Elsevier

Ophthalmology

Volume 112, Issue 4, April 2005, Pages 678-685
Ophthalmology

Original article
Refractive Error and Visual Impairment in School-Age Children in Gombak District, Malaysia

https://doi.org/10.1016/j.ophtha.2004.10.048Get rights and content

Purpose

To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city.

Design

Population-based, cross-sectional survey.

Participants

Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households.

Methods

Random selection of geographically defined clusters was used to identify the study sample. Children in 34 clusters were enumerated through a door-to-door survey and examined in 140 schools between March and July 2003. The examination included visual acuity measurements; ocular motility evaluation; retinoscopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus.

Main Outcome Measures

Distance visual acuity and cycloplegic refraction.

Results

The examined population was 70.3% Malay, 16.5% Chinese, 8.9% Indian, and 4.3% of other ethnicity. The prevalence of uncorrected (unaided), presenting, and best-corrected visual impairment (visual acuity ≤20/40 in the better eye) was 17.1%, 10.1%, and 1.4%, respectively. More than half of those in need of corrective spectacles were without them. In eyes with reduced vision, refractive error was the cause in 87.0%, amblyopia in 2.0%, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected amblyopia. Myopia (spherical equivalent of at least −0.50 diopter [D] in either eye) measured with retinoscopy was present in 9.8% of children 7 years of age, increasing to 34.4% in 15-year-olds; and in 10.0% and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, higher parental education, and Chinese ethnicity. Hyperopia (≥2.00 D) with retinoscopy varied from 3.8% in 7-year-olds, 5.0% with autorefraction, to less than 1% by age 15, with either measurement method. Hyperopia was associated with younger age and “other” ethnicity. Astigmatism (≥0.75 D) was present in 15.7% of children with retinoscopy and in 21.3% with autorefraction.

Conclusions

Visual impairment in school-age children in urban Gombak District is overwhelmingly caused by myopia, with a particularly high prevalence among children of Chinese ethnicity. Eye health education and screening may help address the unmet need for refractive correction.

Section snippets

Sample Selection

Gombak District is 1 of 9 districts in the state of Selangor and part of the metropolitan Kuala Lumpur area. The district has an urban population representative of the multiethnicity of Malaysia. The Gombak District population was 553 410 in the 2000 Census—14% of the total Selangor population—with 58.7% Malay, 26.0% Chinese, 12.6% Indian, and 1.9% other minorities.14 The district has 1 tertiary government hospital (Hospital Selayang), 1 secondary government hospital, 2 private hospitals, 10

Study Population

As the enumeration of eligible children proceeded, it became apparent that the required sample size would not be reached with the originally selected 25 clusters. Accordingly, an additional 10 clusters were randomly selected for inclusion in the study. A total of 35 clusters were, thus, enumerated between January and March 2003. One cluster was subsequently dropped from the study, because the government had moved most of the families to a new location.

A total of 8541 households were identified.

Discussion

A total of 5528 children were enumerated and 4634 (83.8%) examined in this cross-sectional, population-based survey of school-age children in Gombak District. Age distributions of enumerated and examined children were nearly uniform until decreasing with the 13-year cohort and then decreasing further in 15 year olds. This drop-off in examined cases was the result of a smaller number of enumerated cases (older children might have moved away to study in residential schools elsewhere) and of lower

Acknowledgment

The following are recognized for contributions to this study: Dr. Mariam Ismail for administrative support; Dr. A. R. Rosniza, Dr. Ang Chin Sim, Dr. Go Eng Song, I. Nor-Azizah, H. A. Arini, I. Farahiyah, A. H. Rohaiza, M. Diana, and M. Syamzariah for field work and clinical examinations; the Clinical Research Centre, Ministry of Health Malaysia, and the Department of Statistics, Selangor, for sampling and enumeration; Dr. H. Salleh and the Ministry of Education for permission to conduct ocular

References (19)

There are more references available in the full text version of this article.

Manuscript no. 240549.

Supported by the World Health Organization, Geneva, Switzerland (under National Institutes of Health [Bethesda, Maryland] contract no. N01-EY-2103), and the Ministry of Health Malaysia, Kuala Lumpur, Malaysia (Major Research Grant no. 2003/13).

The authors have no financial or other conflicts of interest concerning this study.

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