|Year : 2023 | Volume
| Issue : 2 | Page : 77-80
Head and facial anthropometry of South Indian pediatric population
Diwakar Rao1, L Nivetha1, Sowmya Raveendra Murthy2, N Nishant2, Manaswini Sahoo1, K Lakshmi Naveena1
1 Sankara College of Optometry, Sankara Eye Hospital, Bengaluru, Karnataka, India
2 Department of Pediatric Ophthalmology and Squint, Sankara Eye Hospital, Bengaluru, Karnataka, India
|Date of Submission||07-Aug-2022|
|Date of Decision||26-Dec-2022|
|Date of Acceptance||08-Jan-2023|
|Date of Web Publication||27-Apr-2023|
Sowmya Raveendra Murthy
Department of Pediatric Ophthalmology and Squint, Sankara Eye Hospital, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Purpose: The purpose of this study is to document and describe the head and facial anthropometric data in the pediatric age group using direct and indirect methods. Materials and Methods: It was a prospective study done from January 2021 to June 2021. All children aged 7 to 18 years who attended our pediatric ophthalmology outpatient department were included. Head and facial anthropometric parameters were defined and collected by direct and indirect methods. Rees-Fairbanks facial gauge was used to collect data in the direct method. In the indirect method, three photographs were taken one in straight gaze, the second toward their right side, and the third toward their left side positioned and analyzed by image processing software called ImageJ. Results: Anthropometric data were collected for 254 children which included 125 boys and 129 girls. Facial parameters were recorded by both direct and indirect methods. The highest mean difference between the two methods was <2 mm for linear measurements and <2° for angular measurements. Conclusion: We found that anthropometric data obtained by direct and indirect methods concur to a great extent. Further, the anthropometric data were different in different age groups and may have a bearing on spectacle prescription in children.
Keywords: Facial anthropometry, interpupillary distance, pediatric population, temple width
|How to cite this article:|
Rao D, Nivetha L, Murthy SR, Nishant N, Sahoo M, Naveena K L. Head and facial anthropometry of South Indian pediatric population. J Clin Ophthalmol Res 2023;11:77-80
|How to cite this URL:|
Rao D, Nivetha L, Murthy SR, Nishant N, Sahoo M, Naveena K L. Head and facial anthropometry of South Indian pediatric population. J Clin Ophthalmol Res [serial online] 2023 [cited 2023 Jun 8];11:77-80. Available from: https://www.jcor.in/text.asp?2023/11/2/77/374874
Spectacle usage is a simple and cost-effective modality to reduce one of the major causes of visual (43%) impairment, i.e., uncorrected refractive error. The most common cause of noncompliance to spectacle usage in children is poorly fitting spectacles. Uncorrected refractive errors are a well-known cause of amblyopia and may lead to strabismus in some cases.
Head and facial anthropometric measurements help in designing and constructing spectacle frames which can be well fitting and improve the compliance of spectacle wear. Anthropometric and cephalometric parameters vary considerably depending on the age, gender, geographical region, and racial and ethnic backgrounds of the individual. There are very few studies that have reported normal facial anthropometry values in Indian children. Facial anthropometry can be measured by both direct and indirect methods (photogrammetry).,,
We aim to document and describe the head and facial anthropometric data in the pediatric age group using direct and indirect methods.
| Materials and Methods|| |
It was a prospective descriptive study done from January 2021 to June 2021. This study has been conducted in accordance with the ethical principles mentioned in the Declaration of Helsinki (2013). The study population included from the children visiting pediatric ophthalmology outpatient department of a tertiary eye care hospital. All the children aged 7 to 18 years whose parents provided written consent were included in the study. The lower limit of age was chosen as 7 years for ease of obtaining several measurements and younger ones may not cooperate for the same, especially the direct measurements. Children who were having head and facial abnormalities associated with syndromes, facial deformities, history of any head and facial surgery, systemic diseases which affect the face form and head structure, patients with strabismus, on long-standing systemic steroids, and children who did not cooperate were excluded from our study. This study was approved by the institutional ethics committee of our hospital.
In this study, two methods were used to measure the parameters required to design a spectacle frame. In the direct method, Rees-Fairbank's facial gauge [Figure 1] was used to measure the parameters directly on the face of the subjects. In the indirect method, the photograph of the subjects was taken and analyzed. The photograph of the subject was taken one in straight gaze facing the camera, second toward their right side, and third toward their left side positioned 90° apart from the initial straight gaze with erect body position and no head tilts. The photographs of the subjects were uploaded into image processing software which is called ImageJ. The subject's photographs were taken in a separate room with a camera (Nikon Coolpix ‒ model number: 5200) which was mounted on a tripod stand to maintain the stability of the camera at a distance of 2 meters from the subject's face. The subject's photographs were taken with a neutral facial expression with ear cuffs placed on their ears to locate the ear helix point and 2 points were marked on the subject face by identifying the zygomatic bone (cheek bone) with a temporary marker to measure the head width (HW) and face width (FW), respectively. There were four dots placed on the center of the superior and inferior orbital rim (IOR) with a temporary marker for segment height [Figure 2].
|Figure 2: Different parameters measured by indirect methods (frontal view and lateral view) (a) IICD, (b) OICD, (c) NW (d) IPD, (e) HW, (f) FW, (g) FA (h) TL, (i) crest angle. IICD: Inner inter canthal distance, OICD: Outer intercanthal distance, NW: Nose width, IPD: Interpupillary distance, HW: Head width, FW: Face width, FA: Frontal angle, TL: Temple length|
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A preliminary study was conducted to define different parameters and to minimize the intra and interobserver variability between the three investigators in February 2021. To decrease intra and interobserver variability, we considered some markers on the face. A total of 25 subjects participated in the pilot study. We run the Bland-Altman analysis for both direct and indirect methods and observed that the inter and intraobserver variability among the three investigators was very low. [Table 1] shows the definitions and abbreviations of different parameters measured by direct and indirect methods.
|Table 1: The definitions and abbreviations of different parameters measured by direct and indirect methods|
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Statistical analysis was done by descriptive statistics using the SPSS software (IBM Corp., Released 2013. IBM SPSS Statistics for Windows, version 20.0. Armonk, NY, USA: IBM Corp) and Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA). Data were analyzed, and mean was computed for all parameters.
| Results|| |
Anthropometric data were collected for 254 children, out of which 125 were boys. The age of the population ranged from 7 to 18 years and the mean age was 13.02 ± 3.46 years, (males ‒ 12.81 ± 3.54 and females ‒ 13.21 ± 3.39).
The mean inner intercanthal distance (IICD) by the direct method was 32.04 mm and by the indirect method was 32.66 mm, mean outer intercanthal distance (OICD) by the direct method was 86.30 mm and by the indirect method was 88.19 mm, mean interpupillary distance (IPD) was by direct method 59.29 mm and indirect method was 60.03 mm, mean HW by the direct method was 145.83 mm and by the indirect method was 147.16 mm, and mean FW was by direct method 98.65 mm and by the indirect method was 100.47 mm. The frontal angle by the direct method was right side ‒ 18.56 mm left side ‒ 18.83 mm and by the indirect method was right side ‒ 19.71 mm and left side ‒ 19.95 mm, temple length by the direct method was right side ‒ 69.94 mm left side ‒ 69.78 mm and by the indirect method was right side ‒ 70.50 mm and left side ‒ 70.45 mm, center of superior orbital rim (SOR) by direct method was right side ‒ 10.38 mm left side ‒ 10.65 mm and by indirect method was right side ‒ 10.95 mm and left side ‒11.11 mm, and center of IOR by direct method was right side ‒ 13.67 mm left side ‒ 13.60 mm and by indirect method was right side ‒ 14.10 mm and left side ‒ 14.06 mm.
The highest mean difference between the two methods was <2 mm for linear measurements and <2° for angular measurements
All facial parameters were also calculated for four different age groups (7 to 9, 10 to 12, 13 to 15, and 16 to 18) by both direct and indirect methods. [Figure 3] and [Figure 4] show the age group-wise mean of parameters measured by direct and indirect methods. Head and facial parameters data were different in different age groups.
|Figure 3: Age group-wise head and facial parameters measured by direct and indirect methods. IICD: Inner intercanthal distance, OICD: Outer intercanthal distance, IPD: Interpupillary distance, NW: Nose width, FW: Face width, HW: Head width|
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|Figure 4: Age group-wise head and facial parameters measured by direct and indirect methods. TL: Temple length, FA: Frontal angle, SA: Splay angle, SOR: Superior orbital margin, IOR: Inferior orbital margin|
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| Discussion|| |
Uncomfortable or poorly fitting spectacles are one of the important causes of poor compliance of spectacle usage. Not all frames can be adjustable while dispensing, which can reduce the compliance of spectacle usage in children. Spectacle compliance mostly depends on comfort while using and the choice of the frame in children.
To the best of our knowledge, there are very few published articles which have reported the anthropometric data of the pediatric population for designing the spectacles. Studies done by Jahanbin et al. and Bishara et al. in Iran showed lower IICD values, than our study, whereas Indian studies, showed similar results to our study. A study done in Denmark by Fledelius and Stubgaard shows a higher range in OICD than our study, whereas an Indian study done in Punjab showed a similar result to our study. In IPD measurements, Indian studies., showed similar results to the current study. A study done by Osunwoke et al. in Nigeria also reported similar IPD measurements to our study. Study done in London by Kaye and Obstfeld shows lesser HW measurement than our study. Studies done by Kaye and Obstfeld in London and Marks in New York showed HW more than our study., A study done by Halladay et al. reported a higher IPD than our study but the mean age of their study population was 16.6 ± 5.49 year which was higher when compared to our study.
A study done by Krishnamurthy et al. from South India reported similar IPD, HW, and adverse event values to our study. However, a study done by Kumaran et al. in South India evaluated the spectacle fit objectively in a pediatric population using ocular anthropometric and frame measurements, they reported a higher apical radius and lower HW measurements.
We found that the facial features related to the eye grow at different rates in different age groups and other investigators also found the same result. We found that the highest mean difference between the two methods was <2 mm for linear measurements and <2° for angular measurements. Hence, either of the measurements can be used for measuring facial anthropometry. FW and HW are less in comparison with other countries' data. Nose width in the present study confirms that Indians have a prominent nose structure.
Even though our sample size was small, it is one among the very few studies from India reporting facial anthropometry values for the purpose of spectacle designing.
We hope to incorporate these parameters into future designs of child-specific spectacles to maximize their acceptability to the target populations and thus their impact in reducing the burden of uncorrected refractive error. We hope that more studies related to this study should publish from different geographical locations and different age groups of India so that we can customize the spectacles for children.
| Conclusion|| |
We found that anthropometric data obtained by direct and indirect methods concur, anthropometric data were different in different age groups and would have a bearing on spectacle prescription in children
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]