Home Print this page Email this page Users Online: 175
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2023  |  Volume : 11  |  Issue : 2  |  Page : 77-80

Head and facial anthropometry of South Indian pediatric population


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 Submission07-Aug-2022
Date of Decision26-Dec-2022
Date of Acceptance08-Jan-2023
Date of Web Publication27-Apr-2023

Correspondence Address:
Sowmya Raveendra Murthy
Department of Pediatric Ophthalmology and Squint, Sankara Eye Hospital, Bengaluru, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_99_22

Rights and Permissions
  Abstract 


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.[1] The most common cause of noncompliance to spectacle usage in children is poorly fitting spectacles.[2] Uncorrected refractive errors are a well-known cause of amblyopia and may lead to strabismus in some cases.[3]

Head and facial anthropometric measurements help in designing and constructing spectacle frames which can be well fitting and improve the compliance of spectacle wear.[4] 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.[5] Facial anthropometry can be measured by both direct and indirect methods (photogrammetry).[6],[7],[8]

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 Top


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 1: Rees-Fairbanks facial gauge

Click here to view
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

Click here to view


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

Click here to view


Statistical analysis

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 Top


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)[9] 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

Click here to view
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

Click here to view



  Discussion Top


Uncomfortable or poorly fitting spectacles are one of the important causes of poor compliance of spectacle usage.[2] 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.[10]

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[11],[12] than our study, whereas Indian studies[5],[13] showed similar results to our study. A study done in Denmark by Fledelius and Stubgaard[14] shows a higher range in OICD than our study, whereas an Indian study done in Punjab[13] showed a similar result to our study. In IPD measurements, Indian studies.[5],[13] showed similar results to the current study. A study done by Osunwoke et al. in Nigeria also reported similar IPD measurements to our study.[15] Study done in London by Kaye and Obstfeld shows lesser HW measurement than our study.[16] Studies done by Kaye and Obstfeld in London and Marks in New York showed HW more than our study.[16],[17] 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.[18]

A study done by Krishnamurthy et al. from South India reported similar IPD, HW, and adverse event values to our study.[19] 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.[20]

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 Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012;96:614-8.  Back to cited text no. 1
    
2.
Dandona R, Dandona L, Kovai V, Giridhar P, Prasad MN, Srinivas M. Population-based study of spectacles use in Southern India. Indian J Ophthalmol 2002;50:145-55.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Mohan K, Sharma A. How often are spectacle lenses not dispensed as prescribed? Indian J Ophthalmol 2012;60:553-5.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Tang CY, Tang N, Stewart MC. Ophthalmic anthropometry for Hong Kong Chinese adults. Optom Vis Sci 1998;75:293-301.  Back to cited text no. 4
    
5.
Gupta VP, Sodhi PK, Pandey RM. Normal values for inner intercanthal, interpupillary, and outer intercanthal distances in the Indian population. Int J Clin Pract 2003;57:25-9.  Back to cited text no. 5
    
6.
Guyot L, Dubuc M, Richard O, Philip N, Dutour O. Comparison between direct clinical and digital photogrammetric measurements in patients with 22q11 microdeletion. Int J Oral Maxillofac Surg 2003;32:246-52.  Back to cited text no. 6
    
7.
Tang CY, Tang N, Stewart MC. Facial measurements for frame design. Optom Vis Sci 1998;75:288-92.  Back to cited text no. 7
    
8.
C.Y. Tang (Department of optometry and Radiography), Norman Tang (School of design), and M. C. Stewart (Department of land surveying and geo-informatics), (Hong Kong Polytechnic University, Hunghom, Kowloon HK. Hong Kong: C. Y. Tang; 1998. p. 288-92. Available from: http//Facial_Measurements_for_Frame_Design_.27.pdf. [Last accessed on 2021 Jan 27].  Back to cited text no. 8
    
9.
Ramanathan N, Chellappa R. Modeling Age Progression in Young Faces. IEEE Computer society conference on computer vision and pattern recognition (CVPR'06); 2006. p. 387-94.  Back to cited text no. 9
    
10.
Zhou Z, Kecman M, Chen T, Liu T, Jin L, Chen S, et al. Spectacle design preferences among Chinese primary and secondary students and their parents: A qualitative and quantitative study. PLoS One 2014;9:e88857.  Back to cited text no. 10
    
11.
Jahanbin A, Rashed R, Yazdani R, Shahri NM, Kianifar H. Evaluation of some facial anthropometric parameters in an Iranian population: Infancy through adolescence. J Craniofac Surg 2013;24:941-5.  Back to cited text no. 11
    
12.
Bishara SE, Jorgensen GJ, Jakobsen JR. Changes in facial dimensions assessed from lateral and frontal photographs. Part II – Results and conclusions. Am J Orthod Dentofacial Orthop 1995;108:489-99.  Back to cited text no. 12
    
13.
Singh JR, Banerjee S. Normal values for interpupillary, inner canthal and outer canthal distances in an Indian population. Hum Hered 1983;33:326-8.  Back to cited text no. 13
    
14.
Fledelius HC, Stubgaard M. Changes in eye position during growth and adult life as based on exophthalmometry, interpupillary distance, and orbital distance measurements. Acta Ophthalmol (Copenh) 1986;64:481-6.  Back to cited text no. 14
    
15.
Osunwoke E, Didia B, Olotu E, Yerikema A. A study on the normal values of inner canthal, outer canthal, interpupillary distance and head circumference of 3-21 years Ijaws. Am J Sci Ind Res 2012;3:441-5.  Back to cited text no. 15
    
16.
Kaye J, Obstfeld H. Anthropometry for children's spectacle frames. Ophthalmic Physiol Opt 1989;9:293-8.  Back to cited text no. 16
    
17.
Marks R. Some factors for consideration in the selection and fitting of children's eyewear. Am J Optom Arch Am Acad Optom 1961;38:185-93.  Back to cited text no. 17
    
18.
Halladay AC, Thandiwe M, Ayerakwah P, Dennis S, Joshua M, George K. Ophthalmic anthropometry of an Urban Malawian population. Cogent Med 2019;6:1614287. Avalaible form: https://www.tandfonline.com/doi/epdf/10.1080/2331205X.2019.1614287?needAccess=true&role=button.  Back to cited text no. 18
    
19.
Krishnamurthy S, Gnanasekar VB, Rameshan S, Karunakaran G, Thirumoorthy V, Kumaran AV, et al. Upper face anthropometry parameters of children from South India. Indian J Ophthalmol 2022;70:1064-5.  Back to cited text no. 19
  [Full text]  
20.
Kumaran SL, Periakaruppan SP. Ophthalmic anthropometry versus spectacle frame measurements: Is spectacle fit in children compromised? Asian J Pharm Res Health Care 2022;14:48.  Back to cited text no. 20
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed607    
    Printed20    
    Emailed0    
    PDF Downloaded90    
    Comments [Add]    

Recommend this journal