschool African-American, Hispanic, and non-Hispanic white children participating in the Multiethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study. Data were obtained by parental interview and ocular examination. Odd ratios and 95% confidence intervals were calculated to evaluate the association of demographic, behavioral, and clinical risk factors with esotropia and exotropia. Main Outcome Measures Odds ratios (ORs) for various risk factors associated with esotropia or exotropia diagnosis based on cover testing. Results In multivariate logistic regression analysis, esotropia was independently associated with prematurity, maternal smoking during pregnancy, older preschool age (48–72 months), anisometropia, and hyperopia. There was a severity-dependent association of hyperopia with the prevalence of esotropia, with ORs increasing from 6.4 for 2.00 Diopters (D) to <3.00 D of hyperopia, to 122.0 for ≥ 5.00 D. Exotropia was associated with prematurity, maternal smoking during pregnancy, family history of strabismus, female sex, astigmatism (OR 2.5 for 1.50 to <2.50 D, and 5.9 for ≥ 2.5 D of astigmatism), and aniso-astigmatism in the J0 component (OR ≥ 2 for J0 aniso-astigmatism ≥ 0.25 D). Conclusions Prematurity and maternal smoking during pregnancy are associated with a higher risk of having esotropia and exotropia. Refractive error is associated in a severity-dependent manner to the prevalence of esotropia and exotropia. Because refractive error is correctable, these risk associations should be considered when developing guidelines for the screening and management of refractive error in infants and young children children.

Objective To investigate risk factors associated with unilateral or bilateral decreased visual acuity in preschool children. Design Population-based cross-sectional prevalence study. Participants Population-based samples of 6504 children ages 30-72 months from California and Maryland. Methods Participants were preschool African-American, Hispanic, and non-Hispanic white children from Los Angeles, California, and Baltimore, Maryland. Data were obtained by a parental interview and a detailed ocular examination. Logistic regression models were used to evaluate the independent associations between demographic, behavioral and clinical risk factors with unilateral and bilateral decreased visual acuity. Main Outcome Measures Odds ratios (ORs) for various risk factors associated with inter-ocular difference (IOD) in visual acuity (VA) of 2 or more lines with 20/32 or worse in the worse eye, or bilateral decreased VA worse than 20/40 or worse than 20/50 if younger than 48 months of age. Results In multivariate logistic regression analysis, 2-line IOD with VA 20/32 or worse was independently associated with Hispanic ethnicity (OR 2.05); esotropia (OR 8.98); spherical equivalent (SE) anisometropia (ORs ranging between 1.5 and 39.7 for SE anisometropia ranging between 0.50 to <1.00 diopters and ≥2.00 diopters); and aniso-astigmatism in J0 or J45 (ORs ranging between 1.4 and ≥5.3 for J0 or J45 differences ranging between 0.25 to <0.50 D and ≥1.00 D). Bilateral decreased VA was independently associated with lack of health insurance (OR 2.9); lower primary caregiver education (OR 1.7); astigmatism (OR 2.3 and 17.6 for astigmatism 1.00 to <2.00 D and ≥2.00 D); and SE hyperopia ≥4.00 D (OR 10.8). Conclusions Anisometropia and esotropia are risk factors for IOD in visual acuity. Astigmatism and high hyperopia are risk factors for bilateral decreased visual acuity. Guidelines for the screening and management of decreased visual acuity in preschool children should be considered in light of these risk associations.