|Year : 2018 | Volume
| Issue : 3 | Page : 119-121
To observe the proportion of amblyopia among children presenting in a rural hospital in Central India
Sachin Daigavane, Madhumita Prasad
Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
|Date of Web Publication||17-Jan-2019|
Dr. Sachin Daigavane
Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha - 442 004, Maharashtra
Source of Support: None, Conflict of Interest: None
Objectives: • To screen the children attending the ophthalmology OPD • To know the profile and cause of amblyopia. Materials and Methods: A Cross-sectional study was conducted between August 2017 to February 2018. Children aged 5-20 years were recruited in the study. Children <5 years due to resistance to examination and poor communication were excluded. Visual Acuity and pen light ophthalmic examination were performed for 300 children. Mean age range was 8-12 years. 250 children were from rural areas and 50 from urban areas. Children were subjected to full ophthalmic examination including slit lamp and fundus examination in addition to cycloplegic refraction. Children having vision <6/12 without organic lesion were included in the study. Results: 13 children had amblyopia. The main cause was anisometropia 7 (53%), followed by strabismus 3 (23%), isometropia 2 (15%), and finally deprivation 1 (8%) 7 unilateral and 6 bilateral cases were observed. Conclusion: There is lack of awareness of parents because of illiteracy and ignorance. It is mandatory to improve the facility for checkup and frequent eye screening for refractive errors and strabismus examination and corneal blind and cataract for school children. This Study emphasizes need for time to time eye screening for school children. Amblyopia can have devastating psychosocial and economical fall outs.
Keywords: Amblyopia, refractive errors, visual acuity
|How to cite this article:|
Daigavane S, Prasad M. To observe the proportion of amblyopia among children presenting in a rural hospital in Central India. J Datta Meghe Inst Med Sci Univ 2018;13:119-21
|How to cite this URL:|
Daigavane S, Prasad M. To observe the proportion of amblyopia among children presenting in a rural hospital in Central India. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2020 May 25];13:119-21. Available from: http://www.journaldmims.com/text.asp?2018/13/3/119/250105
| Introduction|| |
Amblyopia is one of the causes of visual impairment in children. It is generally reported to have a prevalence of 2% worldwide. In population-based studies, the prevalence of amblyopia was between 0.14% and 4.7%, and most of these studies in schoolchildren showed that 2% of students had amblyopia.
“Amblyopia” is a reduction in the quality of central, corrected vision resulting from the disturbance in retinal image formation during the first decade of human life.
No cause can be detected by physical examination of the eye; amblyopia is defined by one or more lines difference in visual acuity (VA) between the eyes.
It is one of the major causes of visual disability in children and is usually seen in early childhood.
Amblyopia causes impairment of VA, depth perception, and contrast sensitivity, and this leads to loss of binocular single vision.
Five major causes of amblyopia include:
- Isometropic amblyopia – When the refractive error in the two eyes exceeded or equaled to 5.0 D
- Anisometropic amblyopia – When there is a difference of refractive error in both the eyes of ≥1 D of astigmatism, ≥2 D of hypermetropia, and ≥4 D of myopia
- Strabismic amblyopia – This was defined as amblyopia present in an eye that had constant manifest strabismus
- Meridional amblyopia – When amblyopia was as a result of astigmatism of ≥2.00 D in one or both the eyes
- Mixed amblyopia: It is said to occur when more than one cause of amblyopia is present in a single eye.
The objectives of this study were as follows:
- To screen the children attending the ophthalmology outpatient department (OPD)
- To know the profile and cause of amblyopia.
| Materials and Methods|| |
This cross-sectional study was conducted over a period of 6 months from August 2017 to February 2018. Children aged 5–20 years were recruited. Informed consent was obtained from all participants after the nature, and possible consequences of the study were explained to them.
- Inclusion criteria – All children attending the ophthalmology OPD of age between 5 and 20 years
- Exclusion criteria – Children <5 years because of resistance to examination and poor communication.
The patients were initially evaluated for detailed history and assessing VA using a Snellen chart. Children who were unable to identify the letters on the Snellen chart were tested on Landolt C chart. Pinhole testing was performed for children whose distant VA was 6/9 and below.
An improvement in VA was taken to indicate a probable refractive error while nonimprovement suggests an organic cause or amblyopia.
Any child with a VA of 6l9 or less or with a difference of more than two lines on Snellen chart was further investigated by cycloplegic refraction. For cycloplegic refraction, tropicamide 1% and cyclopentolate 1% were instilled 5 min apart every 10 min for 30 min.
Both autorefractometer and retinoscopy were done to evaluate the refractive status. Furthermore, the patient's anterior segment and fundus will be examined to rule out any other cause of decreased vision. Furthermore, the patient's extraocular movements were checked and a comprehensive pupillary examination was done, and ocular alignment tests such as Hirschberg and cover and uncover were performed with fixation targets at 0.5 m and 4 m.
Amblyopia was diagnosed based on any one of the following criteria with the eye(s) appearing normal on dilated funduscopy.
- Best-corrected VA in that eye was at least two lines worse than the better eye
- Best-corrected VA could not be improved to 6/9 in either eye or both the eyes
- History of patching was present in one eye or both the eyes.
| Results|| |
A total of 300 children were enrolled in this study [Table 4].
Two hundred and fifty (83.3%) children were from rural areas and 50 (16.6%) from urban areas.
The children ranged in age from 8 to 12 years, mean age: 7.962 ± 0.8155 standard deviation.
One hundred and seventy-five (58.5%) were male and 125 (41.6%) were female as shown in [Table 2].
Out of 300 children who were screened, 13 had amblyopia [Table 1].
According to [Table 3], children were more unilateral 7 (78.7%) than bilateral 6 (21.3%).
The main cause of amblyopia was anisometropia 7 (53.8%), followed by strabismus 3 (23%), isometropia 2 (15.2%), and finally, deprivation 1 (8%) as shown in [Table 5].
| Discussion|| |
Amblyopia is mainly caused by uncorrected refractive errors during the first decade of life. After this sensitive period, refractive correction does not improve with correction and the eye becomes Amblyopic. It is necessary to correct the refractive error to prevent amblyopia.
The results revealed that out of 300 children, only 13 cases were amblyopic. Out of these, 8 (61.6%) were boys and 5 (38.4%) were girls. Anisometropic type of amblyopia is the common type amblyopia being 53.8%, strabismic 23%, isometric 15.2%, and stimulus deprivation 8%, and unilateral amblyopia was 7 (78.7%) and bilateral amblyopia was 6 (21.3%).
Timely diagnosis and treatment is likely to reduce the prevalence of amblyopia as it has been seen in many other countries that have taken up mass education and visual screening at community levels.
| Conclusion|| |
There is a lack of awareness of parents because of illiteracy and ignorance. It is mandatory to improve the facility for checkup and frequent eye screening for refractive errors and strabismus examination and corneal blind and cataract for schoolchildren. This study emphasizes need for time to time eye screening for schoolchildren. Amblyopia can have devastating psychosocial and economical fallouts.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Solebo AL, Cumberland PM, Rahi JS. Whole-population vision screening in children aged 4-5 years to detect amblyopia. Lancet 2015;385:2308-19.
Webber AL, Wood J. Amblyopia: Prevalence, natural history, functional effects and treatment. Clin Exp Optom 2005;88:365-75.
Friendly DS. Amblyopia: Definition, classification, diagnosis, and management considerations for pediatricians, family physicians, and general practitioners. Pediatr Clin North Am 1987;34:1389-401.
Aldebasi YH. Prevalence of amblyopia in primary school children in Qassim Province, kingdom of Saudi Arabia. Middle East Afr J Ophthalmol 2015;22:86-91.
] [Full text]
DeSantis D. Amblyopia. Pediatr Clin North Am 2014;61:505-18.
Robaei D, Rose KA, Ojaimi E, Kifley A, Martin FJ, Mitchell P, et al.
Causes and associations of amblyopia in a population-based sample of 6-year-old Australian children. Arch Ophthalmol 2006;124:878-84.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]