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ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 61-64

Prevalence and distribution of ocular morbidities among primary school children in Goa


1 Department of Ophthalmology, Goa Medical College, Bambolim, Goa, India
2 Department of Preventive and Social Medicine, Goa Medical College, Bambolim, Goa, India

Date of Submission20-Mar-2018
Date of Acceptance22-Aug-2018
Date of Web Publication21-Aug-2019

Correspondence Address:
Shekhar O Akarkar
Department of Ophthalmology, Goa Medical College, Bambolim - 403 202, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_34_18

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  Abstract 


Background: Early detection and treatment of ocular morbidity among children is important. Eye screening of school children is useful in detecting the correctable causes of decreased vision, especially refractive errors and minimizing long-term visual disability. This information is essential to plan eye care programs to reduce the burden of visual impairment among them. There is a lack of community studies on ocular morbidity on primary school children in Goa. Aim: The aim was to study the prevalence and distribution of common ocular morbidities among primary schoolchildren in Goa. Settings: This is a community-based study in government and private primary educational schools in Goa. Materials and Methods: In this cross-sectional study, 817 children aged 6–10 years from five primary schools in Goa were screened for detecting ophthalmic problems. Statistical Analysis Used: Proportions and percentages were used. Results: The prevalence of ocular morbidities was 13.22%, and they included refractive errors (9.55%) (predominantly myopia [62.82%]), strabismus (1.1%), conjunctivitis (1.1%), lid swelling (0.74%), and color blindness (0.15%). Conclusion: A high prevalence of ocular morbidity was observed among primary school children. Refractive errors were the most common ocular disorders.

Keywords: Goa, ocular morbidity, prevalence, refractive errors, school children


How to cite this article:
Akarkar SO, Naik PG, Cacodcar JA. Prevalence and distribution of ocular morbidities among primary school children in Goa. J Clin Ophthalmol Res 2019;7:61-4

How to cite this URL:
Akarkar SO, Naik PG, Cacodcar JA. Prevalence and distribution of ocular morbidities among primary school children in Goa. J Clin Ophthalmol Res [serial online] 2019 [cited 2019 Nov 20];7:61-4. Available from: http://www.jcor.in/text.asp?2019/7/2/61/264892



Poor vision in childhood affects performance in school and has a negative influence on the future of children. School children are affected by various eye disorders such as refractive errors, squint, Vitamin A deficiency, and eye infections. Uncorrected refractive errors form one of the important causes of visual impairment and blindness. Uncorrected refractive errors and Vitamin A deficiency forms a major preventable cause of blindness in the young age group, i.e., <20 years. Other common ocular morbidities among school children are conjunctivitis, trachoma, stye, blepharitis, color blindness, chalazion, squint, corneal opacity, exophthalmos, coloboma, pinguecula, subconjunctival hemorrhage, and posterior segment pathology.

Children do not complain of defective vision and may not even be aware of their impaired vision. Such children try adjusting to the problem of defective vision by sitting on the front benches, holding the books close to their eyes, or by squeezing their eyes. The earliest signs of refractive error are strainful eyes with or without redness by evening, watering and headache. Such complaints of the child go unnoticed to the parents due to lack of awareness; more so in rural areas. This warrants early detection and treatment of ocular problems to prevent future blindness. Effective methods of vision screening in school children are useful in detecting correctable causes of decreased vision, especially refractive errors.

Considering the fact that 30% of India's blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, the importance of early detection and treatment of ocular disease and visual impairment among young children is obvious.[1]

In India, several quantitative studies carried out on the health status of school-age children indicated that emphasis was needed on diseases of eye, the prevalence of which was around 4.0%–8.0%.[2],[3] In a nationwide survey, nearly half of the ocular morbidities (49.9%) were due to refractive errors.

No such study was undertaken previously at community level among primary schoolchildren in Goa. Hence, we undertook this study to study the prevalence and distribution of common ocular morbidities among them.


  Materials and Methods Top


This community-based study was carried out in primary school-age children between standard I and IV of five schools from the areas of Mandur (village) and Vasco (city) in Goa. Convenient sampling method was followed. The ethical clearance was obtained from the Institutional Ethics Committee of our Institute. Parents were informed 1 week prior about ophthalmological examination as part of a school screening program, and consent for the examination was obtained from the school principals/headmasters. Children were not administered any eye drops including cycloplegic eye drops at school level. Informed consent was taken for cycloplegic refraction at our outpatient department (OPD) level. Patients' details were entered in a pretested study proforma that included name, age, sex, and standards (I–IV) in which he/she was studying. A detailed history was taken, and complaints were recorded. Visual acuity (VA) was tested using Snellen's chart or E chart at 6 m distance. Pinhole vision testing was done to differentiate refractive error from posterior segment pathology. The right eye was tested first and then the left, both with (presenting VA) and without glasses (uncorrected VA [UCVA]). Ishihara's chart was used to detect color blindness. Ocular motility in the six cardinal directions was checked to rule out paralytic squint. Hirschberg's test was done to rule out strabismus and cover–uncover test was done to identify latent strabismus. Simple torch light examination was done to detect any anterior segment pathology. Undilated fundus examination was done in all children for posterior pole examination. Dilated fundus examination was done in the selected cases of cycloplegic refraction. All children whose VA was ≤6/18 were subjected to autorefraction without cycloplegia with autorefractometer (Biomedix). Retinoscopy under cycloplegia was done in the selected cases at OPD level in the ophthalmology department at our institute. Criteria used to do cycloplegic refraction were the presence of strabismus, amblyopia, nystagmus, refractive error more than ± 2.0 DS, and vision not improving to 6/6 after putting corrective lenses from refraction on autorefractometer. 1% cyclopentolate eye drops every half an hour 4 h prior refraction were used. The principal cause of ocular morbidity was assigned after completion of the ocular examination and the major site of ocular morbidity was noted. Blindness was defined as a corrected VA in the better eye of <3/60.[4] Severe, moderate, and mild visual impairment is defined as a corrected VA in the better eye of 3/60–6/60, 6/60–6/18, and >6/18, respectively.[5] The collected data were thoroughly entered into the Excel spreadsheets and analysis was carried out. SPSS version 11.0 (IBM Corporation, Armonk, New York, USA) for Windows was used to calculate proportions and percentages, and the Chi-square test was used for comparison.


  Results Top


A total of 817 children in the age group of 6-10 years studying in I to IV standards were examined from five different schools from the areas of Mandur and Vasco in the state of Goa. Urban schools examined were Our Lady of Candelaria High School (n = 297, 36.4%) and Greenwich Primary School (n = 125, 15.3%) and rural schools were Government Primary School, Zuari (n = 179, 21.9%), St. Andrew High School (n = 156, 19.1%), and Government Primary School, Mandur (n = 60, 7.3%). Male:female ratio was 1.35:1 among the school children.

The overall prevalence of any ocular morbidity in either eye among primary school children aged 6–10 years was 13.22%. There was no sex preponderance for overall prevalence of ocular morbidity. The most common cause of ocular morbidity was a refractive error (9.55%), followed by strabismus (1.1%), conjunctivitis (1.1%), and lid swelling (0.74%). The most common cause of visual impairment in either eye was due to refractive errors (9.55%), (myopia [62.82%], hypermetropia [29.49%], and astigmatism [7.69%]). In astigmatism, all cases were of simple myopic astigmatism. One case had amblyopia due to high myopic refractive error. One case of pseudophakia in both eyes (congenital cataract) with strabismic amblyopia in the right eye was seen. The percentage of amblyopia was 0.24% (2 cases). In strabismus, esotropia cases (0.85%) were found to be more than exotropia (0.25%). No cases of convergence insufficiency were noted. Convergence assessment was done in cases called for refraction. At the school level, cover–uncover test was done to rule out latent strabismus. However, because of this, there are chances of underreporting convergence insufficiency. No cases were found of Vitamin A deficiency on clinical examination. Assessing the percentage of children with serum retinol would be a more ideal estimate to quantify the Vitamin A deficiency problem in the community. The causes of lid swelling were chalazion (0.24%), stye (0.24%), and dermoid (0.24%). There were no cases with whole globe anomaly, trachoma, and fundus pathology. One case of partial color blindness was detected (0.15%) [Table 1] and [Table 2]. There were no significant differences in ocular morbidities in urban and rural schools (P value at 5% significant level) [Table 3] and [Chart 1]. Gender-wise and age-wise distributions of ocular diseases are given in [Chart 2] and [Chart 3], respectively.
Table 1: Prevalence of ocular morbidities

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Table 2: Distribution of ocular morbidity by any cause

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Table 3: Comparison of ocular morbidity in urban versus rural schools

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[INLINE 1], [INLINE 2], [INLINE 3]

Two children (0.24%) were blind as per the criteria of UCVA <6/60 (0.24%). Sixty-one out of 817 (7.47%) children had unilateral visual impairment in either eye (UCVA ≤6/18 in better eye) [Chart 4]. [INLINE 4]

There was no child blind using criteria best-corrected VA <3/60.


  Discussion Top


A total of 817 children were examined. Of these, 108 children were found to have any ocular morbidity in either eye, the overall prevalence being 13.22%. This prevalence is comparable to a study by Prajapati et al.[6] at Gandhinagar, which reported a 13% prevalence. In the Kariapatti Pediatric Eye Evaluation Project initiated by Aravind Eye Hospitals, Nirmalan et al.[7] found prevalence of 13.6%. Nepal et al.[8] found a prevalence of 11%. Findings in both studies were comparable to our study. Higher prevalence was noted in Delhi-based study conducted by Kumar et al.[9] (22.7%) and by Gupta et al.[10] (31.6%) in Shimla and by Singh et al.[11] (29.35%) in West Uttar Pradesh. This was because of a higher prevalence of trachoma and conjunctivitis. Range of age group was more in the above studies. The lower prevalence in our study could be due to convenient sampling from only five schools. A larger population-based study across Goa could throw more light on the true prevalence of ocular morbidities. The most common cause of ocular morbidity was refractive error (9.55%), followed by strabismus (1.1%), conjunctivitis (1.1%), and lid swelling (0.74%). The most common cause of visual impairment in either eye was due to refractive errors (9.55%) (predominantly myopia [70.51%]). One case of pseudophakia in both eyes (congenital cataract) with strabismus amblyopia in the right eye was noted. A Delhi-based study by Chatrvedi and Aggarwal[12] showed a similar prevalence of refractive error of 7.4%. The Kariapatti Pediatric Eye evaluation project[7] undertaken by Aravind Eye Hospital and Kumar et al.[9] study showed a lower prevalence than our study, which was 0.55% and 5.4%, respectively. Studies by Singh et al.[11] in West Uttar Pradesh, Gupta et al.[10] in Shimla, and Desai et al.[13] in Jodhpur reported a higher prevalence of 17.36%, 22%, and 20.8%, respectively. This difference could be due to different diagnostic criteria used for detection, variance in reading habits and lighting and environmental conditions, and a difference in the sampling methodology.

Lid and adnexal disorders were noted in 0.86% of the children.[7] Similar findings were noted in urban Delhi[14] (1.01%) and Kariapatti[7] study showed similar results (1.5%).

Cases of conjunctivitis were mainly allergic conjunctivitis and detected in 1.1% of the children.[9] This was in accordance with findings by the International Study of Asthma and Allergies in Childhood (0.8%–14.9%).[15] Variation in the prevalence of conjunctivitis can be explained by difference in socioeconomic status, personal hygiene of children, and seasonal variations of occurrence of conjunctivitis.

Disorders of lens were observed in 1 child and 0.15% with pseudophakia in both eyes (operated for congenital cataract). This was <0.21% seen in urban Delhi[14] and higher than the 0.09% seen in Kariapatti study.[7] Strabismus was seen in 1.1% of children.[9] This was higher than 0.53% seen in urban Delhi[14] and 0.4% in Kariapatti.[7] One case of partial color blindness was noted (0.15%). Pratap and Lal[16] reported similar prevalence of color vision defects (0.11%). Higher prevalence has been reported from Rajasthan (2.9%) among 4–16 years by Khurana et al.[17]

The results of the study suggest that screening of school children for ocular problems should be done at regular intervals and it should be one of the prime components of the School Health Program. For this, school teachers should be oriented and trained in identifying common eye problems among school children so that these children can be referred for prompt treatment. They should also impart awareness regarding ocular hygiene among school children. In this manner, the prevalence of preventable causes of blindness among schoolchildren will be minimized. Identification of color vision defects with concurrent vocational counseling should also be done at the earliest in school children to save children from frustration later on and help them to choose a suitable vocation.

Acknowledgment

We are thankful to all the principals of schools in the study for allowing us to carry out this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Prajapati P, Oza J, Prajapati J, Kedia G, Chudasama RK. Prevalence of ocular morbidity among school adolescents of Gandhinagar district, Gujarat. Online J Health Allied Sci 2010;9:5.  Back to cited text no. 6
    
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Nirmalan PK, Vijayalakshmi P, Sheeladevi S, Kothari MB, Sundaresan K, Rahmathullah L, et al. The kariapatti pediatric eye evaluation project: Baseline ophthalmic data of children aged 15 years or younger in Southern India. Am J Ophthalmol 2003;136:703-9.  Back to cited text no. 7
    
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Kumar R, Dabas P, Mehra M, Ingle GK, Saha R, Kamlesh. Ocular morbidity amongst primary school children in Delhi. Health Popul Perspect Issues 2007;30:222-9.  Back to cited text no. 9
    
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Gupta M, Gupta BP, Chauhan A, Bhardwaj A. Ocular morbidity prevalence among school children in Shimla, Himachal, North India. Indian J Ophthalmol 2009;57:133-8.  Back to cited text no. 10
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Chaturvedi S, Aggarwal OP. Pattern and distribution of ocular morbidity in primary school children of rural Delhi. Asia Pac J Public Health 1999;11:30-3.  Back to cited text no. 12
    
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Desai S, Desai R, Desai NC, Lohiya S, Bhargava G, Kumar K, et al. School eye health appraisal. Indian J Ophthalmol 1989;37:173-5.  Back to cited text no. 13
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Strachan D, Sibbald B, Weiland S, Aït-Khaled N, Anabwani G, Anderson HR, et al. Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: The international study of asthma and allergies in childhood (ISAAC). Pediatr Allergy Immunol 1997;8:161-76.  Back to cited text no. 15
    
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