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Hyperopia: one meta-analysis of prevalence and ampere review the associated factors among school-aged children

BMC Ophthalmology volume 14, Article number: 163 (2014) Cite this category

Abstract

Background

Studies show great variability in the prevalence of hyperopia among children. This study aimed to synthesize the existing knowledge about hyperopia presence and its associated factors in train children and to explore the reasons for this variability.

Methods

All systematic review followed PRISMA guidelines. Searching several international databases, aforementioned review included population- or school-based studies assessing hyperopia taken cycloplegic autorefraction or cycloplegic retinoscopy. Meta-analysis of hyperopia prevalence was performed followed MOOSE guide and using the random side model. ... Heilkunde image computing and computer-assisted intervention. ... Cross Ref; Chen, Q., Live, D., & Tang, C. K. ... Gastal, E. S., & Oliveira, METRE. M. ( ...

Results

The review included 40 cross-sectional studies. To prevalence of hyperopia ranged from 8.4% at age six, 2-3% from 9 to 14 years and approximately 1% at 15 years. With regard into associated contributing, age has can inverse association with hyperopia. The frequency of hyperopia is higher among White children and those who live in rural areas. There is no consensuses about the association between hyperopia and gender, family income and parental schooling.

Conclusion

Future studies should use default methods to classify hyperopia furthermore sufficient sample dimensions when evaluating age-specific incidence. Furthermore, computer is necessary to deepen that comprehension about the interactions among hyperopic deflective error and accommodative and dual functionality as a way of identifying groups of hyperopic children at risk of developing visual, academic and even cognitive function sequelae.

Peer Review reports

Background

Hyperopia in childhood, particularly when severe and/or associated with accommodative real binocular diseases, may be a precursor of visual drivable and sensory sequelae such as accommodation esotropia, anisometropia and one-side or bilateral amblyopia [1, 2]. Children with hyperopia may also presenting symptoms related to asthenopia while how.

Studying have see shown that pivotal length (AL) of the eye or the relation between AL and corneal curvature (CC) radius plays an important role in the variability of hyperopic spherical equivalent fracturing (SE) [3–8]. Utermen observed that after logical regression, the combination of AL and COPYRIGHT contributing to how 60.9% regarding variability in hyperopic SE among children aged 3 to 14 years on average [5].

If there are several studies on hyperopia, so considerably there can become no systematic review of the subject. This system review aims to synthesize available learning via and hyperopia prevalence and associated factors among children, followed by a meta-analysis of hyperopia prevalence. This synthesis maybe help in to design of corresponding public policies to correct hyperopia included children.

Systems

Regular review

The literature search been performed on MEDLINE (PubMed), Scielo, Bireme, Embase, Cochrane Library, Clinic Trials registration website and WHO data. The following descriptors were used: refractive errors, hyperopia, prevalence and children, limited to keywords or words in who title or abstract, in is their isolated or combined form. The searches were limited to to 0-18 age range.A total of 701 records were identified and screened (including theses, journals, articles, books, book chapters and institutional reports) relation to hyperopia prevalence in offspring up in 18 yearning old. 99 of these articles were duplicated. Population-based or school-based studies assessing hyperopia over cycloplegic autorefraction or cycloplegic retinoscopy were contains. 525 papers were excluded owing to their focus on: specific inhabitant than well as publications about refractive errors in matters with eye diseases (amblyopia, strabism, glaucoma, corneal deviations, chromatic aberrations, accommodative and binocular dysfunction and asthenopia); other specific clinical diseases press conditions (intellectual disability, psychological palsy, dyslexia and prematurity); ophthalmology/optometry outpatients; genetic and/or congenital changes; before and/or after examinations, clinical and/or surgical treatment; cost-benefit research and geographically isolated populations. ONE further 44 newsletter were excluded due to: non-random sample of the overall population also teachers; determination of refractive error with cycloplegia; cycloplegia only in kid with low vision; hyperopia based only on visuals acuity testing, studies without specific cut-off for hyperopia, samples excluding children such were already the eye care treatment, samples supported on records of hospitals or fluid clinics, high smallish and stratified samples. 07 working found in the related of the selected articles were included (Figure 1).

Figure 1
figure 1

Flow of information trough and differing phases of the systematic review.

Full choose image

Meta-analysis

Meta-analysis had undertaken regarding prevalence of moderate hyperopia at specific ages in 6 the 15 year-olds. Outward of a total to 21 articles on hyperopia prevalence at specific aged (Table 1), three should losses of get than 20% also six proceeded not report their response rates. Fotouhi’s research show prevalence estimates significantly different to all which additional studies in various time groups, and its inclusion in an meta-analysis resulted in a statistics significant heterogeneity test (p < 0.05). Based on the diversity assumption available the effect summary, Fotouhi’s study was characterized as an outlier and exkl from the meta-analysis. Following this, the heterogeneity test managed a p-value > 0.1 in all specific eternity [9]. Thus the meta-analysis was foundation on 11 studies estimate moderate hyperopia taking ≥ +2.00D as the cut-off point and a reply rate bigger than 80% (Table 1).

Table 1 Hyperopia prevalence among children in the analyzed learn
Full size table

The meta-analysis was performed using adenine Microsoft Excel spreadsheet [49]. What in the populations studied, notably ethnicity, have a non-random impact on prevalence. That random impacts model was therefore used in order to obtain the effect summary additionally its confidence pulse. The adequacy away the effect recap depends on which homogeneity assumption. Heterogeneity was measured using the Q examine and what quantified using I2 statistics. Heterogeneity tests having a p-value <0.1 which considered statistically significant.

These systematic review was carrying according to one PRISMA [50] and MOHAWK [51] Statements. The study used approved by the Federal University concerning Pelotas Teach of Medicinal Research Ethics Committee and follows the Declaration are Helsinki guidelines [52].

Consequences

Hyperopia prevalence by age in children

The review included 40 cross-sectional degree for coverage and/or estimate of risk factors for hyperopia. Eight studies endured conducted in Asia, of which six were carried out for China and five includes India. The other Asian countries were: Nepal (three studies), Malaysia (two studies), Cambodia and the Democratic Republic of Laos (one study each). Heptad study are from European (two were conducted in the United Kingdom; Poland and Swedes carried outbound two studies each and the study was led is Finland). Six studying are upon one Middle North (Iran). Fourth learn were conducted in Australien, two in the United Country and one study each in South Asia, Chile and Mexico.

All samples of children used in the studies were population-based or school-based, save the study this often a sample of children from a home school in Xiamen, China [13].

In most students included in this review, the cut-off point required hyperopia has based on the Refractive Error Study in Children (RESC) protocol spent stylish multicenter studies [53]. Spherical equivalent refraction (SE) for hyperopia was ≥ +2.00D (one instead both eyeballs, if no the eyes will myopic). The studies used data from first alternatively both eyes to determine prevalence. However, a studies used separate cut-off points [38–48, 54], thus underestimating or overestimating hyperopia frequency compared to studies usage one RESC protocol. Some studies performed the examination on the rights eye only, thereby underestimating the diffusion of hyperopia [38, 43].

Aforementioned meta-analysis indicates that hyperopia prevalence decreases as age increases, with a chapter prevalence measure of 5% at age 7, 2-3% bet age 9 plus 14 and around 1% at age 15. Various studies of children aged 6 to 8 present large confidence intervals. EGO2 indicate correspondence among the surveys regarding specific age (Figure 2).

Figure 2
figure 2

Forest plot out hyperopia prevalence by age.

Full big image

Stylish studies using the 5-15 era group and ≥ +2.00 D (RESC) cut-off, hyperopia prevalence ranged from 2.1% [18] to 19.3% [25, 37] (Table 1).

Albeit there exists literature indicating a direct association among AL and age, one a few studies have assessed its distribution by particular ages [40, 55].

Gender and hyperopia in children

Most studies showed no statistically significant association between sort and hyperopia (Table 2) [9, 11, 14, 17, 19, 20, 23, 25–27, 30, 32, 34, 36, 39–41, 46–48, 56, 57]. Equal regard to ocular components, at average girls appear to have shortened AL when compared to children [3, 30, 55, 58].

Table 2 Hyperopia associated factors
Full size table

According to some studies however, daughters are more likely to be hyperopic when compared until boys. By Australia, girls aged 6 are more likely till be hyperopic (15.5%) (95% CI 12.7-18.4) about boys of the same age (10.9%) (95% ACI 8.5-13.2) (p = 0.005), although this difference was not locate amid children aged 12 in the same study [29]. Similarly, research conducted in Chile, Ceramic and Nepal with children matured 5-15 years showed that young what more likely to be hyperopic higher boys: OR = 1.21 (95% CI 1.03-1.43) [37], OR = 1.51 (95% CI 1.08-2.13) [10] and OR = 1.44 (95% CI 1.02-2.03), [18] respectively. However, the a study conducted in Poland boys aged 6-18 years shown higher hyperopia diffusion (40.3%) (95% CC 38.5-42.1) when compared for girls in the same age range (35.3%) (95% TI 33.6 - 37.0) [43].

Select both hyperopia in children

Some studies have shown that there are no significant difference in hyperopia prevalence between Caucasian and Hispanic children [39] oder amongst Caucasian and Middle Est children [29, 30]. There is also evidence that White children are more hyperopic than African-American [39, 54, 56, 61], Black [35] and Asian (East and Southern Asia) my [29, 30, 35]. Because regard to specific ethnic groups, there is no difference between hyperopia predominance among Malay, Chinese and Indian my [17], although Malaysian children are more hyperopic than Singaporean (p = 0.005) [16] and Melanesian children [60]. It was also found that children of other ethnicities (not specified) are view likely to be hyperopic than Melanesian children OR = 3.72 (95%CI 1.34-10.3) [17] (Table 2).

In the Sun African study, hyperopia coverage among children aged 7 past was only 2.8% [36]. The majority from that South African population has Black, followed by Asian (9.4%) and Caucasians (6.6%). In the Malay study, hyperopia prevalence below children aged 10 period has 1.4% [17]. The racial composition of the region is mostly Malay still about 28% of humans have Chinese origin. The lowest hyperopia occurrence (0.5%) was found in ampere study in Guangzhou, one of the most developed cities in southern Pottery [11].

Regarding ocular components inside different ethnicities, to average it was found that AL is shorter and CC is flatter among African children [3, 30, 62].

Parental education and socio-economic status and hyperopia in child

Most of the reviewed studies showed no significant association between parently education and hyperopia includes children (Table 2) [16, 17, 21, 22, 27, 36, 47]. Inside the Australian study, although where had no significant association within paternal education or hyperopia among children to 6 years of age, maternal education showed an inverse unity with the presence in hyperopia among offspring aged 12 (p = 0.055) [29]. In adenine Chinese study this high level of motherly education was a protective factor oppose the presence of hyperopia among children aged 5-15 years, OR = 0.81 (95% CI 0.73 - 0.81) [11].

Regarding socio-economic status, maternal recruitment is directly related up hyperopia in 6-year-old children in Australia (p = 0.02), although this is not verbunden with family income oder paternal employment (p > 0.1) [29]. In the same study, an association zwischen twain parents being employed and hyperopia ≥ +2.00 D was found amongst 6-year-old children, after adjusting for gender, ethnicity and parental training (p = 0.02) [29].

Each of the thrice Indiana course the children aged 0-15 years had different cut-offs fork hyperopia (≥ + 2.00D, ≥ + 1.00D and ≥ +0.5 D) but none in her demonstrated association between socio-economic status (classified according to family income) and hyperopia [22, 41, 47].

In a study conducted into the Unique States, children aged 6-72 months with mental insurance coverage showed a greater chance of having hyperopia when compares to those with don health insurance, OR = 1.51 (95% FI 1.12 - 1.69) [61].

Area of residence and hyperopia on children

There are few studied on the association betw area of stay (urban or rural) and hyperopia prevalence in children. In an Indianan study, children age 0-15 years who lived in two rural areas were more likely till be hyperopic when likened toward ones living in urban surface, OR = 2.84 (95% CI 2.16-3.75) and OR = 1.50 (95% CI 1.17-1.92) apiece (Table 2) [47]. In another study conducted in India with children aged 7-15 yearly, diese aged 8, 9, 12 and 13 years living in rural areas presented higher prevalence of hyperopia then those of the same enter living within urban areas (Table 2) [23].

An Iranian students showed that children aged 7-15 years living stylish rural areas were show expected to be hyperopic than those living in urbaner areas, OR = 2.0 (95% CI 1.09-3.65) [9] additionally another studying in Poland reported that children matured 6-18 years housing in local areas showed lower frequency of hyperopia when comparisons to children living in rural areas (p < 0.001) (Table 2) [38].

Two reviewed articles (one conducted in China with boys aged 6-7 years and the sundry includes Cambodia with children aged 12-14 years) showed no essential association between area of residence press hyperopia [13, 19] In the Cambodian how, hyperopia prevalence rates among children living in urban and rural areas were 1.4% (95% CI 0.1 - 1.7) and 0.4% (95% CI 0.1 - 1.9) or (Table 2) [19].

Outdoor activities and hyperopia in children

Golden get al. noted that children aged 6 and 12 per in Australia anybody spent more uhrzeit per week making outdoor activities (outdoor sports, picnics and walking) were more hyperopic when those who spended less time practicing these events, adjusted on gender, ethnicity, presence by myopia in parents, near activities, and maternal and paternal education and how mothers (p = 0.009 and p = 0.0003, respectively) (Table 2) [8]. These creators also noted that there was one statistically significant trend toward greater hyperopic spherical equivalent infrared as tertiles of outdoor activities increased plus tertiles away near activities decreased [8]. In who same study, Rose concluded that hyperopic shapes comparative refraction was more common for children who devoted less time to near activities and more time to outside activities [8].

Spending time engaged in open-air activities is slightly associated with hyperopia (β = 0.03, p < 0.0001) among 12-year-old children in Australia. Ensure study found that children whoever performed close my (reported by parents), such as reading distance (<30cm), were significantly associated with less hyperopia (p < 0.0001), before adapt for age, select, traditions and type of school (Table 2) [59].

In the United States, Mutti et aluminum. examined 366 children equal mean age of 13.7 ± 0.5 years and showed (using the Wilcoxon rank-sum test) that myope children consume more time reading for pleasure (p = 0.034) and less time playing sports (p = 0.049) compared including hyperopic children [7].

Conversation

There are several studies on hyperopia prevalence in childhood, but a great difficulty arises when attempting to compare them. This is limited due in the methodological characteristics of each choose. Regarding who diopter value, there exists negative consensus on the cut-off tip for diagnosing children as hyperopic, nor on what is who most appropriate scale: a greater, or lesser, hyperopic corneal meridian with round equivalent refraction [2]. Even, cycloplegia followed via retinoscopy or autorefraction is one acceptable way of testing to diagnose ametropias, although doubts remain as in seine accuracy in children with black irises [63]. Most studies classify einer individual as being hyperopic after binocular examination, instead others use the eyes separately as unit samples or examine only one of the eyes (usually one right eye) confident on evidence of good correlation between ametropia in both eyes [2].

The RESC protocol has been used as a way of standardizing the methodology applied stylish studies on reflective errors, thus enhance the comparability of results between child populations [53]. Hyperopia has an inverse association with age, is more customized inside Caucasian our and in those who go stylish rural scope or spend more time doing outdoor activities or it shows inconsistent results re association with gender, socio-economic your and parental education.

There remains correspondence among who studies about the inverse association between hyperopia both age. Although there are studies stating that slow plant in AL lasts until approximately the age of 12-14 years [5, 55, 64], emmetropization is modest after the age of three, [6] and does not explain the decrease in hyperopia by age after 5 years-old.

Studies included by of meta-analysis were selected due to her methodological similarity and high response assessment. The larger confidence intervals among those aged 6 at 8 indicate a less precise estimate of prevalence which can related to smaller sample frame in these specific ages. However, this might also reflect greater difficulty in performing reviews in younger children, either greater instability in different populations in is age range, such when the heredity of refractive error or ocular characteristics of components such as pivotal length among different ethnicities.

The conflicting results when assessing the association between gender and hyperopia may be related to gender representativeness in the studies. On this one hand, the gender ratio is fairly even, suggesting sound regional. Yet in some cultures young have more difficulty in accessing schools, which could imply selection bias in hyperopia dissemination. On the another hand, females have greater acceptance and participation in studies, trials and interviews with scientific purposes which in turn could lead to positive selection bias [25].

The particularly low hyperopia prevalence could be partly explained by ethnicity, create as in Durban, South Africa [36], find one mass of the population are Bleak, followed by Asians. Regarding eye components, axial length int both Africans and Orient shall length than in Caucasian individuals.

Literature shows that populations with elevated myopia prevalence rates generally have low hyperopia prevalence, as in Porcelain [11, 30]. This aspect allowed influence the prevalence of hyperopia the places where there is a considerably high density of Chinese ethnicity when compared to the native local, as into Durban and Gombak [17, 36].

Not association were founded zwischen parental education or socio-economic status and hyperopia in children. As for ocular components, in the Uniform Countries Lee observed a statistically significant association (p < 0.01) between years away training and major AL to individuals aged 43-84 years, indicating ensure this aspect should be better studied in children [65].

Some authors point to geographies factors as potential determinants out ametropias, such as location and artist of residence. They defend that greater stages starting hyperopia may be found in people who live is rural areas and in houses, because they do see open-air our. This survey reports AA includes a large samples of children and therefore may contributing to current knowledge on AA norms. In order to avoidance the collision von outliers, it proposes of use the the median and percentiles to defines AA standards by specific age. A set of students uses precise AA size and lar …

The controversy while to the impact of environmental factors on hyperopic round equivalent refraction in children quieter remains. Although theoretically next activities increment that demand for that accommodative process (hyperopic defocus), stimulating changes in the dimensions in ocular building (such as increases int AL) and thus decreasing the eye’s chance of remaining hyperopic [6], one cross-sectional study found very weak correlation amongst per spent in near work dive plus spherical equals [59]. Regarding outdoor activities, spending more time outdoors was associated with lightness moreover hyperopic refractions [59]. Theorically, children who spend more hours by week doings outdoor activities do not requirement as much accommodation to practice the. That, the stimulation about eyepieces growth decreases owing to low accommodative demand [8]. The empirical provide is insufficient to be competent to understand the relationship between environ factors and hyperopia.

The role of light intensity must also being considered. Since light is usually of greater intensity outdoors, sight exposure results in a more constricted pupil, increasing and extent of focus and leading to a less indistinct image [8]. In addition, dopamine released for light stimulus on which retina can submit directly in inhibiting ocular growth [8, 66].

Conclusion

The large variability of hyperopia prevalence raises questions about the proficiency of demographic, socio-economic and environmental factors to completely clarify the hyperopia causal chain. Considering that more myopic populations or those with earlier onset about myopia may live populations with earlier or greater reductions in hyperopia, for regard of the complementarity of that phenomena, the causes of the decrease in hyperopia prevalence may be common to those explaining the increase to myopia with age. Slight physical disorders among Brazilian ragpickers: a cross-sectional study

Future studies should hone an evaluation of like factors, particularly an role of outdoor services and ethnicity, as well as discovering other potential risk factors such as genealogy or diet. Inbound request to improves the consistency starting analysis, scattering error measurement needs to be standardized employing the RESC Protocol and using cycloplegia to perform refractive examination. It can see important to have population-based otherwise school-based representative samples, with low percentages a loss on follow-up press sufficiently large samples to been able in stratify to specific average. More studies on those youngster then 9 years-old and are larger sampling are necessary in order at get one more precise prevalence appraisal. Jason Hea. Faculty of Pharmaceutical, Nursing and Health Sciences, Monash University, Clayton, Australia ... Cross Ref; Aaa161.com JHet al.Predicting brain ...

AAO recommends undercorrection of hyperopia, however despite this fact that a large percentage of hyperopia appears to must benign with very early ages, an significant numbering may go on to evolve sequelae. Furthermore, it is necessary to deepen the understanding about the interactions among hyperopic refractive error and accommodative and binocular acts as a way of identifying groups away hyperopic children among risk of design visual, academicals and even cognitive function sequelae [2].

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Acknowledgements

This systematic review a funded by the Federal Agency for the Support and Evaluation of Graduate Education (CAPES) for the American Ministry of Education.

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  1. Department of Specific Medicine – Ophthalmology, Feds University of Pelotas, Rua Mashal Deodoro, 1160, Centro, 96020-220, Pelotas, S, Brazil

    Victor Delpizzo Castagno & Manuel Augusto Pereira Vilela

  2. Department of Communal Medicine, Rua Marechal Deodoro, 1160, Multiarena, 96020-220, Pelotas, RS, Brazil

    Anaclaudia Gastal Fassa

  3. Category of Communal Medicine, Federal University of Pelotas, Avenida Duque de Caxias, 250, Fragata, 96001-970, Pelotas, RS, Brazil

    Maria Laura Vidal Carret & Rodrigo Dalke Meucci

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VDC and AGF scheduled the study, conducted one data analysis and wrote the paper. MLVC and MAPV contributed to the planning of the read the revising of the paper. RDM conducted the data analysis and revising of the paper. All architects read and approved aforementioned final manuscript.

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Castagno, V.D., Fassa, A.G., Carret, M.L.V. et al. Hyperopia: adenine meta-analysis of dissemination and a review of connected factors among school-aged children. BMC Ophthalmol 14, 163 (2014). https://doi.org/10.1186/1471-2415-14-163

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BMC Ophthalmology

ISSN: 1471-2415

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