Age-Specific Prevalence of Visual Impairment and Refractive Error in Children Aged 3–10 Years in Shanghai, China

Ma, Yingyan; Qu, Xiaomei; Zhu, Xiaofeng; Xu, Xun; Zhu, Jianfeng; Sankaridurg, Padmaja; Lin, Senlin; Lu, Lina; Zhao, Rong; Ling, Wang; Shi, Huijing; Tan, Handong; You, Xiaofang; Hong, Yun–Chul; Sun, Sifei; Wang, Mingjin; He, Xiangui; Zou, Haidong; Congdon, Nathan

doi:10.1167/iovs.16-20243

Cited by 139 publications

(131 citation statements)

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“…Spherical equivalent was used to classify refractive status and was obtained as follows: spherical equivalent = S + C/2. Myopia, emmetropia and hyperopia were defined as spherical equivalent ≤ −0.5 diopters (D), −0.5 D < spherical equivalent < +0.5 D, spherical equivalent ≥ +0.5 D, respectively3146. Myopia was further categorized into high myopia, moderate myopia and mild myopia, which was defined as spherical equivalent ≤ −5.0 D, −5.0 D < spherical equivalent ≤ −3.0 D, −3.0 D < spherical equivalent ≤ −0.5 D, respectively.…”

Section: Methodsmentioning

confidence: 99%

Choroidal Thickness in 3001 Chinese Children Aged 6 to 19 Years Using Swept-Source OCT

Xiong

Deng

et al. 2017

Sci Rep

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The purpose of the cross-sectional study is to describe the values and distribution of choroidal thickness and to explore its related factors, especially age, in Chinese children. A total of 3001 Chinese school children aged 6 to 19 years underwent comprehensive ophthalmic examinations, including axial length and cycloplegic refraction. Choroidal thickness was measured by swept-source optical coherence tomography (SS-OCT). There was a greater difference in the more central regions between the myopes and emmetropes. Multiple regression analysis was performed to determine the associated factors of choroidal thickness. The results demonstrated that age was independently positively related to choroidal thickness for emmetropes (β = 3.859, p < 0.001), and mild myopes with spherical equivalent greater than −2.00 D (−1.25 D < spherical equivalent ≤ −0.50 D: β = 3.476, p = 0.006; −2.00 D < spherical equivalent ≤ −1.25 D: β = 3.232, p = 0.020). However, no significant relationship between age and choroidal thickness was found in children with spherical equivalent ≤ −2.00 D, suggesting that the protective effect of physiologic choroidal growth with age against rapid axial elongation disappeared while axial elongation becomes the dominant determinant of choroidal thickness among children with myopia worse than −2.00 D.

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Section: Methodsmentioning

confidence: 99%

Choroidal Thickness in 3001 Chinese Children Aged 6 to 19 Years Using Swept-Source OCT

Xiong

Deng

et al. 2017

Sci Rep

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“…Since Shanghai has a high myopia prevalence similar to other Asian countries,10, 12, 40 much of the vision impairment is likely to be due to myopia. In this respect, a limitation of the current study is that the refractive status of the children was assessed without cycloplegia and therefore likely to overestimate the prevalence of myopia 41, 42.…”

Section: Discussionmentioning

confidence: 99%

“…Uncorrected refractive error is a common cause of vision impairment in children,2 with myopia being the most frequently seen refractive error, especially in East and Southeast Asian countries,3 such as Singapore, Japan, South Korea, Hong Kong, Taiwan, and parts of mainland China 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15. Elsewhere in the world as in North America, Australia, Europe and Middle East, the prevalence of myopia is also on the rise but at a slower pace 16, 17, 18, 19.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…For example, in children aged 10 years myopia prevalence can range anywhere from 9% to 53% 9, 12, 13, 15, 29, 30. Also, myopia is increasingly being seen in younger, preschool children but very few studies have documented the prevalence of myopia in these populations.…”

Section: Introductionmentioning

confidence: 99%

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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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Incidence of and Factors Associated With Myopia and High Myopia in Chinese Children, Based on Refraction Without Cycloplegia

et al. 2018

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IMPORTANCE Myopia has reached epidemic levels among children in regions of East and Southeast Asia. High myopia is associated with myopic macular degeneration, glaucoma, and retinal detachment.OBJECTIVE To determine the incidence of myopia and high myopia based on refraction without cycloplegia among children in primary and junior high schools in China. DESIGN, SETTING, AND PARTICIPANTSThis observational cohort study was completed in Guangzhou, China. It consisted of a cohort from 19 primary schools, who were followed up from 2010 to 2015, and a cohort from 22 junior high schools, who were followed up from 2010 to 2012. All schools were randomly chosen at rates proportional to the number of schools in each of the city's 11 districts. Students with or without myopia in grade 1 (primary school) or grade 7 (junior high school) were eligible for inclusion. Data analysis occurred from February 2017 to October 2017. MAIN OUTCOMES AND MEASURESMyopia was defined as a spherical equivalent refraction (SER) of −0.50 diopters (D) or less, as measured by subjective refraction without cycloplegia; high myopia was defined as a SER of −6.0 D or less. Annual incidences were defined as the proportion of participants each year found to have myopia or high myopia who did not previously have the condition. Height, weight, axial length (AL), corneal radius of curvature (CRC), and AL/CRC ratio were examined to assess if these measures were associated with future myopia or high myopia.RESULTS A total of 4741 students with or without myopia in either grade 1 for the primary school cohort (mean [SD] age 7.2 [0.4] years; 932 of 1975 [47.2%] female) or grade 7 for the junior high school cohort (mean [SD] age 13.2 [0.5] years; 1254 of 2670 [47.0%] female) were included. Baseline mean (SD) SER was 0.31 (0.86) D among 1975 students in grade 1 vs −1.60 (2.00) D among 2670 students in grade 7. Baseline prevalence of myopia was 12.0% in grade 1 students (n = 237 of 1969) and 67.4% in grade 7 students (n = 1795 of 2663). The incidence of myopia was 20% to 30% each year throughout both cohorts. The incidence of high myopia was initially less than 1% in the primary school cohort (grade 1: n = 2 of 1825; 0.1% [95% CI, 0.0%-0.3%]), but incidence exceeded 2% in the junior high school cohort (in grade 9: n = 48 of 2044; 2.3% [95% CI, 1.0%-3.7%]). CONCLUSIONS AND RELEVANCEThe incidence of myopia among Chinese students based on refraction without cycloplegia is among the highest of any cultural or ethnic group. If confirmed with cycloplegic refraction, interventions to prevent myopia onset in Chinese populations should be initiated in primary schools.

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Age-Specific Prevalence of Visual Impairment and Refractive Error in Children Aged 3–10 Years in Shanghai, China

Abstract: The prevalence of myopia was lower or comparable to that reported in other populations from age 3 to 5 years, but increased dramatically after 6 years, consistent with a strong environmental role of schooling on myopia development.

Cited by 139 publications

References 48 publications

Choroidal Thickness in 3001 Chinese Children Aged 6 to 19 Years Using Swept-Source OCT

Choroidal Thickness in 3001 Chinese Children Aged 6 to 19 Years Using Swept-Source OCT

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

Incidence of and Factors Associated With Myopia and High Myopia in Chinese Children, Based on Refraction Without Cycloplegia

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