Multi-Ethnic Pediatric Eye Disease Study Research Articles

Prevalence of Comprehensive Eye Examination in Preschool Children With Eye Conditions

IntroductionThe study's purpose is to assess the prevalence of comprehensive eye examinations (CEE) in multi-ethnic preschool children, including children with visually significant eye conditions, and identify factors associated with CEE. MethodsA sample of 9,197 African American (AA), Hispanic (HS), Asian American (AS), and non-Hispanic White (NHW) 6- to 72-month-old children was recruited for the Multi-Ethnic Pediatric Eye Disease Study from 2003-2011. Logistic regression performed in 2022 identified independent factors associated with parent-reported history of CEE. The proportion of children with previous CEE and the proportion with undetected amblyopia or strabismus were measured. ResultsCEE prevalence was 6.3% overall, and 38.3%, 24.8%, 19.1%, 15.1%, and 9.8% among children with strabismus, amblyopia, significant anisometropia, hyperopia, and astigmatism, respectively. Children without prior CEE were more likely to have undetected amblyopia or strabismus than those with CEE history (Ps<0.001). CEE prevalence was higher among older children. Prevalence varied by race/ethnicity, with 8.1%, 7.9%, 6.3%, and 4.9% of NHW, AS, AA, and HS children having had prior CEE, respectively; however, the differences did not remain after adjusting for other associated factors. Older age, a primary caregiver with a college/university degree or higher, having vision insurance, gestational age <33 weeks, neurodevelopmental disorder diagnosis, strabismus, and ocular disease history were all associated with a relatively higher CEE prevalence in multivariable analyses (P≤0.003 for all). ConclusionsCEE was uncommon among preschool children, including those with treatable vision disorders. Interventions, like parent education and vision insurance, are needed to improve CEE access and utilization for at-risk preschool children.

Delayed Diagnosis of Amblyopia in Children of Lower Socioeconomic Families: The Hong Kong Children Eye Study

ABSTRACT Aims To determine the prevalence of amblyopia and the factors associated with delayed diagnosis among school-aged children in Hong Kong. Methods Completed comprehensive ophthalmoscopic examinations were conducted among 4.273 children aged 6–8 years in the population-based Hong Kong Children Eye Study. New and previous diagnoses of amblyopia were identified. Socioeconomic status was surveyed through questionnaires. Results According to criteria from the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS), amblyopia was present in 43 out of 4,273 children (1.01%; 95% CI, 0.71–1.31). Among them, 33 (0.77%) were newly detected cases that were more likely from families living in Public Rental Housing or subdivided flats (OR, 4.22; P = .012), with lower paternal (OR 6.68, P = .008) and maternal education levels (OR, 4.38; P = .039). Multivariate analysis revealed associations of amblyopia with hyperopia (≥+2.00D; OR, 6.23; 95% CI, 2.86–13.56, P < .001), astigmatism (≥+2.00D; OR, 24.88; 95% CI, 10.69–57.91, P < .001) and anisometropia (≥2.00D; OR, 14.49; 95% CI, 5.93–37.63, P < .001). Conclusion These children with delayed diagnoses of amblyopia were more likely to come from lower socioeconomic backgrounds. Public education aimed at increasing awareness and utilization of child vision screening among such families is needed.

Amblyopia screening effectiveness at 3–4 years old: a cohort study

ObjectiveTo study the effectiveness of amblyopia screening at ages 3–4.Methods and AnalysisFrom a population with no previous screening, a cohort of 2300 children with 3–4 years old attending school (91%...

Risk factors for astigmatism in the Vision in Preschoolers Study.

To determine demographic and refractive risk factors for astigmatism in the Vision in Preschoolers Study. Three- to 5-year-old Head Start preschoolers (N = 4040) from five clinical centers underwent comprehensive eye examinations by study-certified optometrists and ophthalmologists, including monocular visual acuity testing, cover testing, and cycloplegic retinoscopy. Astigmatism was defined as the presence of greater than or equal to +1.5 diopters (D) cylinder in either eye, measured with cycloplegic refraction. The associations of risk factors with astigmatism were evaluated using the odds ratio (OR) and its 95% confidence interval (CI) from logistic regression models. Among 4040 Vision in Preschoolers Study participants overrepresenting children with vision disorders, 687 (17%) had astigmatism, and most (83.8%) had with-the-rule astigmatism. In multivariate analyses, African American (OR, 1.65; 95% CI, 1.22 to 2.24), Hispanic (OR, 2.25; 95% CI, 1.62 to 3.12), and Asian (OR, 1.76; 95% CI, 1.06 to 2.93) children were more likely to have astigmatism than non-Hispanic white children, whereas American Indian children were less likely to have astigmatism than Hispanic, African American, and Asian children (p < 0.0001). Refractive error was associated with astigmatism in a nonlinear manner, with an OR of 4.50 (95% CI, 3.00 to 6.76) for myopia (≤-1.0 D in spherical equivalent) and 1.55 (95% CI, 1.29 to 1.86) for hyperopia (≥+2.0 D) when compared with children without refractive error (>-1.0 D, <+2.0 D). There was a trend of an increasing percentage of astigmatism among older children (linear trend p = 0.06). The analysis for risk factors of with-the-rule astigmatism provided similar results. Among Head Start preschoolers, Hispanic, African American, and Asian race as well as myopic and hyperopic refractive error were associated with an increased risk of astigmatism, consistent with findings from the population-based Multi-ethnic Pediatric Eye Disease Study and the Baltimore Pediatric Eye Disease Study. American Indian children had lower risk of astigmatism.

Color Vision Deficiency in Preschool Children: The Multi-Ethnic Pediatric Eye Disease Study

To determine the sex- and ethnicity-specific prevalence of color vision deficiency (CVD) in black, Asian, Hispanic, and non-Hispanic white preschool children. Population-based, cross-sectional study. The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children in Southern California. A total of 5960 subjects 30 to 72 months of age were recruited for the study, of whom 4177 were able to complete color vision testing (1265 black, 812 Asian, 1280 Hispanic, and 820 non-Hispanic white). Color vision testing was performed using Color Vision Testing Made Easy color plates (Home Vision Care, Gulf Breeze, FL), and diagnostic confirmatory testing was performed using the Waggoner HRR Diagnostic Test color plates (Home Vision Care). Testability of color vision in preschool children between 30 and 72 months of age and prevalence of CVD stratified by age, sex, and ethnicity. Testability was 17% in children younger than 37 months of age, increasing to 57% in children 37 to 48 months of age, 89% in children 49 to 60 months of age, and 98% in children 61 to 72 months of age. The prevalence of CVD among boys was 1.4% for black, 3.1% for Asian, 2.6% for Hispanic, and 5.6% for non-Hispanic white children; the prevalence in girls was 0.0% to 0.5% for all ethnicities. The ethnic difference in CVD was statistically significant between black and non-Hispanic white children (P = 0.0003) and between Hispanic and non-Hispanic white children (P = 0.02). In boys, most CVD cases were either deutan (51%) or protan (34%); 32% were classified as mild, 15% as moderate, and 41% as severe. Testability for CVD in preschool children is high by 4 years of age. The prevalence of CVD in preschool boys varies by ethnicity, with the highest prevalence in non-Hispanic white and lowest in black children.

A Close Look at Pediatric Eye Disease

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)

Risk Factors for Amblyopia in the Vision in Preschoolers Study

To evaluate risk factors for unilateral amblyopia and for bilateral amblyopia in the Vision in Preschoolers (VIP) study. Multicenter, cross-sectional study. Three- to 5-year-old Head Start preschoolers from 5 clinical centers, overrepresenting children with vision disorders. All children underwent comprehensive eye examinations, including threshold visual acuity (VA), cover testing, and cycloplegic retinoscopy, performed by VIP-certified optometrists and ophthalmologists who were experienced in providing care to children. Monocular threshold VA was tested using a single-surround HOTV letter protocol without correction, and retested with full cycloplegic correction when retest criteria were met. Unilateral amblyopia was defined as an interocular difference in best-corrected VA of 2 lines or more. Bilateral amblyopia was defined as best-corrected VA in each eye worse than 20/50 for 3-year-olds and worse than 20/40 for 4- to 5-year-olds. Risk of amblyopia was summarized by the odds ratios and their 95% confidence intervals estimated from logistic regression models. In this enriched sample of Head Start children (n = 3869), 296 children (7.7%) had unilateral amblyopia, and 144 children (3.7%) had bilateral amblyopia. Presence of strabismus (P<0.0001) and greater magnitude of significant refractive errors (myopia, hyperopia, astigmatism, and anisometropia; P<0.00001 for each) were associated independently with an increased risk of unilateral amblyopia. Presence of strabismus, hyperopia of 2.0 diopters (D) or more, astigmatism of 1.0 D or more, or anisometropia of 0.5 D or more were present in 91% of children with unilateral amblyopia. Greater magnitude of astigmatism (P<0.0001) and bilateral hyperopia (P<0.0001) were associated independently with increased risk of bilateral amblyopia. Bilateral hyperopia of 3.0 D or more or astigmatism of 1.0 D or more were present in 76% of children with bilateral amblyopia. Strabismus and significant refractive errors were risk factors for unilateral amblyopia. Bilateral astigmatism and bilateral hyperopia were risk factors for bilateral amblyopia. Despite differences in selection of the study population, these results validated the findings from the Multi-Ethnic Pediatric Eye Disease Study and Baltimore Pediatric Eye Disease Study.

Prevalence of Myopia, Hyperopia, and Astigmatism in Non-Hispanic White and Asian Children: Multi-Ethnic Pediatric Eye Disease Study

To determine the age-, gender-, and ethnicity-specific prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white (NHW) and Asian preschool children. Population-based, cross-sectional study. A population-based sample of 1501 NHW children and 1507 Asian children aged 6-72 months from Los Angeles County and Riverside County, California. Eligible children underwent an in-home and in-clinic interview and a comprehensive eye examination including cycloplegic autorefraction from 100 census tracts. The proportion of children with myopia (spherical equivalent [SE] ≤-1.00 diopter [D]), hyperopia (SE ≥ +2.00 D) and cylindrical refractive error ≥1.50 D in the worse eye. The astigmatism type was defined as with-the-rule (WTR; +cylinder axis 90°±15°) and against-the-rule (ATR; + cylinder axis 180°±15°); all other orientations were considered oblique (OBL). The prevalence of myopia, hyperopia, and astigmatism in NHW children was 1.20% (95% confidence interval [CI], 0.76%-1.89%), 25.65% (95% CI, 23.5%-27.9%), and 6.33% (95% CI, 5.21%-7.68%), respectively. The prevalence of WTR, ATR, and OBL astigmatism in NHW children was 4.33%, 1.00%, and 1.00%, respectively. Prevalence was lower with older age groups for astigmatism (P = 0.0002), but not for myopia (P = 0.82) or hyperopia (P = 0.31). In Asian children, the prevalence of myopia, hyperopia, and astigmatism was 3.98% (95% CI, 3.11%-5.09%), 13.47% (95% CI, 11.8%-15.3%), and 8.29% (95% CI, 7.01%-9.80%), respectively. The prevalence of WTR, ATR, and OBL astigmatism was 6.50%, 0.80%, and 1.00% respectively. The prevalence of hyperopia was higher in girls than boys (P = 0.0002), but no differences were found for myopia and astigmatism. Hyperopia was the most common refractive error in both Asian and NHW children. However, compared with NHW children, myopia was relatively more prevalent, and hyperopia less prevalent, among Asian children. The prevalence of astigmatism was greatest in infants, and WTR astigmatism predominated at all ages. Myopia showed relatively stable prevalence across age groups, whereas hyperopia prevalence decreased after infancy and then increased again in older age groups; however, longitudinal studies are needed to evaluate refractive changes over time in individual children. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Prevalence of Amblyopia or Strabismus in Asian and Non-Hispanic White Preschool Children: Multi-Ethnic Pediatric Eye Disease Study

To determine the age- and race-specific prevalence of amblyopia in Asian and non-Hispanic white children aged 30 to 72 months and of strabismus in children aged 6 to 72 months. Cross-sectional survey. A population-based, multiethnic sample of children aged 6 to 72 months was identified in Los Angeles and Riverside counties in California to evaluate the prevalence of ocular conditions. A comprehensive eye examination and in-clinic interview were conducted with 80% of eligible children. The examination included evaluation of ocular alignment, refractive error, and ocular structures in children aged 6 to 72 months, as well as a determination of optotype visual acuity (VA) in children aged 30 to 72months. The proportion of 6- to 72-month-old participants with strabismus and 30- to 72-month-olds with optotype VA deficits and amblyopia risk factors consistent with study definitions of amblyopia. Strabismus was found in 3.55% (95% confidence interval [CI], 2.68-4.60) of Asian children and 3.24% (95% CI, 2.40-4.26) of non-Hispanic white children, with a higher prevalence with each subsequent older age category from 6 to 72 months in both racial/ethnic groups (P=0.0003 and 0.02, respectively). Amblyopia was detected in 1.81% (95% CI, 1.06-2.89) of Asian and non-Hispanic white children; the prevalence of amblyopia was higher for each subsequent older age category among non-Hispanic white children (P=0.01) but showed no significant trend among Asian children (P=0.30). The prevalence of strabismus was similar in Asian and non-Hispanic white children and was found to be higher among older children from 6 to 72 months. The prevalence of amblyopia was the same in Asian and non-Hispanic white children; prevalence seemed to be higher among older non-Hispanic white children but was relatively stable by age in Asian children. These findings may help clinicians to better understand the patterns of strabismus and amblyopia and potentially inform planning for preschool vision screening programs. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Prevalence and Causes of Visual Impairment in Asian and Non-Hispanic White Preschool Children: Multi-Ethnic Pediatric Eye Disease Study

To determine the prevalence and causes of decreased visual acuity (VA). Population-based cross-sectional study. Multi-ethnic sample of children 30 to 72 months of age identified in Los Angeles. All eligible children underwent a comprehensive ophthalmic evaluation including monocular VA testing, cover testing, cycloplegic autorefraction, fundus evaluation, and VA retesting with refractive correction. Decreased VA was defined as presenting or best-measured VA worse than 20/50 in children 30 to 47 months of age and worse than 20/40 for children 48 months of age and older. The prevalence and causes of decreased VA were determined, for both presenting and best-measured VA, in the better-seeing and the worse-seeing eyes. Prevalence and causes of decreased vision. Presenting VA was assessed in 1840 children and best-measured VA was assessed in 1886 children. Presenting VA was decreased in the worse eye of 4.2% of Asian children and of 3.6% of non-Hispanic white (NHW) children. Close to one-fourth of these cases had no identifiable cause, and 81% of these resolved on retesting. Decreased presenting VA in the worse eye with an identifiable ophthalmic cause was present in 3.4% of Asian children and in 2.6% of NHW children. Decreased presenting VA attributable to simple refractive error (myopia ≥ 0.5 diopters [D]; hyperopia ≥ 3.0 D; astigmatism ≥ 2.0 D or ≥ 1.5 D for children older than 36 months) was present in the worse eye of 2.3% of Asian children and of 1.4% of NHW children and in the better eye of 0.5% of Asian children and of 0.3% of NHW children. Decreased best-measured VA attributable to a cause was present in the worse eye of 1.2% of both Asian children and NHW children and in the better eye of 0.2% of Asian and of 0.3% of NHW children. Amblyopia related to refractive error was the most common cause, and was 10 times as common as ocular disease. Severe visual impairment was rare. Seventy percent of all decreased VA in Asian and NHW preschool children and more than 90% of decreased VA with an identifiable cause is related to refractive error--either uncorrected refractive error or amblyopia resulting from refractive error. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Anisometropic refractive errors occur more frequently in left eyes than right

A laterality bias in the development of amblyopia has been reported, with the left eye being affected more frequently. Possible explanations proposed for this include laterality in the development of anisometropia, microtropia, or ocular dominance. The present study evaluates the laterality of amblyogenic anisometropia in the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS).

Risk Factors for Astigmatism in Preschool Children: The Multi-Ethnic Pediatric Eye Disease and Baltimore Pediatric Eye Disease Studies

To evaluate risk factors for astigmatism in a population-based sample of preschool children. Population-based cross-sectional study. Population-based samples of 9970 children ages 6 to 72 months from Los Angeles County, California, and Baltimore, Maryland. A cross-sectional study of children participating in the Multiethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study was completed. Data were obtained by clinical examination or by in-person interview. Odds ratios and 95% confidence intervals (CI) were calculated to evaluate potential associations between clinical, behavioral, or demographic factors and astigmatism. Odds ratios (ORs) for various risk factors associated with astigmatism. Participants with myopia (≤-1.0 diopters) were 4.6 times as likely to have astigmatism (95% CI, 3.56-5.96) than those without refractive error, whereas participants with hyperopia (≥+2.00 diopters) were 1.6 times as likely (95% CI, 1.39-1.94). Children 6 to <12 months of age were approximately 3 times as likely to have astigmatism than children 5 to 6 years of age (95% CI, 2.28-3.73). Both Hispanic (OR, 2.38) and African-American (OR, 1.47) children were as likely to have astigmatism than non-Hispanic white children. Furthermore, children whose mothers smoked during pregnancy were 1.46 times (95% CI, 1.14-1.87) as likely to have astigmatism than children whose mothers did not smoke. In addition to infancy, Hispanic and African-American race/ethnicity and correctable/modifiable risk factors such as myopia, hyperopia, and maternal smoking during pregnancy are associated with a higher risk of having astigmatism. Although the prevalence of smoking during pregnancy is typically low, this association may suggest etiologic pathways for future investigation. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Risk Factors Associated with Childhood Strabismus: The Multi-Ethnic Pediatric Eye Disease and Baltimore Pediatric Eye Disease Studies

To investigate risk factors associated with esotropia or exotropia in infants and young children. Population-based cross-sectional prevalence study. Population-based samples of 9970 children 6 to 72 months of age from California and Maryland. Participants were preschool African-American, Hispanic, and non-Hispanic white children participating in the Multi-Ethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study. Data were obtained by parental interview and ocular examination. Odd ratios and 95% confidence intervals were calculated to evaluate the association of demographic, behavioral, and clinical risk factors with esotropia and exotropia. Odds ratios (ORs) for various risk factors associated with esotropia or exotropia diagnosis based on cover testing. In multivariate logistic regression analysis, esotropia was associated independently with prematurity, maternal smoking during pregnancy, older preschool age (48-72 months), anisometropia, and hyperopia. There was a severity-dependent association of hyperopia with the prevalence of esotropia, with ORs increasing from 6.4 for 2.00 diopters (D) to less than 3.00 D of hyperopia, to 122.0 for 5.00 D or more of hyperopia. Exotropia was associated with prematurity, maternal smoking during pregnancy, family history of strabismus, female sex, astigmatism (OR, 2.5 for 1.50 to <2.50 D of astigmatism, and 5.9 for ≥2.5 D of astigmatism), and anisoastigmatism in the J0 component (OR, ≥2 for J0 anisoastigmatism of ≥0.25 D). Prematurity and maternal smoking during pregnancy are associated with a higher risk of having esotropia and exotropia. Refractive error is associated in a severity-dependent manner to the prevalence of esotropia and exotropia. Because refractive error is correctable, these risk associations should be considered when developing guidelines for the screening and management of refractive error in infants and young children. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Prevalence of Astigmatism in 6- to 72-Month-Old African American and Hispanic Children: The Multi-Ethnic Pediatric Eye Disease Study

To determine the age-, gender-, and ethnicity-specific prevalence of astigmatism in African American and Hispanic children aged 6 to 72 months. Population-based, cross-sectional study. The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children ages 6 to 72 months in Los Angeles County, California. Seventy-seven percent of eligible children completed a comprehensive eye examination. This report provides the results from 2994 African American and 3030 Hispanic children. Eligible children in 44 census tracts were identified during an in-home interview and scheduled for a comprehensive eye examination and in-clinic interview. Cycloplegic autorefraction was used to determine refractive error. The proportion of children with astigmatism defined as cylindrical refractive error ≥ 1.50 diopters (D) in the worse eye. The astigmatism type was defined as with-the-rule (WTR) (+ cylinder axis 90 ± 15 degrees) and against-the-rule (ATR) (+ cylinder axis 180 ± 15 degrees); all other orientations were considered oblique (OBL). The prevalence of astigmatism and its types were also determined for worse eye cylindrical refractive error ≥ 3.00 D. Prevalence of astigmatism ≥ 1.50 D was higher in Hispanic children compared with African American children (16.8% vs. 12.7%, respectively; P<0.0001). Hispanic children also showed a higher prevalence of astigmatism ≥ 3.00 D than African American children (2.9% vs. 1.0% respectively; P<0.0001). The prevalence of astigmatism ≥ 1.50 D showed a significant decreasing trend with age (P<0.0001). The prevalence of WTR, ATR, and OBL astigmatism ≥ 1.50 D was 13.9%, 0.6%, and 2.2%, respectively, in Hispanic children, and 7.8%, 2.2%, and 2.7%, respectively, in African American children. We observed ethnicity-related differences in astigmatism prevalence in preschool children. The age-related decrease in astigmatism prevalence in preschool children likely reflects emmetropization.

General Health-Related Quality of Life in Preschool Children with Strabismus or Amblyopia

To explore the associations of general health-related quality of life (GHRQOL) with strabismus or amblyopia in preschool children. Population-based study. Sample of children aged 25 to 72 months in the Multi-ethnic Pediatric Eye Disease Study (MEPEDS). The Pediatric Quality of Life Inventory (PedsQL), a measure of GHRQOL, was administered to the parents of the children. The PedsQL consists of 4 subscales (physical, emotional, social, and school functioning) and 3 composite scores (physical summary, psychosocial summary, and total). Regression models were used to evaluate the associations of GHRQOL with strabismus (in children 25-72 months) or amblyopia (in children 30-72 months). Of the 4218 children aged ≥25 months, 121 (2.9%) were diagnosed with strabismus. Significant differences were found in all 3 composite scores between children with and without strabismus, before and after controlling for gender, age, race, family income, systemic health conditions, and prior knowledge of strabismus diagnosis (P<0.05). These differences were present in esotropes, exotropes, children with intermittent strabismus, and children with constant strabismus. A total of 3318 children were aged ≥30 months, and 71 children (2.1%) had amblyopia. There were no significant differences in any PedsQL scores between children with and without amblyopia, even after adjusting for gender, age, race, and family income (P>0.05). Strabismus was associated with significantly worse GHRQOL in preschool children. Although we did not find any detectable association between amblyopia and GHRQOL, further study using vision-specific instruments is required to explore the impact of both strabismus and amblyopia on pediatric quality of life.

Prevalence of Myopia and Hyperopia in 6- to 72-Month-Old African American and Hispanic Children: The Multi-Ethnic Pediatric Eye Disease Study

To determine the age-, gender-, and ethnicity-specific prevalence of myopia and hyperopia in African American and Hispanic children aged 6 to 72 months. Population-based cross-sectional study. The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children aged 6 to 72 months in Los Angeles County, California. Seventy-seven percent of eligible children completed a comprehensive eye examination. This report focuses on results from 2994 African American and 3030 Hispanic children. Eligible children in 44 census tracts were identified during an in-home interview and scheduled for a comprehensive eye examination and in-clinic interview. Cycloplegic autorefraction was used to determine refractive error. The proportion of children with spherical equivalent (SE) myopia </= -1.00 diopter (D) and SE hyperopia >/= +2.00 D in the worse eye. Prevalence of myopia and hyperopia is also reported using alternative threshold definitions. Prevalence of myopia was higher in African American (6.6%) compared with Hispanic children (3.7%; P<0.001). Hispanics showed a higher prevalence of hyperopia than African American children (26.9% vs. 20.8% respectively, P<0.001). The prevalence of myopia showed a significant decreasing trend with age (P<0.001). Hyperopia prevalence reached a low point at approximately 24 months of age but increased and remained higher than that thereafter. No significant gender differences were found in the prevalence of refractive error for either ethnic group. We observed ethnicity-related differences in both hyperopia and myopia prevalence in preschool children. The age-related decrease in myopia prevalence in preschool children could reflect early emmetropization and contrasts with the increase in myopia prevalence known to occur in older school-aged children. The limits of emmetropization are evident, however, in the persistently elevated prevalence of hyperopia beyond 24 months of age. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Anisometropia in Hispanic and African American Infants and Young Children: The Multi-Ethnic Pediatric Eye Disease Study

To determine anisometropia prevalence and associated risk factors in Hispanic and African American preschoolers.Population-based, cross-sectional study.We included 3030 Hispanic and 2994 African American children aged 6 to 72 months from Inglewood, California.Retinomax autorefraction was performed on all participants after cycloplegia. Anisometropia was defined by difference in spherical equivalent (SE), by difference in plus cylinder in any axis (cylindrical), and by difference in cylinder axis vectors (vertical Jackson cross cylinder vector [J0] and oblique Jackson cross cylinder vector [J45] between the eyes. Strabismus was determined by prism-cover testing. A parental questionnaire explored potential risk factors including developmental delay, prematurity, prenatal exposure, and family history.Anisometropia prevalence stratified by age, gender, and ethnicity. The association of anisometropia with strabismus and other biological risk factors was assessed.The prevalence of SE anisometropia > or =1.0 diopter (D) was 4.3% for Hispanics and 4.2% for African Americans. Prevalence of cylindrical anisometropia > or =1.0 D was 5.6% and 4.5%, respectively. Prevalence of cylindrical or SE anisometropia > or =3.0 D was < or =0.4% for both ethnic groups. Cylinder vector anisometropia > or =0.5 was twice as common as cylindrical anisometropia > or =1.0 D. The SE anisometropia decreased at age 1 year in Hispanics (P = 0.0016) but not African Americans. Cylindrical anisometropia decreased in the first year of life in both ethnic groups (P < or = 0.001). There was no trend in SE or cylindrical anisometropia beyond 1 year of age, but cylinder vector anisometropia steadily decreased beyond 1 year of age in both ethnic groups. Cylinder vector anisometropia was more prevalent among African Americans, but there was no difference in other measurements of anisometropia between ethnic groups. Anisometropia did not vary by gender. Strabismus was associated with all types of anisometropia. No association of anisometropia with gestational age, birth weight, cerebral palsy, family history, or prenatal exposure could be identified.Spherical and cylindrical anisometropia (> or =1.0 D) each affect 4% to 6% of Hispanic and African American preschoolers. Anisometropia > or =3.0 D is rare. Except for cylinder axis vector, the prevalence of anisometropia does not diminish beyond 1 year of age. Strabismus is associated with all forms of anisometropia.The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Prevalence and Causes of Visual Impairment in African-American and Hispanic Preschool Children: The Multi-Ethnic Pediatric Eye Disease Study

To determine the prevalence and causes of decreased visual acuity (VA) in a population-based study of minority preschool children. Population-based, cross-sectional study. Children 30 to 72 months of age in 44 census tracts in Los Angeles County. A population-based sample of children underwent comprehensive ophthalmic evaluation including monocular VA testing, cover testing, cycloplegic autorefraction, anterior segment and fundus evaluation, and VA retesting with refractive correction. The prevalence and etiology of decreased VA were determined, for both presenting and best-measured VA, and better eye and worse eye. Prevalence of decreased presenting and best-measured VA with an identifiable ophthalmic etiology. Presenting VA was assessed in 3207 children and best-measured VA in 3364 children. Although nearly one third of cases of worse-eye decreased presenting VA were without an identifiable ophthalmic etiology, this proportion decreased with increasing age. Decreased presenting VA that resolved with retesting and was associated with uncorrected refractive error was present in the worse eye of 4.3% of African-American children and 5.3% of Hispanic children, and in the better eye of 1.9% of African-American children and 1.7% of Hispanic children. Decreased best-measured VA that was not immediately correctable with spectacles and that was because of ocular disease, unilateral or bilateral amblyopia, or probable bilateral ametropic amblyopia, was seen in the worse eye of 1.5% of African-American and 1.9% of Hispanic children, and in the better eye of 0.8% of African-American and 0.6% of Hispanic children. Amblyopia related to refractive error was the most common cause. More than 5% of African-American and Hispanic preschool children in Los Angeles County have either correctable visual impairment from uncorrected refractive error or visual impairment from amblyopia related to refractive error.

Visual Acuity Norms in Pre-School Children: The Multi-Ethnic Pediatric Eye Disease Study

To provide population-based normative data for monocular visual acuity (VA) and interocular differences in VA (IOD) in Black and Hispanic children 30 to 72 months of age without visually significant refractive errors or ophthalmic abnormalities.In a population-based cohort of children in the Multi-Ethnic Pediatric Eye Disease Study, monocular HOTV VA measurements using the Amblyopia Treatment Study protocol were analyzed using continuous and dichotomous outcomes for VA and IOD, after excluding subjects with ophthalmic abnormalities or refractive error.The analysis cohort consisted of 1722 Black and Hispanic children aged 30 to 72 months. Mean logMAR VA improved with age (p < 0.0001) and male gender (p = 0.0008). The proportion of children achieving VA 20/40 or better was associated with age (p < 0.0001), but not ethnicity or gender, and was 81, 94, 99, and virtually 100% in children aged 30 to 35, 36 to 47, 48 to 59, and 60 to 72 months of age, respectively. The most stringent VA threshold that excluded <5% of normal children was 20/63, 20/50, 20/32, and 20/32 for children aged 30 to 35, 36 to 47, 48 to 59, and 60 to 72 months, respectively. Children attending preschool or daycare achieved VA 20/32 more often than those not attending, after age adjustment (p = 0.01), as did children from higher-income families (p = 0.04). There was no association between mean absolute IOD and age (p = 0.45), ethnicity (p = 0.12), or gender (p = 0.19). The proportion of children with an IOD of 0 to 1 lines was higher in males than females (p = 0.02); it did not vary by age (p = 0.06) or ethnicity (p = 0.17). An IOD of 2 or more lines occurred in 6% of normal children.VA test performance in normal pre-school children improves with age. We propose new age-specific thresholds for defining abnormal monocular VA using HOTV optotypes in children between 2 and 5 years of age, for use in screening, clinical practice, and research.

Testability of the Retinomax Autorefractor and IOLMaster in Preschool Children: The Multi-ethnic Pediatric Eye Disease Study

To determine the testability of Retinomax and IOLMaster ocular biometry in preschool children.Population-based study of inner city preschool children in Los Angeles County.Two thousand five hundred forty-five Hispanic and 2178 African American children 6 to 72 months old.Subjects were identified by door-to-door screening within previously identified contiguous census tracts. Pediatric ophthalmologists or optometrists performed comprehensive eye examinations on all subjects. Refractive error and keratometry measurements were attempted on all subjects with the Retinomax autorefractor after cycloplegia. Axial length measurements with the IOLMaster partial coherence interferometer were attempted on those subjects ages 30 to 72 months.Ability to obtain high confidence autorefraction readings or axial length measurements on both eyes.Overall, 89% were testable in both eyes with the Retinomax device, and 91% of the children were testable with the IOLMaster. Testability rose sharply with age, so that by age 36 months 98% of children were testable with the Retinomax device and 90% were testable with IOLMaster. There were no consistent gender- or ethnicity-related differences in testability overall or when stratified by age for either device.Young children can be reliably tested for ocular biometry with the Retinomax and IOLMaster devices. This may impact strategies for management of cataracts and refractive errors in preschool children.