Abstract
BackgroundTo date there have been few systematic attempts to establish the general prevalence of asthenopia in unselected populations of school-aged children. Thus, the aim of this study was to determine whether the incorporation of Borsting et al’s 2003 Revised Convergence-Insufficiency Symptom Survey (CISS) into a general school vision screening could aid in the identification of children with visual discomfort and indicate the need for further investigation.MethodsVision screening of an unselected middle school population investigated and analysed the incidence of self-reported nearwork-related visual discomfort via the CISS along with distance and near visual acuities plus non-cycloplegic autorefraction using a Shin-Nippon NVision-K 5001.ResultsOf the 384 unselected students approached in Grades 6–9, 353 participated (92.2%, mean 13.2 ± 1.4 years). The mean CISS score for the population without amblyopia and/or strabismus (96.0% of all students) was 16.8 ± 0.6, i.e., 45% of students in this cohort had CISS scores greater than one standard deviation above the mean found by Borsting et al. in 2003 during their validation study of the CISS on 9 to 18 year old children without binocular anomalies. Regression analyses indicated significantly higher (p < 0.001) mean CISS scores for the 3.2% who were hyperopes ≥ + 2.00D by non-cycloplegic autorefraction (27.7 ± 14.7) and for those who were amblyopic (24.3 ± 6.6) or strabismic (34.0 ± 9.8). The mean CISS score of 31.6 ± 9.0 for non-amblyopic/strabismic students having near vision poorer than 0.1 LogMAR was significantly higher (p < 0.001) than for those with good acuity.ConclusionThe most important finding of this study was the high incidence of asthenopia in an unselected population and that refractive status per se was not a major contributor to CISS scores. The results highlight the usefulness of the CISS questionnaire for assessment of visual discomfort in school vision screenings and the need for future exploration of near binocular vision status as a potential driver of asthenopia in school students, especially given current trends for frequent daily use of computers and handheld devices and necessarily prolonged accommodative-convergence effort at near, both at school and at home.
Highlights
To date there have been few systematic attempts to establish the general prevalence of asthenopia in unselected populations of school-aged children
The few systematic attempts to establish the general prevalence of asthenopia in normal unselected populations of school children [17,18,19,20] reflect a prevalence ranging from 15 to 32% of non-clinical patients [21] possibly due to the differences in the definition of oculo-visual discomfort, or the criteria for classification of symptoms, and the differing conditions under which the data was collected
Ophthalmic clinicians have considered asthenopic symptoms in children and young adults to relate to refractive error, given the accommodation/ convergence triad and evidence that uncorrected hyperopia is often associated with excessive accommodative demand [29]
Summary
To date there have been few systematic attempts to establish the general prevalence of asthenopia in unselected populations of school-aged children. Dysfunctional accommodation and convergence may induce ocular discomfort during prolonged periods of reading or attending to computers or handheld devices at near as is the accepted norm for most young adolescent-aged individuals. Such prolonged nearwork both at school and at home has been independently reported to be associated with an increased prevalence of asthenopic symptoms [19, 30,31,32,33,34], that include headaches, psychological and head/neck muscular strain [22, 35, 36]
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