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Astigmatism in Chinese preschool children: prevalence, change, and effect on refractive development

D S P Fan¹, S K Rao², E Y Y Cheung¹, M Islam¹, S Chew³ and D S C Lam¹

¹ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong, People’s Republic of China
² Sankara Nethralaya, Medical and Vision Research Foundations, Chennai, India
³ Singapore Eye Research Institute, Singapore

Correspondence to:
Correspondence to:
Professor D S C Lam
Chairman and Professor, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, 3/F, University Eye Center, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong; dennislam{at}cuhk.edu.hk

Aim: To study the prevalence, type, and progression of astigmatism in Chinese preschool children, and its effect on refractive development.

Methods: A cross sectional study of preschool children was carried out in two randomly selected kindergartens. A cohort study was performed on a subset of children, five years after initial examination. Refractive error (measured by cycloplegic autorefraction) and axial ocular dimensions (measured by ultrasonography) were the main study outcomes.

Results: 522 children participated in the study; the mean age was 55.7 months (SD 10.9; range 27 to 77). Mean cylinder reading was –0.65 D (SD 0.58; range 0.00 to –4.75), and with the rule astigmatism was predominant (53%). In the 108 children studied longitudinally, the mean cylinder reading reduced from –0.62 D to –0.50 D (p = 0.019). The presence of astigmatism in initial examination predisposed the eyes towards greater myopisation (p<0.001). In addition, children with increased astigmatism had greater myopic progression (p<0.001) and axial length growth (p = 0.002).

Conclusions: This study reports a high prevalence of astigmatism in Chinese preschool children. The presence of astigmatism, and particularly with increasing astigmatism, appears to predispose the children to progressive myopia. Further studies are warranted.

Abbreviations: ATR, against the rule; SER, spherical equivalent refraction; WTR, with the rule

Keywords: astigmatism; cross sectional study; longitudinal study; myopia

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