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ORIGINAL ARTICLE
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Prevalence of uncorrected refractive errors among adults attending at a tertiary care hospital – A retrospective study


 Department of Ophthalmology, Adesh Medical College and Hospital, Shahbad, Haryana, India

Date of Submission22-Feb-2021
Date of Decision20-Aug-2021
Date of Acceptance20-Aug-2021

Correspondence Address:
Sujit Das,
Department of Ophthalmology, Adesh Medical College and Hospital, Near Ambala Cantt, Vill-Mohri, Shahbad - 136 135, Haryana
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_145_21

  Abstract 


Background: This hospital-based study was done to estimate the prevalence of uncorrected refractive errors in adults attending to our outpatient department (OPD). Aims and Objectives: 1. To estimate the prevalence of uncorrected refractive errors in adults attending to our OPD. 2. Effects of uncorrected refractive errors on education, social life, job, psychological impact. Materials and Methods: In this hospital-based retrospective study, 570 refractive error patients above 18 years of age were included. All known cases of refractive error, not using glasses, were also included in this study. As per the WHO criteria, visual acuity <6/18 of Snellen visual acuity chart was taken as visually impaired while legal blindness was defined as visual acuity of 6/60 or less. Those who had ocular or any kind of systemic illness were excluded from this study. Manual retinoscopy followed by subjective verification, detailed slit lamp examination, and dilated fundus evaluation was done in all cases at the time of presentation. Postmydriatic refraction was mandatory in all who were below 21 years of age. All statistical analysis later on conducted in SPSS version 27 retrospectively. Results: Out of 570 patients with refractive error analyzed, 55.81% (N = 317) were found males and 44.19% (N = 251) were females. Refractive error was 50.18% (N = 285) among Hindu population whereas in the Muslim population, it was found 49.82% (N = 283). Refractive error was mostly encountered in students (46.65%, N = 265) followed by housewives (31.87%, N = 181). The most common cause of hospital visit was headache (71.48%, N = 406). The most common refractive error was compound myopic astigmatism (43.56%, N = 248). The prevalence of refractive error was 3.8% with a legal blindness of 39.40% (N = 99) in male and 37.10% (N = 118) in female. A total of 435 (76.58%) patients were freshly diagnosed in our study. A total of 20.25% (N = 115) patients refused to wear glasses because of social factors. A total of 2.10% (N = 12) patients were rejected for various jobs, whereas among 10.56% (N = 60) of cases, refractive error had the social and psychological effect in their life. Poor performance in education was found among 11.27% (N = 64) of cases. Conclusions: Adult screening for uncorrected refractive errors should be incorporated into the health-care system, especially for housewives, and always wearing a glass in cases of refractive error should be encouraged and campaigned.

Keywords: Astigmatism, hyperopia, myopia, refractive error



How to cite this URL:
Das S, Shergill S S. Prevalence of uncorrected refractive errors among adults attending at a tertiary care hospital – A retrospective study. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 6]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=346444




  Introduction Top


Uncorrected refractive errors are a leading cause of avoidable visual disability globally, and no age, gender, or ethnic group is exempt from its visually disabling effects.[1],[2] The global initiative for the elimination of avoidable blindness sets a major challenge to work relentlessly to avoid the preventable blindness. This initiative will also require both government and private sector's commitment to allocate more budgets to increase significantly the provision and uptake of eye care services. Refractive errors have been listed, along with cataract, trachoma, onchocerciasis, and childhood blindness, among eye problems whose prevention and cure should provide enormous savings and facilitate societal developments.[1],[2] The number of visually impaired persons in the world is about 259 millions. This estimate includes 98 million persons with visual impairment due to uncorrected refractive error.[3] Lack of refractive correction bears important consequences for the individual and the community in terms of lost education and employment opportunities, compromised quality of life, and decreased socioeconomic productivity. Therefore, refractive errors have been identified as a priority area of the global initiative for the prevention of avoidable blindness under the “Vision 2020 right to sight” program.[4] Refractive errors (emmetropias) are not eye diseases; they are disorders in which the dioptric power of the eye has changed so that the parallel rays of light from infinity, with the accommodation at rest, are focused either in front or behind the retina with the result either the vision is impaired or the asthenopic symptoms develop in the patient. The global survey on the prevalence of blindness and its causes reported refractive errors as a major cause of visual loss throughout the world. Results of various surveys showed that in eyes with visual acuity of <6/18 refractive errors caused as much visual loss as cataract.[5] Uncorrected refractive errors are an important cause of visual impairment in many countries. In a study conducted in New Delhi, refractive error was the cause in 81.7% of eyes with vision impairment.[6] Refractive errors have been shown to affect approximately one-third of those aged 40 years and above in the US and Western Europe and one-fifth of the Australians in the same age group.[7] This study was conducted to estimate the prevalence of refractive errors in the adult population, which is also a hidden burden on society.


  Materials and Methods Top


The study was conducted at our hospital from May 2020 to December 2020. It was a single-centered hospital-based survey. People aged 18 years and above who attended at our outpatient department (OPD) for any ocular complaints were included in the study. A total of 15,000 patients attended to our OPD during that period. All those whose presenting visual acuity was found to be <6/6 on the Snellen visual acuity chart were included in this study. All those who were earlier diagnosed as a case of refractive error were also included in this study. Those who had known corneal pathology, uveitis, glaucoma, pterygium, pupillary abnormality, cataract, dry eyes, eyelid pathology, convergence weakness, amblyopic, posterior segment pathology, or any known systemic illness were excluded. The WHO criteria of visual acuity <6/18 were taken as visually impaired while <3/60 was taken as blindness. Legal blindness was defined as visual acuity of 6/60 or less.[8] Visual acuity was done through the Snellen chart for distance vision. Objective refraction (manual retinoscopy) followed by subjective verification was done in all cases. Detailed slit lamp examination and dilated fundus evaluation were done in all cases. Postmydriatic refraction was performed in all who were below 21 years of age. Refractive errors requiring a correction of more than 0.25 D (plus/minus/cylindrical lenses) were classified as refractive errors and were further categorized as myopia, hypermetropia, and astigmatism. Myopia was classified as low to moderate (<–5.00D), high myopia (>−5.00 to − 10.00), and extreme high myopia (>-10.00D).[9] Astigmatism was measured in minus cylinders. If the required minus cylinder was at 180°/0°±15°, then the astigmatism was termed as with-the-rule (WTR); if the axis of the minus cylinder was 90°±15°, then it was termed as against-the-rule (ATR) astigmatism; and if the axis was 20°–70° and 110°–160°, i.e. between that of WTR and ATR, then it was classified as oblique astigmatism.[10] All the data later on entered into SPSS version 27 (Statistical Package for the Social Sciences IBM(International business Machine), Chicago, United state) and analyzed. Chi-square test was used to observe the association of the refractive error with respect to age, sex, education of father, occupation, and ethnicity. P < 0.05 was considered significant.


  Results Top


Out of 570 eye patients with refractive error included, 55.81% (N = 317) were found males and 44.19% (N = 251) were females. Refractive error was found more prevalent among Hindu population 50.18% (N = 285) whereas in the Muslim population, it was 49.82% (N = 283). Refractive error was mostly encountered among students (46.65%, N = 265) followed by housewives (31.87%, N = 181). The most common cause of hospital visit was headache (71.48%, N = 406) [Table 1]. P value and mean deviation of visual acuity at presentation and after correction have been shown in [Table 2]. The prevalence of refractive error was 3.8%. Mean age of the patients was 26.545 in male and in the female, it was 28.562. The prevalence of visually disabling/impairment (LogMAR 0.6 [6/24]) was 18.30% (N = 46) in males and 21.10% (N = 67) in females. The prevalence of visually disabling/impairment (LogMAR 0.8 [6/36]) was 21.10% (N = 53) in males and 23.30% (N = 74) in females. The prevalence of visually disabling/impairment (LogMAR 1 [6/60]) was 39.49% (N = 99) in males and 37.10% (N = 118) in females. The most common refractive error was found compound myopic astigmatism (43.56%, N = 248) followed by simple myopia (27.64%, N = 157) [Table 3]. A total of 435 (76.58%) patients were freshly diagnosed, whereas 135 (23.77%) patients had known refractive error. A total of 433 (76.23%) patients were not using glasses without any cause (casual), whereas 0.7% (N = 04) did not wear because of professional factor. A total of 115 (20.25%) patients did not wear glasses because of social factor [Table 4]. A total of 2.10% (N = 12) patients were rejected for various jobs because of their refractive error, whereas in 10.56% (N = 60) of cases, refractive error had the social and psychological effect in their life. Poor performance in education was found among 11.27% (N = 64) of cases [Table 5].
Table 1: Demographic distribution and presenting complaints

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Table 2: Visual acuity

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Table 3: Type of refractive error

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Table 4: Factors associated with refractive error

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Table 5: Affects of refractive error on life

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  Discussion Top


Refractive error is the most common ocular disorder. This hospital-based cross-sectional study focused on the prevalence and distribution of uncorrected refractive errors in the adult attending to our OPD. In the present study, the prevalence of refractive error was 3.8% with a legal blindness of 39.40% (N = 99) in male and 37.10% (N = 118) in female. Criteria for legal blindness was 6/60 or less as recommended by Kalikivayi et al.[11] Study results are in agreement with the result of Kalikivayi et al.[11] and Nepal et al.[12] There are marked differences in the prevalence of certain refractive errors among various racial and ethnic groups. These differences probably reflect the unique genetic make-up of these various groups. whereas population-based studies from the United States[13],[14] and Australia[10],[15] have reported a prevalence of myopia ranging from 15% to 76% in adults. The prevalence has reported to be significantly higher in Singapore 35%.[16] Asian countries in particular have also been experiencing a dramatic increase in the prevalence of myopia. Here, in this study, simple myopia was found in 27.64% (N = 157) of cases. In most of the epidemiological studies, auto refractometer was used,[17] but this study employed the manual refraction with subjective verification.[10] There was a remarkable increase in the prevalence of refractive errors with the increasing age which correlates with other studies as well.[17],[18],[19] For the analysis of refractive errors, data pertaining to the right eye were used because no significant difference was noted between the two eyes and it has been reported as a valid strategy employed by other investigators.[20],[21],[22] In our study, most common refractive error was found compound myopic astigmatism (43.56%, N = 128), followed by simple myopia (27.64%, N = 157) and simple myopic astigmatism (16.14%, N = 92). This is similar to studies from Sumatra,[23] Singapore,[16] India,[20] and Bangladesh[18] in which myopia was the most common refractive error. The Eye Disease Prevalence Research group[7] also found myopia to be greater than hypermetropia in the US, Western Europe, and Australian population. In this study, refractive error was found to be more in female than men (55.9% in female and 44.1% in males; P = 0.034) and it does not correlate with the findings reported by Bourne et al.[18] and Hyams et al.[24] In the Indian study,[20] no significant correlation between gender and prevalence of myopia was noted while a Finish study done in rural population showed a higher prevalence of myopia in females. In our study, myopia up to -6D was found in 99.29% (N = 566) of cases, whereas in 04 cases (0.70%), myopia was found pathological. In a study from the US, the prevalence of high myopia was 3.2% and that of extreme high myopia 0.2%. In the Melbourne Visual Impairment Project, the prevalence of high myopia was 2% and extreme myopia 0.3%.[24] The prevalence of high myopia in the studies from Bangladesh (1.8%), Singapore (Indian population 2.1%), and India (4.5%) was higher than the prevalence in this study while it is comparable to a study from Saw et al. from Sumatra (0.6%).[23] The prevalence of hypermetropia was 10.14% in our study population. The lower prevalence of hypermetropia in 30–40-year age group and peaking in the 51–60-year group is similar to the pattern observed in the studies from Bangladesh[18] India,[20] Singapore,[16] and Indonesia.[23]


  Conclusions Top


Uncorrected refractive errors still account for a large proportion of subnormal vision, blindness, and visual impairment in our community. Keeping in view, the avoidable nature of visual impairment caused by refractive errors, effective measures for screening, and correction of refractive errors should be taken on a priority basis for adults, especially for housewives. Patients own health awareness play a key role in managing this family burden, social burden, and national and the global burdens.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Murthy GV, Gupta SK, Ellwein LB, Muñoz SR, Pokharel GP, Sanga L, et al. Refractive error in children in an urban population in New Delhi. Invest Ophthalmol Vis Sci 2002;43:623-31.  Back to cited text no. 6
    
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Wong TY, Foster PJ, Hee J, Ng TP, Tielsch JM, Chew SJ, et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Invest Ophthalmol Vis Sci 2000;41:2486-94.  Back to cited text no. 16
    
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Shah SP, Jadoon MZ, Dineen B, Bourne RR, Johnson GJ, Gilbert CE, et al. Refractive errors in the adult pakistani population: The national blindness and visual impairment survey. Ophthalmic Epidemiol 2008;15:183-90.  Back to cited text no. 17
    
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Bourne RR, Dineen BP, Ali SM, Noorul Huq DM, Johnson GJ. Prevalence of refractive error in Bangladeshi adults: Results of the National Blindness and Low Vision Survey of Bangladesh. Ophthalmology 2004;111:1150-60.  Back to cited text no. 18
    
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Raju P, Ramesh SV, Arvind H, George R, Baskaran M, Paul PG, et al. Prevalence of refractive errors in a rural South Indian population. Invest Ophthalmol Vis Sci 2004;45:4268-72.  Back to cited text no. 19
    
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Dandona R, Dandona L, Naduvilath TJ, Srinivas M, McCarty CA, Rao GN. Refractive errors in an urban population in Southern India: The Andhra Pradesh Eye Disease Study. Invest Ophthalmol Vis Sci 1999;40:2810-8.  Back to cited text no. 20
    
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Wu HM, Seet B, Yap EP, Saw SM, Lim TH, Chia KS. Does education explain ethnic differences in myopia prevalence? A population – Based assessment of young adult males in Singapore. Optom Vis Sci 2001;78:234-9.  Back to cited text no. 21
    
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Saw SM, Gazzard G, Koh D, Farook M, Widjaja D, Lee J, et al. Prevalence rates of refractive errors in Sumatra, Indonesia. Invest Ophthalmol Vis Sci 2002;43:3174-80.  Back to cited text no. 23
    
24.
Hyams SW, Pokotilo E, Shkurko G. Prevalence of refractive errors in adults over 40: A survey of 8102 eyes. Br J Ophthalmol 1977;61:428-32.  Back to cited text no. 24
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

 
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