Refractive Errors in South east Asia

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Refractive Errors in South east Asia

• Srinivas Marmamula M.Sc(CEH,London)
• L V Prasad Eye Institute,India
• PhD student UNSW
• Vision CRC, Australia

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SEARO

• SEARO comprises of 10 countries from Asia
• 1. Bangladesh
• 2.     Bhutan
• 3.     India
• 4.     Indonesia
• 5.     Democratic People's Republic of Korea
• 6.     Maldives
• 7.     Myanmar
• 8.     Nepal
• 9.     Sri Lanka
• 10. Thailand

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Background

• There has been growing interest in myopia as a
  public health problem in Asia due to increased
  prevalence of myopia over the past decades.
• The general trend is that the prevalence rates of
  myopia are highest in urban areas of Asia such as
  Taiwan, Hong Kong and Singapore, and lowest in
  predominantly agricultural areas in non-Asian
  countries.

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Refractive Errors Magnitude

• Limited comparability of data due to
• Different definitions
• Different measurement methods
• Differences in reporting
• Use of convenience samples
• Different sex and age distribution

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Refractive error study in children

• Objective To assess prevalence of refractive
  errors and causes of VI in children of different
  ethnic origins and cultural settings
• Population-based cross-sectional study of
  refractive errors in children aged 5 to 15 years
• Main outcome Presenting, uncorrected and
  best-corrected visual acuity and refractive
  errors under cycloplegia

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RESC Study areas
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RESC Causes of VI
VI UCVA of lt 20/40
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RESC - Refractive errors
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India

• The Andhra Pradesh Eye Disease Study (APEDS) is a
  population-based epidemiologic study of over
  10,000 people in four areas representative of the
  Indian state of Andhra Pradesh.
• The study was done in 1 Urban, 3 Rural areas of
  the state

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Causes of Blindness - APEDS
Prevalence of total Cataract 0.81
44.3 Refractive error 0.30 16.4 Reti
nal disease 0.20 10.9 Glaucoma 0.15
8.2 Corneal disease 0.13 7.1 Optic
atrophy 0.11 6.0 Amblyopia 0.07
3.8 Microphthalmos 0.02 1.1 Other 0.04
2.2 1.84
100
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Blindness due to refractive errors APEDS
Prevalence of total Refractive
error 0.30 16.4 Myopia
0.21 11.5 Aphakia 0.06 3.3
Hyperopia 0.03 1.6
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APEDS MVI (lt6/18-6/60)

• Cause Prev. of
  total
• Refractive error 3.70 45.8
• Cataract 3.30 39.9
• Retinal disease 0.30 3.4
• Amblyopia 0.20 2.7
• Corneal disease 0.19 2.3
• Optic atrophy 0.15 1.8
• Glaucoma 0.08 1.0
• Others 0.17 3.1
• 8.09
  100

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Epidemiology of refractive errors
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Bangladesh

• A nationally representative sample of 12 782
  adults 30 years of age and older
• 6412 (57.3) were emmetropic
• 2469 (22.1) were myopic (lt-0.5 D)
• 2308 (20.6) were hypermetropic (gt0.5 D).
• 216 subjects (1.8) were high myopic (lt-5 D)

Bourne RR, Dineen BP, et al. Ophthalmology 2004
Jun111(6)1150-60
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Bangladesh

• Myopia was more common in men (26.3) than in
  women (21.0)
• Hyperopia was more common in women (27.4) than
  in men (15.8).
• Myopia increased with age (17.5 of those aged
  30-39 years were myopic, compared with 65.5 of
  those age 70 years and older).

Bourne RR, Dineen BP, et al. Ophthalmology 2004
Jun111(6)1150-60
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Nepal

• Refractive error was measured in 555 Tibetan
  children in Kathmandu and 270 Sherpa children in
  the Solu Khumbu region of Nepal
• Myopia - Sherpa children - 2.9
• - Tibetan children - 21.7
• The range of refractive errors was -6.50 to 7.00
  D for the Tibetan children and -1.00 to 3.50 D
  for the Sherpa children.

Garner LF et al. Optom Vis Sci. 1999
May76(5)282-5.
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Nepal

• Tibetan and Sherpa children living in Nepal share
  a common ancestry in Tibet and areas the north of
  Nepal
• The prevalence of myopia in Sherpa children is
  low and their rural lifestyle appears to be
  relatively unstressed.
• Tibetan children have a higher prevalence of
  myopia and more rigorous schooling.
• Garner LF et al. Optom Vis Sci. 1999
  May76(5)282-5.

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Nepal

• 1100 children from three schools
• 5 and 16 years of age
• B P Nepal, S Koirala et al. BJO 200387531-53

• Male
  Female Total
• Refractive error 41 (3.73) 48 (4.36)
  89 (8.09)
• Simple myopia 22 (2.0) 25 (2.27)
  47 (4.27)
• Myopic astig. 10 (0.91) 18 (1.63)
  28 (2.54)
• Hyperopia   9 (0.82)  5 (0.45)
  14 (1.27)

Myopia gt0.5 Ds Hyperopia gt 1.0 Ds, Astig. gt 0.50
dioptre after cyclo. refraction
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Taiwan review of 5 surveys
Lin LL, Shih YF, et al. Ann Acad Med Singapore.
2004, Jan 33(1) 27-33
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Ethnicity - Singapore Malaysia
Compare the prevalence of refractive errors in
Malay, Chinese and Indian children in Malaysia
and Singapore
Saw SM, Goh PP et al. Br J Ophthalmol. 2006
Oct90(10)1230-5
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Singapore

• A prospective cohort study, the Singapore Cohort
  Study of the Risk Factors for Myopia (SCORM), was
  conducted in two schools in Singapore
  (1999-2002).
• Children aged 7 to 9 years (n981) were followed
  up over a 3-year period
• Saw SM, Tong et al. IOVS 2005 Jan46(1)51-7

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Singapore

• The 3-year cumulative incidence rates were
• 47.7 - 7 year old children
• 38.4 - 8 year old children
• 32.4 - 9 year old children
• Saw SM, Tong et al. IOVS 2005 Jan46(1)51-7

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Singapore

• 157 second year medical students (aged 19-23
  years) in Singapore were examined.
• Myopia - 89.8 (SE gt -0.50 D).
• Hyperopia - 1.3 (SE gt 0.50 D)
• Astigmatism - 82.2 (Cylgt 0.50 D).
• Woo WW, Lim KA, etal. Singapore Med J. 2004 Oct
• 45(10)470-4.

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Singapore

• Grade 9 and 10 students (n 946) aged 15-19
  years
• Myopia (SEgt0.50 D -73.9
• Hyperopia (SE gt0.50 D) - 1.5
• Astigmatism (Cylinder gt-0.50 D) - 58.7
• Anisometropia (SE diff. gt1.00 D) - 11.2
• Quek TP, Chua CG,et al.Ophthalmic Physiol Opt.
  2004 Jan24(1)47-55.

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Singapore

• Adult Chinese population in Singapore, aged 40 to
  79 years
• Prevalence of myopia - 38.7
• Hyperopia - 28.4
• Astigmatism - 37.8
• Anisometropia - 15.9
• Prevalence of high myopia was 9.1

Wong TY, Foster PJ, et al. IOVS 2000
Aug41(9)2486-94
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Indonesia

• Prevalence survey of 1043 adults gt21 years of
  age was conducted in five rural villages and one
  provincial town of the Riau Province, Sumatra,
  Indonesia.
• Prevalence of myopia (SE gt-1.0 D) - 26.1
• Hyperopia (SE gt 1.0 D) - 18.5
• Astigmatism (gt -1.0 Dcyl) - 15.1

Saw SM, Gizzard G, et al. IOVS 2002
Oct43(10)3174-80
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Korea

• 519 children between 3 and 6 years of age from 12
  kindergartens in Seoul.
• Prevalence of myopia was 8.7 (SEgt-0.50 D)
• The odds ratio of myopia when one parent had
  myopia was 2.2 times higher than when neither
  parent had myopia.
• Kim SJ -Taehan Kanho Hakhoe Chi. 2005
  Apr35(2)390-8

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Summary
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Summary
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Summary
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CHALLENGES FOR FUTURE

• Current data from East Asian population indicate
  that both the rate and severity of myopia may be
  increasing over time.
• It is possible that ocular morbidity related to
  myopia may constitute an important clinical,
  public health, and economic problem over the next
  two to three decades.
•  The eye care has to gear-up for this emerging
  challenge

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World free of VI from uncorrected Refractive
errors by 2020
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Thank you
srioptom_at_lvpei.org