High Rates of Uncorrected Vision Conditions among Schoolchildren in Rural Queensland, Australia.

SIGNIFICANCE: This study is the first to report high rates of uncorrected vision conditions among Australian secondary schoolchildren living in a rural area and to comment on the rate of eye examinations undertaken on Australian Indigenous children. Uncorrected vision problems that continue throughout the school years have significant implications for children's quality of life and education. PURPOSE: This study aimed to investigate the prevalence of uncorrected vision conditions among Australian schoolchildren. METHODS: Participants included 280 students from rural primary and secondary schools (aged 4 to 18 years), of whom 40% identified as being of Aboriginal and/or Torres Strait Islander descent (Indigenous). All participants underwent an eye examination including measurements of monocular distance and near visual acuity, assessment of accommodative and vergence function, stereoacuity, color vision, and cycloplegic autorefraction. A parental questionnaire was used to determine whether the child had previously had his/her eyes examined. RESULTS: The overall prevalence of uncorrected vision conditions in this population was 35%. The odds of previously having had an eye examination were 2.3× higher for non-Indigenous compared with Indigenous children despite both groups exhibiting high rates of uncorrected vision conditions (Indigenous, 31 [29%]; non-Indigenous, 66 [40%]; χ21 = 3.24, P = .07). Of the children who had significant refractive error (Indigenous, 23 [21%]; non-Indigenous, 49 [30%]; χ21 = 2.70, P = .10), 82% were uncorrected, and only 39% of Indigenous children and 54% of non-Indigenous children had previously had an eye examination. CONCLUSIONS: These findings suggest that high rates of uncorrected vision conditions are present among Australian primary and secondary schoolchildren from a rural area and highlight that Indigenous children are much less likely to have had an eye examination. Understanding factors that affect the rate of eye examinations and compliance with spectacle correction must be addressed given the potential impact of these vision conditions.

Impact of spectacles wear on uncorrected visual acuity among urban migrant primary school children in China: a cluster-randomised clinical trial.

OBJECTIVE: To estimate the effect of providing free spectacles on uncorrected visual acuity (VA) among urban migrant Chinese school children. DESIGN: Exploratory analysis from a parallel cluster-randomised clinical trial. METHODS: After baseline survey and VA screening, eligible children were randomised by school to receive one of the two interventions: free glasses and a teacher incentive (tablet computer if ≥80% of children given glasses were wearing them on un-announced examination) (treatment group) or glasses prescription and letter to parents (control group). The primary outcome was uncorrected logarithm of the minimal angle of resolution (LogMAR) VA at study closeout, adjusted for baseline uncorrected VA. RESULTS: Among 4376 randomly selected children, 728 (16.6%, mean age 10.9 years, 51.0% boys) at 94 schools failed VA screening and met eligibility criteria. Of these, 358 children (49.2%) at 47 schools were randomised to treatment and 370 children (50.8%) at 47 schools to control. Among these, 679 children (93.3%) completed follow-up and underwent analysis. Spectacle wear in the treatment and control groups was 68.3% and 29.3% (p<0.001), respectively. Uncorrected final VA for eyes of treatment children was significantly better than control children, adjusting only for baseline VA (difference of 0.039 LogMAR units, 95% CI: 0.008, 0.070, equivalent to 0.39 lines, p=0.014) or baseline VA and other baseline factors (0.040 LogMAR units, 95% CI 0.007 to 0.074, equivalent to 0.40 lines, p=0.020). CONCLUSION: We found no evidence that spectacles wear worsens children's uncorrected VA among urban migrant Chinese school children.

Chinese Expert Consensus on Perioperative Medication in Laser Corneal Refractive Surgeries (2019).

Laser corneal refractive surgery has become an important treatment to correct ametropia in recent years. Rational medication in the perioperative period is essential to ensure the success of the surgery and to reduce complications. However, in this area there has been no consistent understanding and unified application guide across the world. Experts in Refractive Surgery Group, Ocular Microcirculation Branch of Chinese Society of Microcirculation who are specialized in keratology and optometry had initiated extensive and rigorous discussions and reached a consensus on appropriate medication before, during and after the refractive surgeries. The consensus covers a broad spectrum of commonly used ophthalmic solutions, provides recommendations of routine and enhanced medication on prevention and management of adverse reactions and complications related to the laser corneal refractive surgeries. We hope the consensus serves as a standard perioperative medication regimen for ophthalmologists, helps to ensure the safety and effectiveness of laser corneal refractive surgeries, and improves the quality and outcome of the refractive surgeries.

Comparison of Chinese and North American Tomographic Parameters and the Implications for Refractive Surgery Screening.

PURPOSE: The aim of this study was to determine whether there are significant clinical variations in the Belin/Ambrosio Enhanced Ectasia Display (BAD display) parameters between Chinese and North American eyes and whether any variations are related to differences in corneal diameter. DESIGN: Retrospective observational study. METHODS: Files were generated from patients seeking refractive surgical correction. Patients with previous surgery, evidence of corneal ectasia, or scans representing a non-normal cornea were excluded. Unpaired t tests were performed for all variables. Regression analyses were performed for all variables with respect to corneal diameter, and compared to evaluate the influence of corneal diameter between populations. Data were graphed as standard scores (z scores) to compare different parameters. RESULTS: 127 North American and 49 Chinese patients met study criteria. Statistically significant differences existed for corneal diameter (P < 0.01), anterior elevation at the thinnest point (P < 0.01), and Df (P < 0.01). In both populations, statistically significant correlations existed between corneal diameter and most indices, and most profoundly on pachymetric progression and final D. Regression slopes revealed a statistically significant difference for the influence of corneal diameter on ARTmax (P = 0.04) and was nearly significant for final D (P = 0.06). CONCLUSIONS: Corneal diameter had the greatest influence on pachymetric progression and final D, and more profoundly in the Chinese. This suggests that incorporating corneal diameter as an additional variable may make the BAD display more universally applicable. Also, the differences in anterior elevation parameters suggest that specific ethnic/geographic normative values may be beneficial for the BAD display.

A Randomized Noninferiority Trial of Wearing Adjustable Glasses versus Standard and Ready-made Spectacles among Chinese Schoolchildren: Wearability and Evaluation of Adjustable Refraction III.

PURPOSE: To compare wear of standard, adjustable, and ready-made glasses among children. DESIGN: Randomized, controlled, open-label, noninferiority trial. PARTICIPANTS: Students aged 11 to 16 years with presenting visual acuity (VA) ≤6/12 in both eyes, correctable to ≥6/7.5, subjective spherical equivalent refractive error (SER) ≤-1.0 diopters (D), astigmatism and anisometropia both <2.00 D, and no other ocular abnormalities. METHODS: Participants were randomly allocated (1:1:1) to standard glasses, ready-made glasses, or adjustable glasses based on self-refraction. We recorded glasses wear on twice-weekly covert evaluation by head teachers (primary outcome), self-reported and investigator-observed wear, best-corrected visual acuity (BCVA) (not prespecified), children's satisfaction, and value attributed to glasses. MAIN OUTCOME MEASURE: Proportion of glasses wear on twice-weekly covert evaluation by head teachers over 2 months. RESULTS: Among 379 eligible participants, 127 were allocated to standard glasses (mean age, 13.7 years; standard deviation [SD], 1.0 years; 54.3% were male), 125 to ready-made (mean age, 13.6; SD, 0.83; 45.6%), and 127 to adjustable (mean age, 13.4 years; SD, 0.85; 54.3%). Mean wear proportion of adjustable glasses was significantly lower than for standard glasses (45% vs. 58%; P = 0.01), although the adjusted difference (90% confidence interval [CI], -19.0% to -3.0%) did not meet the prespecified inferiority threshold of 20%. Self-reported (90.2% vs. 84.8%, P = 0.64) and investigator-observed (44.1% vs. 33.9%, P = 0.89) wear did not differ between standard and adjustable glasses, nor did satisfaction with (P = 0.97) or value attributed to study glasses (P = 0.55) or increase in quality of life (5.53 [SD, 4.47] vs. 5.68 [SD, 4.34] on a 100-point scale, P > 0.30). Best-corrected visual acuity with adjustable glasses was better (P < 0.001) than with standard glasses. Change in power of study lenses at the end of the study (adjustable: 0.65 D, 95% CI, 0.52-0.79; standard, 0.01 D; 95% CI, -0.006 to 0.03, P < 0.001) was greater for adjustable glasses, although interobserver variation in power measurements may explain this. Lens scratches and frame damage were more common with adjustable glasses, whereas lens breakage was less common than for standard glasses. CONCLUSIONS: Proportion of wear was lower with adjustable glasses, although VA was better and measures of satisfaction and quality of life were not inferior to standard glasses.

Vision impairment and refractive errors in refugees presenting to community optometry clinics in Victoria, Australia.

BACKGROUND: There is a paucity of data relating to refugee eye health in Australia. This study aimed at investigating the spectrum of vision impairment and other ocular conditions in refugees utilising the Victorian Eyecare Service operated by the Australian College of Optometry. METHODS: A cross-sectional study of electronic clinical records of 518 individuals (adults and children) recognised as refugees by the Australian College of Optometry and treated between January 2013 and May 2014 were identified. Extracted data included presenting visual acuities, best-corrected visual acuities, and final refraction values (using spherical equivalents), for both eyes. Diagnoses of presenting ocular conditions were also extracted. RESULTS: Of all refugees examined, 129 (27.2 per cent) had some degree of vision impairment (≤ 6/9.5) based on presenting visual acuities in their better eye; five (1.0 per cent) being of a severe (≤ 6/60) or profound (≤ 6/120) nature. In contrast, 27 (6.3 per cent) refugees had some degree of vision impairment based on best-corrected visual acuities in their better eye; two (0.4 per cent) being of a severe or profound nature. The prevalence of myopia (≥ -0.50 D) in the better eye was 23.0 per cent (n = 114); 25 (5.0 per cent) being moderate (≥ -3.00 D) to high (≥ -6.00 D). The prevalence of hypermetropia (≥ +2.00 D) in the better eye was 3.2 per cent (n = 16); 12 (2.4 per cent) being moderate (≥ +2.25 D) to high (≥ +5.25 D). The most common ocular conditions diagnosed at initial presentation were refractive error (n = 104, 20.1 per cent) and dry eyes (n = 57, 11.0 per cent). CONCLUSION: Mild vision impairment and refractive error are significant issues for refugees attending the Australian College of Optometry, emphasising the need for optometry, particularly refractive, services in this population.

Status of visual impairment among indigenous (Orang Asli) school children in Malaysia.

BACKGROUND: School children are considered a high-risk group for visual impairment because uncorrected refractive errors and problems such as amblyopia can seriously affect their learning abilities and their physical and mental development. There are many studies reporting the prevalence of refractive errors among school children of different ethnic groups in Malaysia, however, studies concerning the prevalence of refractive errors among indigenous or Orang Asli children are very limited. Therefore, the objective of this study was to determine the prevalence and causes of visual impairment among Orang Asli children. METHODS: One hundred ten Orang Asli children aged 7 to 12 years old in Negeri Sembilan, Malaysia were selected. 51% of these children were boys while the remainders were girls. They underwent visual acuity test, cover test, Hirschberg's test, ocular external assessment and ophthalmoscopy. Children who failed the vision screening were then referred for further eye examination. RESULTS: Of these 110 Orang Asli children, 46 failed the vision screening and subsequently 45 of them were confirmed to have visual problems (40.9% of the total subjects). The main cause of visual impairment in this study was refractive error (34.5% of the total subjects) where the main refractive error found was hyperopia (28.2%) followed by amblyopia (2.7%), strabismus (1.8%) and ocular abnormalities (1.8%). CONCLUSION: Hence, vision screening and a comprehensive eye examination is very important and needs to be done on all Orang Asli children so that any visual problems can be detect at an early stage to avoid the development of learning difficulties among these already disadvantaged children.

Spectacles need and ownership among multiethnic students in rural China.

OBJECTIVES: The aim of this study is to describe the prevalence and associated factors of spectacles need and ownership among multiethnic school students in rural China. STUDY DESIGN: School-based cross-sectional study. METHODS: This school-based eye study was conducted in Yunnan province located in Southwestern China. Questionnaires were filled out by children with the help of their parents concerning demographic characteristics, spectacles usage, and myopia-related lifestyle exposures. Spectacles need was defined as participants who had an uncorrected visual acuity (VA) of less than 6/12 but could be corrected to more than 6/12 in the better-seeing eye, with myopia of less than -0.5 diopters (D), hyperopia of more than +2.0 D, or astigmatism of more than 0.75 D in both eyes. Definition of spectacles ownership was based on spectacles wearing at school on the examination day. RESULTS: Among the 7681 students aged 5-16 years participating in this study, 7166 (93.3% of the study participants) successfully completed VA tests and questionnaires. The rate of spectacles need among children with an uncorrected VA of 6/12 or worse in either eye was 68.3% (623/912). Among the students who needed spectacles, only 18.9% owned them. Multivariate analyses revealed that spectacles ownership was significantly associated with increasing age (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.08-1.55), more time on reading and writing (OR = 1.66; 95% CI: 1.15-2.40), having myopic friend(s) (OR: 1.90; 95% CI: 1.01-3.56), self-awareness of myopia (OR: 6.67; 95% CI: 2.48-17.92), and poorer uncorrected VA (OR: 4.57; 95% CI: 2.78-7.52). CONCLUSIONS: We observed a lower rate of spectacles ownership among rural children compared with those of similar ages in urban China. These findings may have important public health implications for China and other countries regarding vision-related health resources allocation.

Reduced vision, refractive errors and health-related quality of life among adolescents in rural China.

BACKGROUND: To determine the associations of reduced presenting visual acuity (VA), refractive errors and health-related quality of life (HRQoL) in healthy adolescents in rural China. METHODS: A total of 2,235 grade 7 students without systemic medical problems from 10 middle schools aged 13-14 years in Mojiang, a small county located in southwestern China, were included in the analysis. Reduced VA was defined as presenting VA of worse than 6/12 in the presence of an ophthalmic aetiology which could be identified. The refractive status of each participant was measured after cycloplegia using an autorefractor. The Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales was used for measuring HRQoL of the participants. RESULTS: Among all the participants included in the data analysis, 279 (12.5 per cent) individuals were affected by reduced VA based on the better-seeing eye data. After adjusting for the effect of gender, body mass index, the education level of the father, and the use of a corrective device, the total (adjusted mean difference: -3.27; 95 per cent confidence interval [CI] -4.95 to -1.59; p = 0.01), social functioning (adjusted mean difference: -3.44; 95 per cent CI -5.87 to -1.01; p = 0.02) and school functioning scores (adjusted mean difference: -3.12; 95 per cent CI -5.89 to -0.35; p = 0.04) of the adolescents with reduced presenting VA were significantly lower compared with those with normal vision. The associations between corrected refractive errors and HRQoL were not significant. CONCLUSIONS: Healthy adolescents with reduced VA reported lower HRQoL scores including total, social functioning and school functioning scores, compared with those with normal vision.

Prevalence and causes of blindness, visual impairment among different ethnical minority groups in Xinjiang Uygur autonomous region, China.

BACKGROUND: The aim of this cross-sectional study is to ascertain the prevalence and causes of blindness, visual impairment, uptake of cataract surgery among different ethnic groups in Xinjiang Uygur Autonomous Region, China. METHODS: Four thousand one hundred fifty people at 50 years and above from different minority ethnic groups were randomly selected for an eye examination. The four trained eye teams collected data using tumbling E visual chart, torch, portable slit lamp and direct ophthalmoscope in 2015. The World Health Organization's definition of blindness and visual impairment (VI) was used to classify patients in each ethnic group. Data were analyzed by different minority groups and were compared with Han Chinese. RESULTS: 3977 (95.8%) out of 4150 people were examined. The prevalence of blindness from the study population was 1.7% (95% confidence interval: 1.3-2.2%).There was no significant difference in prevalence of blindness between Han Chinese and people of Khazak and other minority ethnic groups, nor, between male and female. Cataract was the leading course (65.5%) of blindness and uncorrected refractive error was the most common cause of VI (36.3%) followed by myopic retinopathy. The most common barrier to cataract surgery was lack of awareness of service availability. CONCLUSIONS: This study documented a low blindness prevalence among people aged 50 years and over comparing to prevalence identified through studies of other regions in China. It still indicates blindness and un-operated cataract as the significant public health issue, with no evidence of eye health inequalities, but some inequities in accessing to cataract surgery amongst ethnic minority groups in Xinjiang.

Refractive error in Chinese with type 2 diabetes and its association with glycaemic control.

BACKGROUND: The aim of this study was to determine the prevalence of refractive errors and their association with glycaemic control among adults with type 2 diabetes mellitus (T2DM) in eastern China. METHODS: A community-based survey, including 913 adults with T2DM aged 30 to 89 years, was conducted. Refractive error was assessed by autorefraction, after which subjective refraction was performed. Ocular biometric parameters were measured by non-contact partial coherence laser interferometry. Myopia was defined as spherical equivalent (SE) less than -0.50 dioptres (D), high myopia as SE less than -5.00 D, hyperopia as SE greater than 0.50 D and astigmatism as cylinder less than -0.50 D. RESULTS: After excluding participants who had undergone cataract surgery, 839 were included in the data analyses and 96.1 per cent were found to have refractive errors. The overall prevalences of myopia, high myopia, hyperopia and astigmatism were 28.2 per cent (95 per cent confidence interval [CI] 25.2-31.3), 6.3 per cent (95 per cent CI 4.7-8.0), 46.4 per cent (95 per cent CI 43.0-49.7) and 81.0 per cent (95 per cent CI 78.4-83.7) with no gender differences observed (all p > 0.10). In multivariate analysis, myopia was associated with decreasing age (odds ratio [OR] = 0.86, p = 0.01; per year increase), higher blood levels of haemoglobin A1c (HbA1c ) (OR = 1.12, p = 0.05; per unit increase), higher education levels (OR = 5.10, p < 0.001; university or college versus illiterate or primary school) and the presence of nuclear cataract (OR = 2.36, p < 0.001). CONCLUSIONS: Refractive errors may be associated with glycaemic control among T2DM patients. Longitudinal analyses are warranted to examine the relationship between changes in HbA1c and the development of refractive errors.

Ocular Determinants of Refractive Error and Its Age- and Sex-Related Variations in the Chinese American Eye Study.

Importance: Uncorrected refractive error (RE) is a leading cause of visual impairment, and variations in ocular anatomy determine RE. The unique ocular determinants of RE in Chinese American individuals have not been studied previously. Objective: To report ocular determinants of RE in a Chinese American population 50 years and older in Monterey Park, California. Design, Setting, and Participants: The Chinese American Eye Study, a population-based, cross-sectional study, was conducted from February 1, 2010, through October 31, 2013, in Monterey Park, with this particular data analysis performed from January 1 through December 31, 2016. This study included data from 4582 participants who underwent an eye examination to obtain axial length (AL), central corneal thickness, vitreous chamber depth (VCD), anterior chamber depth (ACD), lens thickness (LT), corneal power (CP), noncycloplegic subjective refraction, and lens nuclear opalescence (NOP) grading. Data from the right phakic eye of each participant were used. Multiple regression models (standardized regression coefficients [SRCs] and semipartial correlation coefficients squared [SPCCs2]) identified key determinants of RE. Main Outcomes and Measures: Ocular determinants of RE. Results: Among the 4071 participants eligible for analysis (1496 men [36.7%] and 2575 women [63.3%]; mean [SD] age, 60.5 [8.1] years), mean (SD) RE was -0.52 (2.95) diopters (D), with no sex-related difference. A hyperopic shift occurred in women from -0.62 (2.95) D at 50 to 59 years to 0.60 (1.62) D at 80 years or older and in men from -0.69 (3.00) D at 50 to 59 years to 0.40 (2.29) D at 80 years or older (P < .001 for both). Compared with men, women had shorter AL (mean [SD], 23.62 [1.34] vs 24.14 [1.27] mm; P = .006), shorter ACD (mean [SD], 3.33 [0.34] vs 3.44 [0.34] mm; P < .001), and steeper CP (mean [SD], 43.50 [1.52] vs 42.88 [1.45] D; P = .02), after adjusting for age and height. No sex differences were found in VCD, LT, and NOP after height adjustment. Compared with younger individuals, older individuals had shallower ACD, thicker LT, and more NOP compared with younger individuals (P < .001 for both), even after adjustment for height. Axial length was the strongest determinant of RE (SRC = -0.92; SPCC2 = 0.55), followed by CP (SRC = -0.43; SPCC2 = 0.15). When individual components of AL were evaluated, VCD had the greatest contributing effect (SRC = -0.99; SPCC2 = 0.52), followed by CP (SRC = -0.47; SPCC2 = 0.15) and LT (SRC = -0.29; SPCC2 = 0.06). Conclusions and Relevance: These data suggest that Chinese American individuals have longer AL and greater contribution of AL to RE than do Latino and other Chinese populations. Future studies should explore risk factors for increased AL in Chinese Americans and potential interventions that may ultimately prevent myopia-related disease.

Differences in retinal shape between East Asian and Caucasian eyes.

PURPOSE: To investigate whether retinal shape is different between East Asians and Caucasians. METHODS: There were 36 East Asian and 40 Caucasian young adults, with refractions between +0.75D and -5.50D. Peripheral eye lengths were obtained after pupil dilation using the Lenstar partial coherence interferometer. Measurements were obtained along the horizontal and vertical meridians of the visual field out to ±35° and ±30°, respectively, in 5° steps. Retinal co-ordinates were estimated using a validated method from the peripheral eye length measurements and ray-tracing through a modified Le Grand full theoretical eye. Rays were directed normally towards the anterior cornea. Retinal shapes were described in terms of vertex radius of curvature (Rv ), asphericity (Q) and equivalent radius of curvature (REq ) along both horizontal and vertical meridians. RESULTS: Rv was smaller in East Asian than in Caucasians (mean difference ± 95% CI -0.7 ± 0.5 mm), along the horizontal meridian than the vertical meridian (-1.2 ± 0.6 mm), and in myopia than in emmetropia (-1.0 ± 0.6 mm). Rv along the horizontal meridian, but not along the vertical meridian, became smaller as myopia increased. Q did not vary significantly with meridian, refraction group or race. The same pattern of results occurred for REq as for Rv . The percentage differences of heights under the estimated retinal surfaces showed steeper retinas in East Asians than in Caucasians; the differences between East Asian and Caucasian emmetropes were 2.5% and <1% along horizontal and vertical meridians, respectively, and corresponding differences for myopes were 4.6% and 1.8%. CONCLUSION: East Asians had steeper retinas than Caucasians. The horizontal meridian had steeper retinas than the vertical meridian. Myopes had steeper retinas than emmetropes. Racial differences in retinal shape in both emmetropes and myopes, combined with the high prevalence of myopia in East Asia, suggest that retinal shape may play a role in myopia development.

The UCLA preschool vision program, 2012-2013.

PURPOSE: To introduce the University of California Los Angeles (UCLA) Preschool Vision Program (UPVP) and describe the utilization pattern and challenges of the first year of implementation. METHODS: The UPVP aims to improve vision in 3- to 5-year-old preschoolers of Los Angeles County. On the first visit, trained personnel use a handheld autorefractometer (Retinomax 3; Righton, Japan) for initial screening and identify those who would benefit from a complete eye examination. On the second visit, the UCLA Mobile Eye Clinic staff and ophthalmologists provide follow-up examinations. Prescribed eyeglasses are fit and provided by program personnel on the school site on a separate visit. Follow-up calls are made to ensure compliance. RESULTS: From a population of 12,088 children in 215 preschools, 11,260 preschoolers (mean age, 4.3 years; 49.2% females) were screened successfully. In this sample, 86% were Latino, and almost all (97%) spoke either Spanish or English. About 65% of referred preschoolers underwent a complete eye examination. Prescription eye glasses were provided for 850 preschoolers (7.5%); 95 children (0.8%) were newly diagnosed with amblyopia. CONCLUSIONS: A large proportion of Los Angeles County preschoolers with refractive errors have unmet needs in terms of refractive correction. Further studies are recommended to understand barriers to eye care for children and to devise initiatives for Los Angeles's large, densely populated, and complex community to increase awareness and willingness.

East London's Homeless: a retrospective review of an eye clinic for homeless people.

BACKGROUND: There is very little published work on the visual needs of homeless people. This paper is the first study to investigate the visual needs of homeless people in the UK. Although similar work has been done in other countries, this study is unique because the United Kingdom is the only country with a National Health Service which provides free healthcare at the point of access. This study analysed the refractive status of the sample used, determined the demographics of homeless people seeking eye care and established if there is a need for community eye health with access to free spectacle correction in East London. METHODS: This retrospective case study analysed the clinical records of 1,141 homeless people using the Vision Care for Homeless People services at one of their clinics in East London. All eye examinations were carried out by qualified optometrists and, where appropriate, spectacles were dispensed to patients. Data captured included age, gender, ethnicity and refractive error. Results were analysed using two-sample t-tests with Excel and Minitab. RESULTS: Demographics of age, gender and ethnicity are described. Spherical equivalents (SE) were calculated from prescription data available for 841 clinic users. Emmetropia was defined as SE-0.50DS to +1DS, myopia as SE < -0.50DS, and hyperopia as SE > +1DS. The majority of clinic users were male (79.2 %, n = 923). Approximately 80 % (n = 583) of clinic users were white, 10 % (n = 72) were 'black', 4 % (n = 29) 'Asian' and the remaining 5.6 % (n = 40) were of 'mixed ethnicity' and 'other' groups. The mean age of females attending the clinic was significantly lower than that of males (45.9 years, SD = 13.8 vs' 48.4 years, SD = 11.8) when analysed using a two-sample t-test (t (317) = 2.44, p = 0.02). One third of service users were aged between 50-59 years. Myopia and hyperopia prevalence rates were 37.0 % and 21.0 % respectively. A total of 34.8 % of homeless people were found to have uncorrected refractive error, and required spectacle correction. CONCLUSIONS: This study has identified a high proportion of uncorrected refractive error in this sample and therefore a need for regular eye examinations and provision of refractive correction for homeless people.

A Visual Profile of Queensland Indigenous Children.

PURPOSE: Little is known about the prevalence of refractive error, binocular vision, and other visual conditions in Australian Indigenous children. This is important given the association of these visual conditions with reduced reading performance in the wider population, which may also contribute to the suboptimal reading performance reported in this population. The aim of this study was to develop a visual profile of Queensland Indigenous children. METHODS: Vision testing was performed on 595 primary schoolchildren in Queensland, Australia. Vision parameters measured included visual acuity, refractive error, color vision, nearpoint of convergence, horizontal heterophoria, fusional vergence range, accommodative facility, AC/A ratio, visual motor integration, and rapid automatized naming. Near heterophoria, nearpoint of convergence, and near fusional vergence range were used to classify convergence insufficiency (CI). RESULTS: Although refractive error (Indigenous, 10%; non-Indigenous, 16%; p = 0.04) and strabismus (Indigenous, 0%; non-Indigenous, 3%; p = 0.03) were significantly less common in Indigenous children, CI was twice as prevalent (Indigenous, 10%; non-Indigenous, 5%; p = 0.04). Reduced visual information processing skills were more common in Indigenous children (reduced visual motor integration [Indigenous, 28%; non-Indigenous, 16%; p < 0.01] and slower rapid automatized naming [Indigenous, 67%; non-Indigenous, 59%; p = 0.04]). The prevalence of visual impairment (reduced visual acuity) and color vision deficiency was similar between groups. CONCLUSIONS: Indigenous children have less refractive error and strabismus than their non-Indigenous peers. However, CI and reduced visual information processing skills were more common in this group. Given that vision screenings primarily target visual acuity assessment and strabismus detection, this is an important finding as many Indigenous children with CI and reduced visual information processing may be missed. Emphasis should be placed on identifying children with CI and reduced visual information processing given the potential effect of these conditions on school performance.

Seven-year incidence of uncorrected refractive error among an elderly Chinese population in Shihpai, Taiwan: The Shihpai Eye Study.

PURPOSE: To report the 7-year incidence of uncorrected refractive error in a metropolitan Chinese elderly population. METHODS: The Shihpai Eye Study 2006 included 460/824 (55.8%) subjects (age range 72-94 years old) of 1361 participants in the 1999 baseline survey for a follow-up eye examination. Visual acuity was assessed using a Snellen chart, uncorrected refractive error was defined as presenting visual acuity (naked eye if without spectacles and with distance spectacles if worn) in the better eye of <6/12 that improved to no impairment (≥6/12) after refractive correction. RESULTS: The 7-year incidence of uncorrected refractive error was 10.5% (95% confidence interval (CI): 7.6-13.4%). 92.7% of participants with uncorrection and 77.8% with undercorrection were able to improve at least two lines of visual acuity by refractive correction. In multivariate analysis controlling for covariates, uncorrected refractive error was significantly related to myopia (relative risk (RR): 3.15; 95% CI: 1.31-7.58) and living alone (RR: 2.94; 95% CI 1.14-7.53), whereas distance spectacles worn during examination was protective (RR: 0.35; 95% CI: 0.14-0.88). CONCLUSION: Our study indicated that the incidence of uncorrected refractive error was high (10.5%) in this elderly Chinese population. Living alone and myopia are predisposing factors, whereas wearing distance spectacles at examination is protective.

The Association of Refractive Error with Glaucoma in a Multiethnic Population.

PURPOSE: To evaluate the association between refractive error and the prevalence of glaucoma by race or ethnicity. DESIGN: Cross-sectional study. PARTICIPANTS: Kaiser Permanente Northern California Health Plan members with refractive error measured at 35 years of age or older between 2008 and 2014 and with no history of cataract surgery, refractive surgery, or a corneal disorder. METHODS: We identified 34 040 members with glaucoma or ocular hypertension (OHTN; cases) and 403 398 members without glaucoma (controls). Glaucoma cases were classified as primary angle-closure glaucoma (PACG); 1 of the 4 forms of open-angle glaucoma: primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pigmentary glaucoma (PIGM), and pseudoexfoliation glaucoma (PEX); or OHTN. Refractive error, expressed as spherical equivalent (SE), was coded as a continuous trait and also as categories. Logistic regression analyses were used to estimate the association between refractive error and the prevalence of glaucoma overall and in specific racial or ethnic groups. MAIN OUTCOME MEASURES: The association between refractive error and glaucoma subtypes evaluated as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: In controls, the mean SE was -0.59 diopters (D) (standard deviation, 2.62 D). Each 1-D reduction in SE was associated with a 22% decrease in the odds of PACG (OR, 0.78; 95% CI, 0.77-0.80) and with increases in the odds of open-angle glaucoma ranging from 1.23 (95% CI, 1.20-1.26) for PIGM, to 1.07 (95% CI, 1.03-1.11) for PEX, and to 1.05 (95% CI, 1.04-1.06) for OHTN. In addition, we observed a stronger association between myopia and POAG among non-Hispanic whites (OR, 1.12; 95% CI, 1.11-1.13) and NTG among Asians (OR, 1.17; 95% CI, 1.15-1.20) and non-Hispanic whites (OR, 1.19; 95% CI, 1.15-1.22). CONCLUSIONS: Myopia was associated with an increased prevalence of all forms of open-angle glaucoma and OHTN, whereas hyperopia was associated with a substantially increased prevalence of PACG. Although high myopia is a strong risk factor for glaucoma subtypes, low and moderate myopia also have a significant effect on glaucoma risk. Additionally, there were moderate racial differences in the association of myopia with the risk of POAG and NTG.