Association Between Visual Acuity and Cycloplegic Refractive Error in 3- to

This study presents the relationship between distance visual acuity and a range of uncorrected refractive errors, a complex association that is fundamental to clinical eye care and the identification of children needing refractive correction. This study aimed to analyze data from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study to describe the relationship between distance uncorrected refractive error and visual acuity in children. Subjects were 2212 children (51.2% female) 6 to 14 years of age (mean ± standard deviation, 10.2 ± 2.1 years) participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study between 2000 and 2010. Uncorrected distance visual acuity was measured using a high-contrast projected logMAR chart. Cycloplegic refractive error was measured using the Grand Seiko WR-5100K autorefractor. The ability of logMAR acuity to detect various categories of refractive error was examined using receiver operating characteristic curves. Isoacuity curves show that increasing myopic spherical refractive errors, increasing astigmatic refractive errors, or a combination of both reduces distance visual acuity. Visual acuity was reduced by approximately 0.5 minutes of MAR per 0.30 to 0.40 D of spherical refractive error and by approximately 0.5 minutes of MAR per 0.60 to 0.90 D of astigmatism. Higher uncorrected hyperopic refractive error had little effect on distance visual acuity. Receiver operating characteristic curve analysis suggests that a logMAR distance acuity of 0.20 to 0.32 provides the best balance between sensitivity and specificity for detecting refractive errors other than hyperopia. Distance acuity alone was ineffective for detecting hyperopic refractive errors. Higher myopic and/or astigmatic refractive errors were associated with predictable reductions in uncorrected distance visual acuity. The reduction in acuity per diopter of cylindrical error was about half that for spherical myopic error. Although distance acuity may be a useful adjunct to the detection of myopic spherocylindrical refractive errors, accommodation presumably prevents acuity from assisting in the detection of hyperopia. Alternate procedures need to be used to detect hyperopia.

To collect data on refractive errors and visual impairment in adults with an intellectual disability (ID) in the Netherlands. A randomized sample of 2100 participants was drawn from a base population of 9000 adults with intellectual disabilities in the Netherlands. This article reports on the first 900 participants. All participants underwent a protocol-based on-site ophthalmological assessment carried out by skilled investigators. Co-operation was classified according to the number of tests that could be carried out reliably and was good or excellent in 80% of subjects, average in 13% and poor in 7%. Refraction could be reliably assessed in 505/900 (56%) subjects. There was an increased risk of visual impairment in all subgroups compared to the general Dutch population. Visual acuity (VA) was related to the level of ID, but refractive errors were not. New spectacles were prescribed in 106 cases (12%). Of 374 people in whom both monocular VA and the refractive error of the right eye could be reliably assessed, 153 (41%) had a pretest prescription, 16 (10%) of which we found to be inadequate. Of the 221 participants without a pretest prescription, 41 (19%) benefited from correction. Only 38/84 (45%) subjects aged 50 years or older, who could benefit from correction for near vision, had near spectacles. New correction increased the mean distant VA significantly from 0.44 to 0.65 (p < 0.0005). With some adaptations, visual screening is feasible in a majority of adults with ID. Visual impairment and refractive errors are much more prevalent in adults with ID than in the normal population. Accurate spectacle correction resulted in significant improvement in distant VA.

To determine the sensitivity and specificity of noncycloplegic autorefraction for determining refractive status compared to cycloplegic autorefraction. The target population was noninstitutionalized citizens of all ages, residing in Tehran in 2002, selected through stratified cluster sampling. From 6497 eligible residents, 70.3% participated in the study, from August to November 2002. Here, we report data on 3501 people over the age of 5 years who had autorefraction with and without cycloplegia (two drops of cyclopentolate 1.0% 5 min apart, with autorefraction 25 min after the second drop). Overall, the sensitivity of noncycloplegic autorefraction for myopia was 99%, but the specificity was only 80.4%. In contrast, the sensitivity for hyperopia was only 47.9%, but the specificity was 99.4%. At all ages, noncycloplegic autorefraction overestimated myopia and underestimated hyperopia. Overestimation of myopia was highest in the 21-30 and 31-40 year groups. Underestimation of hyperopia was high up to the age of 50 (20-40%), but decreased with age, to about 8% after the age of 50, down to almost 0% after 70. The difference in mean spherical equivalent with and without cycloplegia fell from 0.71 dioptres (D) in the 5-10 age group to 0.14D in those over 70. Use of noncycloplegic autorefraction in epidemiological studies leads to considerable errors relative to cycloplegic measurements, except in those over 50-60. The difference between cycloplegic and noncycloplegic measurements varies with age and cycloplegic refractive category, and there is considerable individual variation, ruling out adjusting noncycloplegic measurements to obtain accurate cycloplegic refractions.

Background: Preterm birth potentially plays an important role in visual development. Studies have shown that frequency of myopia, astigmatism, anisometropia, strabismus, and amblyopia in children born preterm is higher than term children. Objective: The aim is to study different types of refractive errors in children under-five years of age born preterm and term. Methods: Comparative cross-sectional study was carried out among 64 children aged 5 years or less. Age, gender, and social status were noted. Children were subjected to refraction according to their age. Detailed anterior segment and posterior segment examination as per the cooperation of the child was conducted with torch light or slit-lamp examination with Ziess, Appasamy AARU 2000. Visual acuity was examined with appropriate methods suitable for age. Results: Fifty percent were preterm and 50% were term. About 50% were male and 50% were female. The most common refractive error was hypermetropia (42%). Among those with compound types of refractive errors, the most common was compound myopic astigmatism ≥2 diopters (17%). Compound types of refractive error were significantly more (62.5%) among the preterm compared to 31.2% among term; significantly more (91.7%) among those born &lt;32 weeks of gestation compared to 45% and 45.5% among those born between 33 and 36 weeks and born &gt;36 weeks of gestational, respectively; significantly more (88.9%) among low birth weight babies compared to 40% among normal birth weight babies. Age and gender were not significantly associated with compound types of refractive errors (P &gt; 0.05). Conclusion: Most common refractive error was hypermetropia. Among those with compound types of refractive errors, the most common was compound myopic astigmatism ≥2 diopters. Being preterm, born at the gestational age of &lt;32 weeks and low birth weight were significant risk factors for compound types of refractive errors.

Introduction: Refractive errors (RE) are the leading cause of visual impairment and disability among children globally. Limited research exists on the relationship between anthropometric measures and refractive errors. This study aims to determine the correlation between weight, height, body mass index (BMI), and refractive errors in children. Methods: This cross-sectional study employed purposive sampling in orphanages across Malang City. Participants were selected based on specific inclusion criteria. Data on their weight, height, BMI, and types of refractive errors were collected as ordinal data. Refractive errors were measured objectively using an auto-refractometer, categorizing refractive errors as myopia and hyperopia based on spherical equivalent results. To minimize subjective bias, we utilized a large sample size and established clear inclusion and exclusion criteria. Additionally, we defined operational definitions for each standardized measurement to ensure consistency and accuracy. Statistical analyses were conducted using an unpaired T-test and Spearman’s correlation test with SPSS software. Results: A total of 362 participants aged 5–18 were included in the study, with 284 participants diagnosed with myopia and 78 with hyperopia. No significant differences were observed in mean body weight, height, or BMI between the myopia and hyperopia groups. Spearman's correlation test indicated no significant relationship between refractive errors and body weight (p &gt; 0.05), height (p &gt; 0.05), or BMI (p &gt; 0.05). Conclusion: The study found no significant correlation between anthropometric status and the presence of refractive errors in children. Future research should consider more diverse settings and explore additional risk factors contributing to the prevalence of refractive abnormalities in children.

PurposeTo describe the development and validation of a smartphone-based visual acuity (VA) test called Vision at home (V@home).MethodsThree study populations (elderly Chinese, adolescent Chinese, and Australian groups) underwent distance and near VA testing using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the V@home device; all VA tests used tumbling E optotypes. VA tests were repeated with one eye, selected randomly. Distance VA was measured monocularly at 2 m, and near VA was measured binocularly at 40 cm. Participants also completed a questionnaire about their satisfaction with the device. V@home VA (logMAR) was compared to VA for ETDRS charts at distance and near and test-retest reliability.ResultsThe mean difference between V@home and ETDRS distance VA across all groups ranged from −0.010 to −0.100 logMAR. Tolerant weighted kappa (TWK) agreement ranged from substantial (0.742) in the Australian group to almost perfect (0.950) in the adolescent Chinese group. There was high agreement of V@home with near ETDRS VA across all groups, with a mean difference of −0.092 to −0.042 logMAR and a TWK of 0.736 to 0.837. Test-retest reliability was also high (difference: −0.018 to 0.026) for both distance and near VA tests (95% limits of agreement: −0.289 to 0.258 for distance and −0.235 to 0.199 for near). The majority of participants were satisfied with V@home.ConclusionsV@home could accurately and reliably measure both distance and near VA and is well accepted by participants.Translational RelevanceThe V@home system could potentially serve as a useful tool to improve eye care accessibility, especially in underdeveloped areas with limited eye care personnel and resources.

This study aimed to characterize the impact of age on visual performance by analyzing monocular defocus curves across a wide age range in healthy phakic eyes. This observational cross-sectional study included 105 subjects, evenly distributed into seven age groups (20-65 years). Monocular visual acuity (VA) was measured at defocus levels from -3.00 D to +1.00 D in 0.50 D steps. Defocus curves were analyzed using four key metrics: baseline VA at zero defocus, curve slope, area under the curve (AUC), and the negative defocus cut-off point at 0.2 logMAR VA. A linear mixed-effects model assessed group differences in defocus curve shape, while non-parametric and parametric tests evaluated differences in AUC and cut-off points. We found that defocus curves remained stable up to 44 years of age, with a significant decline in baseline VA, curve steepness, and overall visual performance beginning at 45 years. AUC values significantly decreased with age, with a clear demarcation between younger (G1-G3; 20-44 years) and older groups (G4-G7; 45-65 years). The 0.2 logMAR cut-off point could not be reached in most younger subjects, indicating preserved accommodative capacity. In contrast, older subjects showed a progressive reduction in depth of focus, with statistically significant differences particularly between groups G4 (45-50 years) and G7 (61-65 years). Overall, these results indicate that defocus curve analysis reveals a functional inflection point in visual performance beginning at 45 years of age. This transition reflects early presbyopic changes, marked by reduced tolerance to defocus and diminished depth of focus. These findings support the use of defocus curves as a valuable tool to assess age-related visual changes beyond conventional distance and near VA tests.

Background: Children of school age are susceptible to refractive error, which has a significant negative influence on lowering the learning capacity and educational potential. Aim: To estimate the frequency of different types of refractive erors in children, age group 11 to 16 year, visiting eye OPD H.M.C Peshawar. Study Design: Cross sectional descriptive study. Place and duration of study: Study has been conducted at Eye OPD of H.M.C Peshawar in three months duration. Methods: A total of 308 patients fulfilling the inclusion criterion were examined for Visual acuity. Distance visual acuity was measured both monocularly and binocularly by using a Snellen E chart at a distance of 6 meter. After refraction, best corrected visual acuity was assessed and recorded. Refractive status was recorded according to the criterion. Results: A total of 308 subjects were examined, out of which 73 (23%) were having Ammetropia i.e. having refractive error. Among 73 refractive error children 27 (36.98 %) were having Myopia and 24 (32.87%) were having Hyperopia and 22 (30.13%) were Astigmatic. It was found that male were more affected than females, having frequency of 63% and 36.98% respectively. Conclusion: Refractive error can no longer be ignored as a target for urgent action. The world must make every effort to meet the goals of VISION 2020. A child’s whole life may get ruined just because of uncorrected or inappropriately corrected Refractive error. There is dire need of public awareness regarding refractive errors and availability of services. The results show a great burden of refractive error patients on the hospital, so the facilities of the refractive services need to be increased. Keywords: Refractive error, visual acquity, Ammetropia, Hyperopia, Myopia

Background Refractive error is defined as the inability of the eye to bring parallel rays of light into focus on the retina, resulting in nearsightedness (myopia), farsightedness (Hyperopia) or astigmatism. Uncorrected refractive error in children is associated with increased morbidity and reduced educational opportunities. Vision screening (VS) is a method for identifying children with visual impairment or eye conditions likely to lead to visual impairment. Objective To analyze the utility of vision screening conducted by teachers and to contribute to a better estimation of the prevalence of childhood refractive errors in Apurimac, Peru. Design A pilot vision screening program in preschool (Group I) and elementary school children (Group II) was conducted with the participation of 26 trained teachers. Children whose visual acuity was<6/9 [20/30] (Group I) and≤6/9 (Group II) in one or both eyes, measured with the Snellen Tumbling E chart at 6 m, were referred for a comprehensive eye exam. Specificity and positive predictive value to detect refractive error were calculated against clinical examination. Program assessment with participants was conducted to evaluate outcomes and procedures. Results A total sample of 364 children aged 3–11 were screened; 45 children were examined at Centro Oftalmológico Monseñor Enrique Pelach (COMEP) Eye Hospital. Prevalence of refractive error was 6.2% (Group I) and 6.9% (Group II); specificity of teacher vision screening was 95.8% and 93.0%, while positive predictive value was 59.1% and 47.8% for each group, respectively. Aspects highlighted to improve the program included extending training, increasing parental involvement, and helping referred children to attend the hospital. Conclusion Prevalence of refractive error in children is significant in the region. Vision screening performed by trained teachers is a valid intervention for early detection of refractive error, including screening of preschool children. Program sustainability and improvements in education and quality of life resulting from childhood vision screening require further research.

Uncorrected refractive error in children leads to various problems in their daily life and can cause multiple problems. Objective: The current study was conducted to determine the presences of headache, eye strain and uncorrected refractive error in school going children. Methods: The study was conducted on 220 school going children of ages between 5 to 15 years. Patients with complain of headache and eye strain were included in the study after taking informed consent. All other patients with any type of squint, amblyopic, nerve palsies, or any other pathology were not included in the current study. Equipment used during the data collection include distance visual acuity chart (Snellen chart), trial box, occludes, pen torch, retinoscopy and auto refractometer. Results: Out of the total 220 participants, patients presented with complain of headache and eyestrain were 114 (51.8%) and 106(48.2%) respectively. Out of the total 220 patients, 80(36.4%) were myopic, 48(21.8%) were hyperopic and 46(20.9%) were astigmatic. Patients with no refractive error were 46(20.9%). Out of the total patients, 78(35.5%) found with mild degree of refractive error. Out of the total patients, 46(20.9%) were presented with visual acuity of 6/6. Conclusion: This study concludes that children complain of headache and eye strain can be associated with the uncorrected refractive error. Mild degrees of refractive error are more prevalent as compared to moderate and severe refractive errors. Myopia is more prevalent in school going children complaining of headache and eye strain as compared to hyperopia and astigmatism.

Background: Refractive error is one of the most common causes of the visual impairment and second leading cause of treatable blindness. The objective of the study was to determine the mag­nitude of refractive errors in children.&#x0D; Methods: This was a hospital based cross-sectional study conducted on 254 children attending Ophthalmology OPD of Manipal Teaching Hospital, Pokhara. The children whose visual acuity was worse than 6/6 but improved with pinhole were included in this study. Vision test, retinoscopy and subjective refraction was done in all subjects and cycloplegic refraction was done when needed. Statistical analysis was carried out using Epi-info version 7.&#x0D; Results: The commonest type of refractive error was astigmatism (46.06%) followed by myopia (42.31%). Majority of children had low grade of refractive errors (46.85%). Among the children, “with the rule astigmatism” was maximum (27.56%). Majority of children were in the age between 11 to 15 years (77.95%). The refractive error was seen more in female (63.78%). Among the chil­dren of refractive errors, 29.13% had family history, 33.46% had given the history of wearing spec­tacles and 10.24% children had amblyopia. There was statistically significant association between refractive errors and age groups, history of wearing spectacles, amblyopia and grading of refractive errors. However, there was no statistically significant association of refractive error with gender, residence and family history.&#x0D; Conclusions: Astigmatism was the common type of refractive error followed by myopia. This study emphasizes the importance of detection of refractive error in children.

To investigate the agreement between a mobile applet-based visual acuity (VA) self-test program and the conventional VA tests. This consecutive case series study included 121 children and adults (242 eyes). Patients were classified into three groups according to age (children, adolescents, and adults). They underwent uncorrected distance visual acuity (UDVA) testing, distance visual acuity with available spectacle correction (DVA with ASC) testing at 2.5-m distance, uncorrected near visual acuity (UNVA) testing, and near visual acuity with available spectacle correction (NVA with ASC) testing at a 0.4-m distance using a mobile applet-based VA self-test program and conventional VA tests in two eyes. Correlations among UDVA, DVA with ASC, UNVA, and NVA with ASC between the two methods were significant in all subjects (all p < 0.001). The intraclass correlation coefficient were 0.960, 0.845, 0.960, and 0.669, respectively (all p < 0.001). The proportions of bias outside the 95% confidence interval limit of agreements were 6.20%, 4.82%, 7.08%, and 6.10%, respectively. There were significant differences in NVA with ASC between the two methods (p < 0.05) in the adolescent group, but no differences in measured parameters were found among children and adult groups. There is good agreement between the mobile applet-based VA self-test program and the conventional VA tests. The VA self-test has good practical value especially in the current pandemic, allowing self-screening of visual acuity, myopia control, and remote management of visual impairment in ocular morbidity.

Refractive error is a common cause of amblyopia. To determine prevalence of amblyopia and the pattern and the types of refractive error in children with amblyopia in a tertiary eye hospital of Nepal. A retrospective chart review of children diagnosed with amblyopia in the Nepal Eye Hospital (NEH) from July 2006 to June 2011 was conducted. Children of age 13+ or who had any ocular pathology were excluded. Cycloplegic refraction and an ophthalmological examination was performed for all children. The pattern of refractive error and the association between types of refractive error and types of amblyopia were determined. Amblyopia was found in 0.7 % (440) of 62,633 children examined in NEH during this period. All the amblyopic eyes of the subjects had refractive error. Fifty-six percent (248) of the patients were male and the mean age was 7.74 ± 2.97 years. Anisometropia was the most common cause of amblyopia (p less than 0.001). One third (29 %) of the subjects had bilateral amblyopia due to high ametropia. Forty percent of eyes had severe amblyopia with visual acuity of 20/120 or worse. About twothirds (59.2 %) of the eyes had astigmatism. The prevalence of amblyopia in the Nepal Eye Hospital is 0.7%. Anisometropia is the most common cause of amblyopia. Astigmatism is the most common types of refractive error in amblyopic eyes.

Background Screening for amblyopia at earliest is important for early treatment and better prognosis. This study aimed to evaluate the validity of uncorrected distant and near visual acuity (VA) and stereoacuity for screening amblyopia in grade-1 students in primary school in central China. Methods By stratified cluster sampling, 3112 grade-1 students from 11 Anyang primary schools were selected for the study. All the participants underwent uncorrected distant and near VA, stereopsis test, cycloplegic refraction, best corrected VA (BCVA), cover test, and ocular movement examination. VA was measured with a logarithm of the minimum angle of resolution (logMAR) chart. Stereoacuity was measured with the Lang II stereo card and TNO test. Amblyopia was defined as the BCVA less than or equal to 0.1 logMAR units of any eye in the absence of significant pathological abnormalities. The sensitivity, specificity, and positive and negative predictive value of uncorrected VA and stereoacuity for amblyopia were analyzed. Results Out of the 3112 eligible students, 2893 (92.96%) completed the examinations. The average age of the students was (7.10t0.41) years. Screened by distant VA with low cutoff (logMAR 0.1), high cutoff (logMAR 0.0), and near VA (logMAR 0.0), 31.64%, 73.18%, and 50.23% students were abnormal, respectively. Screened by stereopsis test, only 4.69% students were abnormal. Diagnosed by a senior pediatric ophthalmologist, 61 students had amblyopia. The sensitivities of distant VA with low/high cutoff and near VA were 92.31%, 100%, and 80.77%, respectively, whereas that of stereoacuity by TNO test was 15.38%. Simultaneous testing of either two of the three tests improved the sensitivity. Conclusions Distant VA test of high cutoff alone displays a high sensitivity but a low specificity. Simultaneous testing of distant VA of low cutoff and stereoacuity is a better choice to balance between sensitivity and specificity.

To determine the distribution of refractive errors in a school-age population in Quintana Roo (Mexico) in the framework of an international cooperation campaign for the prevention of blindness. A sample of 2647 school-age children (ranging from 5 to 14 years old) with a mean age of 9.1±1.9 years old were tested by trained volunteers for distance visual acuity (VA) and refractive errors. The first screening examination included uncorrected distance visual acuity (UDVA) and VA with a +2.00 D lens. Inclusion criteria for a second complete cycloplegic eye examination performed by an optometrist were UDVA <20/25 (0.10 logMAR or 0.8 decimal) and/or VA with +2.00 D ≥20/25. A total of 633 (23.9%) children underwent the second complete eye examination. Mean logMAR UDVA was 0.035±0.094 (range 1.00 to 0.00 logMAR) for the right eyes and 0.036±0.160 (range 1.00 to 0.00 logMAR) for the left eyes. Bilateral amblyopia was found in 17 children (2.7% of refracted eyes; 0.64% of the total). The main reason for visual impairment (VI) in the sample analyzed was found to be refractive errors. In 12 children (1.9% of refracted eyes; 0.45% of the total) the VI was bilateral and 9 (1.4% of refracted eyes; 0.34% of the total) achieved a corrected distance visual acuity of 20/25 or better in both eyes. Mean magnitude of sphere and refractive cylinder was +0.20±0.96 D and -0.43±0.85 D in right eyes, and +0.24±1.08 and -0.43±0.83 D in left eyes. The proportion of myopic eyes [standard equivalent (SE) ≤-0.50 D] was 4.6% of the whole sample (5290 eyes). The mean magnitude of myopia was -0.84±3.44 D for the right eyes and -0.82±5.21 D for the left eyes. The proportion of hyperopic patients (SE≥+2.00 D) was 2.4% (15/633), which corresponded to 0.60% of the whole sample (32/5290 eyes). No statistically significant correlation of age to manifest sphere or cylinder was found. VI due to uncorrected refractive errors can be easily corrected with glasses but it is still a burden to be treated. Myopia is prevalent in this sample. More efforts towards correcting uncorrected refractive errors are needed.