Abstract
BackgroundIn many countries, access to general health and eye care is related to an individual’s socioeconomic status (SES). We aimed to examine the prevalence of oculo-visual disorders in children in Istanbul Turkey, drawn from schools at SES extremes but geographically nearby.MethodsThree school-based vision screenings (presenting distance visual acuity, cover test, eye assessment history, colour vision, gross stereopsis and non-cycloplegic autorefraction) were conducted on 81% of a potential 1014 primary-school children aged 4–10 years from two private (high SES) schools and a nearby government (low SES) school in central Istanbul. Prevalence of refractive errors and school-based differences were analysed using parametric statistics (ANOVA). The remaining oculo-visual aspects were compared using non-parametric tests.ResultsOf the 823 children with mean age 6.7 ± 2.2 years, approximately 10% were referred for a full eye examination (8.2% and 16.3% of private/government schools respectively). Vision had not been previously examined in nearly 22% of private school children and 65% of government school children. Of all children, 94.5% were able to accurately identify the 6/9.5 [LogMAR 0.2] line of letters/shapes with each eye and 86.6% the 6/6 line [LogMAR 0], while 7.9% presented wearing spectacles, 3.8% had impaired colour vision, 1.5% had grossly impaired stereo-vision, 1.5% exhibited strabismus, 1.8% were suspected to have amblyopia and 0.5% had reduced acuity of likely organic origin. Of the 804 without strabismus, amblyopia or organic conditions, 6.0% were myopic ≤ − 0.50DS, 0.6% hyperopic ≥ + 2.00DS, 7.7% astigmatic ≥1.00 DC and 6.2% anisometropic ≥1.00DS.ConclusionsThe results highlight the need for general vision screenings for all children prior to school entry given the varied and different pattern of visual problems associated with lifestyle differences in two populations raised in the same urban locale but drawn from different socioeconomic backgrounds.
Highlights
In many countries, access to general health and eye care is related to an individual’s socioeconomic status (SES)
A number of studies of children from what is often considered to be the lower socioeconomic groups in more rural areas of Eastern Turkey do exist [9,10,11,12]. In general these rural studies have reported a low prevalence of oculo-visual disorders [9,10,11,12], in 2013 Gursoy et al found a significantly higher prevalence of myopia leading them to call for a large-scale national screening program [10]
This study was intended as a school screening and did not conform fully to the standardised Refractive Error Study in Children (RESC) epidemiological protocol adopted in a number of regions of the world [25]
Summary
Access to general health and eye care is related to an individual’s socioeconomic status (SES). The prevalence of myopia has been shown to have risen dramatically in Asia in recent decades and to be greater in the youth of urban communities compared to non-urban areas [13], suggesting that a greater prevalence of refractive errors and other visual conditions are likely to be found in Istanbul, the largest city of Turkey, than in the rural areas that have previously been examined This expectation is enhanced by considerations of prevalence of visual anomalies in children from suburbs of lower socioeconomic status, who would be expected to receive reduced health and educational experiences or opportunities. The concern with monitoring the prevalence of myopia derives from the potential for visual impairment or blindness that accompanies the higher degrees of myopia [14]
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