A Close Look at Pediatric Eye Disease

Abstract

The prevalence of visually significant and treatable eye disorders among children is much lower than the rate reported for adults. However, when there is a cost-effective intervention, the gain in quality of life will extend over many years. This premise is consistent with one of the vision objectives of Health People 2020, a national strategic plan developed by the United States Department of Health and Human Services: to reduce the prevalence of visual impairment in children. To assess the value of programs for prevention, detection, and treatment of visual impairment in children, as well as to design future interventions, it is necessary to know the prevalence of pediatric eye disease. Even better would be data describing any differences among identifiable subgroups of that population. Such differences could be present because of demographic and clinical characteristics, such as race or ethnicity or gender. Additionally, prevalence data affords the opportunity to assess differences in groups based on social, economic, and environmental disadvantages. Differences in health caused by such factors often are termed health disparities or inequalities. Prevalence data should enable designers of childhood vision screening programs to refine clinical care guidelines to target important risk factorsddemographic, clinical, social, and economic. Such population data also are crucial to ophthalmologists and health care planners to appropriately weigh the most effective methods detailed in guidelines to manage the eye care in a targeted group. Identification of health disparities could lead to development of guidelines and interventions specific to those at-risk groups. Three recently completed National Eye Institute-funded studies provide prevalence data for preschool children. Two of the studies were population-based, whereas the third was a defined cohort study among children in the Head Start program. In each protocol, a complete ophthalmic examination was performed to determine the presence of pathologic features, both visually important and visually unimportant. These 3 studies did not assess the value of any interventions with a longitudinal cohort. Rather, the population-based studies provided eye-specific prevalence data for subgroups of urban children based on race or ethnicity and also provided the required comparison data with which to analyze the Head Start data published in this issue of Ophthalmology (see article on page 630). The 2 cross-sectional population-based studies characterized the prevalence of eye disease among urban children 6 through 72 months of age from white, black, Hispanic, and Asian populations in Baltimore, Maryland (Baltimore Pediatric Eye Disease Study [BPEDS]), and Los Angeles, California (Multi-Ethnic Pediatric Eye Disease Study [MEPEDS]). In these studies, the prevalence of amblyopia ranged from 1% to 4%, that of myopia ( 1.00 diopters [D]) ranged from 0.5% to 5.8%, that of hyperopia ( þ2 D)