exudates and Refractive-Errors

There are 161 million people living with vision impairment, due to uncorrected refractive errors. A further 510 million people are living with near-vision impairment. There is a need for clearly defined indicators that capture the quality of refractive error service outputs and outcomes and provide insights to shape, change and stimulate action. This study aims to evaluate the quality of refractive error care (Q.REC) in Cambodia, Malaysia and Pakistan, by using unannounced standardised patients (USPs) to identify the proportion of prescribed and dispensed spectacles appropriate for people's refractive error needs and pinpoint/detail opportunities for quality improvement.. A cross-sectional Q.REC study will be conducted in randomly selected optical services in Cambodia (180 services, 900 USP visits), the Klang Valley in Malaysia (66 services, 198 USP visits) and in Jhang, Sahiwal and Khanewal districts of Punjab region/state in Pakistan (64 services, 256 USP visits). USPs will receive baseline refractions by three skilled study optometrists/refractionists trained in the Q.REC protocol. USPs will then visit individual optical services, undergo a refraction, purchase spectacles or lenses (if recommended) and record observations about which elements of a refraction and dispensing were conducted. The study optometrist/refractionist will assess each pair of dispensed spectacles by examining the USP's aided visual acuity and visual comfort at distance and/or near and compare the lens prescription to the averaged baseline refraction.. This study has been approved by the University of New South Wales Human Research Ethics Committee (HC210102), the National Ethics Committee for Health Research in Cambodia (043 NECHR), National Medical Research Registry and the Medical Research and Ethics Committee (NMRR-21-689-59279) in Malaysia and the College of Ophthalmology & Allied Vision Sciences Ethical Review Board (COAVS 545/2021) in Pakistan. Written informed consent will be obtained from USPs. Service owners will have the opportunity to opt-out verbally or in writing. Results will be disseminated locally through workshops including the relevant local ministry of health personnel and stakeholders, published in peer-reviewed publications and presented at national and international conferences.

Topics: Cambodia; Cross-Sectional Studies; Humans; Malaysia; Pakistan; Refractive Errors

Uncorrected refractive error, especially myopia, in young children can cause permanent visual impairment in later life. However, data on the normative development of refractive error in this age group is limited, especially in Malaysia. The aim of this study was to determine the distribution of refractive error in a sample of infants and young children between the ages of 6 to 36 months in a prospective, cross-sectional study. Cycloplegic retinoscopy was conducted on both eyes of 151 children of mean age 18.09 ± 7.95 months. Mean spherical equivalent refractive error for the right and left eyes was +0.85 ± 0.97D and +0.86 ± 0.98D, respectively. The highest prevalence of refractive error was astigmatism (26%), followed by hyperopia (12.7%), myopia (1.3%) and anisometropia (0.7%). There was a reduction of hyperopic refractive error with increasing age. Myopia was seen to emerge at age 24 months. In conclusion, the prevalence of astigmatism and hyperopia in infants and young children was high, but that of myopia and anisometropia was low. There was a significant reduction in hyperopic refractive error towards emmetropia with increasing age. It is recommended that vision screening be conducted early to correct significant refractive error that may cause disruption to clear vision.

Topics: Age Factors; Astigmatism; Child, Preschool; Cross-Sectional Studies; Female; Humans; Hyperopia; Infant; Infant Health; Malaysia; Male; Myopia; Pilot Projects; Prevalence; Prospective Studies; Refractive Errors

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.. 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.. 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%).. 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.

Topics: Asian People; Child; Cross-Sectional Studies; Ethnicity; Female; Humans; Malaysia; Male; Prevalence; Refractive Errors; Students; Vision Disorders; Vision Tests; Visual Acuity

Near work, accommodative inaccuracy and ambient lighting conditions have all been implicated in the development of myopia. However, differences in accommodative responses with age and refractive error under different visual conditions remain unclear. This study explores differences in accommodative ability and refractive error with exposure to differing ambient illumination and visual demands in Malay schoolchildren and adults.. Sixty young adults (21-25 years) and 60 schoolchildren (8-12 years) were recruited. Accommodative lag and accommodative fluctuations at far (6 m) and near (25 cm) were measured using the Grand Seiko WAM-5500 open-field autorefractor. The effects of mesopic room illumination on accommodation were also investigated.. Repeated-measures ANOVA indicated that accommodative lag at far and near differed significantly between schoolchildren and young adults [F(1.219, 35.354) = 11.857, p < 0.05]. Post hoc tests using the Bonferroni correction showed that at near, there was a greater lag in schoolchildren (0.486 ± 0.181 D) than young adults (0.259 ± 0.209 D, p < 0.05). Repeated-measures ANOVA also revealed that accommodative lag at near demands differed statistically between the non-myopic and myopic groups in young adults and schoolchildren [F(3.107, 31.431) = 12.187, p < 0.05]. Post hoc tests with Bonferroni correction showed that accommodative lag at near was significantly greater in myopic schoolchildren (0.655 ± 0.198 D) than in non-myopic schoolchildren (0.202 ± 0.141 D, p < 0.05) and myopic young adults (0.316 ± 0.172 D, p < 0.05), but no significant difference was found between myopic young adults (0.316 ± 0.172 D) and non-myopic young adults (0.242 ± 0.126 D, p > 0.05). Accommodative lag and fluctuations were greater under mesopic room conditions for all ages [all p < 0.05].. Greater accommodative lag was found in myopes than in emmetropes, in schoolchildren than in adults, and under mesopic conditions than under photopic conditions. Accommodative fluctuations were greatest in myopes and in mesopic conditions. These results suggest that differences exist in the amount of blur experienced by myopes and non-myopes at different ages and under different lighting conditions.

Topics: Accommodation, Ocular; Adult; Child; Color Vision; Emmetropia; Female; Humans; Lighting; Malaysia; Male; Prevalence; Refraction, Ocular; Refractive Errors; Young Adult

To screen for visual impairment in Malaysian preschool children.. Visual screening was conducted in 400 preschool children aged 4 to 6 years. The screening involved two basic procedures; the distant visual acuity test using the Sheridan Gardiner chart and the depth perception test using the Langs stereoacuity test. Criteria for referral were a visual acuity of 6/12 or less in the better eye or a fail in the depth perception test.. The prevalence of visual impairment was 5% (95% confidence interval [CI] = 3.3, 7.6). Of the 400 preschool children screened, 20 of them failed the distant visual acuity test or the stereopsis test. Refractive errors were the most common cause of visual impairment (95%, 95% CI = 76.2, 98.8); myopic astigmatism was the commonest type of refractive error (63.2%, 95% CI = 40.8, 80.9).. The study is a small but important step in the effort to understand the problem of visual impairment among our preschool children. Our study showed that it is feasible to measure distant visual acuity and stereopsis in this age group.

Topics: Child; Child, Preschool; Cross-Sectional Studies; Depth Perception; Feasibility Studies; Female; Humans; Malaysia; Male; Refractive Errors; Vision Disorders; Vision Screening; Visual Acuity

To assess changes in anterior segment parameters of keratoconus eyes at different stages of the disease in a sample of the Asian population.. Files of 32 patients (48 eyes) diagnosed as clinical keratoconus were assessed and the following parameters noted: central corneal thickness (CCT), thinnest corneal thickness (TCT), location of thinnest pachymetry, anterior chamber depth (ACD) at the centre from posterior corneal surface, ACD at 1, 2 and 3mm inferior-paracentral, ACD at thinnest pachymetry, anterior chamber volume (ACV) and anterior chamber angle (ACA). For analysis, keratoconus eyes were classified into 3 subgroups according to mean keratometry readings (mild: K≤47.0D, moderate: 47.0

Topics: Adolescent; Adult; Anterior Eye Segment; Comorbidity; Corneal Topography; Female; Humans; Keratoconus; Malaysia; Male; Refractive Errors; Retrospective Studies; Young Adult

This study aims to assess the optic disc characteristics in healthy adult Malays and to correlate them with age, gender and refractive errors.. Cross-sectional study.. A total of 200 voluntary participants (106 women and 94 men) among Malay students aged 20 to 37 years at Health Campus, Universiti Sains Malaysia.. The relationship between Heidelberg Retinal Tomograph parameters with age, gender and refractive error were analysed with correlation tests and multiple linear regression analyses..   Twelve parameters, that is, disc area, rim area, cup area, cup to disc area, cup volume, rim volume, height variation contour, cup shape measure, mean cup depth, maximum cup depth, mean retinal nerve fibre layer thickness and retinal nerve fibre layer cross-sectional area..   Disc area, rim area and cup : disc area ratio averaged 2.24 ± 0.52 (mean ± standard deviation), 1.64 ± 0.32 and 0.25 ± 0.12 mm(2) , respectively. Five parameters (disc area, cup area, cup volume, cup : disc area ratio and mean retinal nerve fibre layer thickness) showed statistically significant difference between men and women. Age was negatively and significantly correlated with rim area with coefficient r = -0.21, P = 0.003. All optic disc parameters were significantly correlated (P < 0.05) with disc area, except cup shape measure..   One or more of optic disc parameters were affected significantly by age, gender and disc area in healthy adult Malays' eyes. These factors need to be considered during the evaluation of optic disc.

Topics: Adult; Asian People; Cross-Sectional Studies; Female; Humans; Lasers; Malaysia; Male; Ophthalmoscopy; Optic Disk; Reference Values; Refractive Errors; Young Adult

Refractive error remains one of the primary causes of visual impairment in children worldwide, and the prevalence of refractive error varies widely. The objective of this study was to determine the prevalence of refractive error and study the possible associated factors inducing refractive error among primary school children of Malay ethnicity in the suburban area of Kota Bharu, Kelantan, Malaysia.. A school-based cross-sectional study was performed from January to July 2006 by random selection on Standard 1 to Standard 6 students of 10 primary schools in the Kota Bharu district. Visual acuity assessment was measured using logMAR ETDRS chart. Positive predictive value of uncorrected visual acuity equal or worse than 20/40, was used as a cut-off point for further evaluation by automated refraction and retinoscopic refraction.. A total of 840 students were enumerated but only 705 were examined. The prevalence of uncorrected visual impairment was seen in 54 (7.7%) children. The main cause of the uncorrected visual impairment was refractive error which contributed to 90.7% of the total, and with 7.0% prevalence for the studied population. Myopia is the most common type of refractive error among children aged 6 to 12 years with prevalence of 5.4%, followed by hyperopia at 1.0% and astigmatism at 0.6%. A significant positive correlation was noted between myopia development with increasing age (P <0.005), more hours spent on reading books (P <0.005) and background history of siblings with glasses (P <0.005) and whose parents are of higher educational level (P <0.005). Malays in suburban Kelantan (5.4%) have the lowest prevalence of myopia compared with Malays in the metropolitan cities of Kuala Lumpur (9.2%) and Singapore (22.1%).. The ethnicity-specific prevalence rate of myopia was the lowest among Malays in Kota Bharu, followed by Kuala Lumpur, and is the highest among Singaporean Malays. Better socio-economic factors could have contributed to higher myopia rates in the cities, since the genetic background of these ethnic Malays are similar.

Topics: Child; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Malaysia; Male; Prevalence; Refraction, Ocular; Refractive Errors; Retrospective Studies; Schools; Suburban Population; Vision, Low; Visual Acuity

Down syndrome is a common chromosomal anomaly. Few reported studies make reference to the ocular status in Asian children with Down syndrome. The purpose of this study was to determine the visual and binocular status of a sample of Down syndrome children in Malaysia.. A total of 73 Malaysian children with Down syndrome (38 boys and 35 girls) in the Kuala Lumpur area aged one to 12 years were examined. Cycloplegic refraction was performed on each eye and binocular visual acuity was assessed using the Cardiff acuity card or the LogMAR chart. Binocular functions were assessed using the cover test and Lang's stereo acuity test.. The mean age of the subjects was 6.01 +/- 3.41 years. Refraction of the right eye showed that 10 per cent of the subjects were myopic, 20 per cent were hyperopic and 70 per cent had no significant refractive error. The mean spherical equivalent was +0.92 +/- 2.32 DS for the right eye and +0.99 +/- 2.21 DS for the left. The mean of binocular LogMAR VA was 0.36 +/- 0.22 (6/12). Cover test revealed that 21 subjects had strabismus (of those, 33 per cent had unilateral esotropia, 52 per cent had alternating esotropia, nine per cent had unilateral exotropia and five per cent had alternating exotropia). Only 22 subjects gave clear positive response to the stereotest. Other ocular findings included ptosis (one per cent), abnormal head posture (seven per cent) and nystagmus (six per cent).. Malaysian children with Down syndrome have a high incidence of refractive error and strabismus. Regular visual examination is important so that corrective lenses can be prescribed to improve vision and to enhance the quality of life of these children in Malaysia.

Topics: Child; Child, Preschool; Down Syndrome; Female; Humans; Incidence; Infant; Malaysia; Male; Refraction, Ocular; Refractive Errors; Strabismus; Vision, Binocular; Visual Acuity

To compare the prevalences of refractive errors in Malay, Chinese and Indian children in Malaysia and Singapore.. Children aged 7-9 years from three schools in the Singapore Cohort study of the Risk factors for Myopia (n = 1962) and similarly aged children from a random cluster sample in the metropolitan Kuala Lumpur area in the Malaysia Refractive Error Study in Children (n = 1752) were compared. Cycloplegic autorefraction was conducted in both countries.. The prevalence of myopia (spherical equivalent of at least -0.5 diopters (D) in either eye) was higher in Singapore Malays (22.1%) than in Malays in Malaysia (9.2%; 95% confidence interval (CI) 11.2 to 14.7; p<0.001). Similarly, Singapore Chinese (40.1%) had higher prevalences than Malaysian Chinese (30.9%; 95% CI 1.5 to 16.9). Singapore Indians had a higher prevalence (34.1%) than Malaysian Indians (12.5%; 95% CI 17.4 to 25.9). The multivariate odds ratio of astigmatism (cylinder at least 0.75 D in either eye) in Singapore Malays compared with Malaysian Malays was 3.47 (95% CI 2.79 to 4.32). Ethnicity-specific hyperopia rates did not differ in Singapore and Malaysia.. The ethnicity-specific prevalences of myopia in Singapore Malays, Chinese and Indians are higher than those in Malaysian Malays, Chinese and Indians. As Malays, Chinese and Indians in Malaysia have genetic make-up similar to that of Malays, Chinese and Indians in Singapore, environmental factors may contribute to the higher myopia rates.

Topics: Asian People; Astigmatism; Child; Educational Status; Female; Humans; Hyperopia; Malaysia; Male; Myopia; Prevalence; Refractive Errors; Singapore; White People

To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city.. Population-based, cross-sectional survey.. Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households.. Random selection of geographically defined clusters was used to identify the study sample. Children in 34 clusters were enumerated through a door-to-door survey and examined in 140 schools between March and July 2003. The examination included visual acuity measurements; ocular motility evaluation; retinoscopy and autorefraction under cycloplegia; and examination of the external eye, anterior segment, media, and fundus.. Distance visual acuity and cycloplegic refraction.. The examined population was 70.3% Malay, 16.5% Chinese, 8.9% Indian, and 4.3% of other ethnicity. The prevalence of uncorrected (unaided), presenting, and best-corrected visual impairment (visual acuity < or =20/40 in the better eye) was 17.1%, 10.1%, and 1.4%, respectively. More than half of those in need of corrective spectacles were without them. In eyes with reduced vision, refractive error was the cause in 87.0%, amblyopia in 2.0%, other causes in 0.6%, and unexplained causes in 10.4%, mainly suspected amblyopia. Myopia (spherical equivalent of at least -0.50 diopter [D] in either eye) measured with retinoscopy was present in 9.8% of children 7 years of age, increasing to 34.4% in 15-year-olds; and in 10.0% and 32.5%, respectively, with autorefraction. Myopia was associated with older age, female gender, higher parental education, and Chinese ethnicity. Hyperopia (> or =2.00 D) with retinoscopy varied from 3.8% in 7-year-olds, 5.0% with autorefraction, to less than 1% by age 15, with either measurement method. Hyperopia was associated with younger age and "other" ethnicity. Astigmatism (> or =0.75 D) was present in 15.7% of children with retinoscopy and in 21.3% with autorefraction.. Visual impairment in school-age children in urban Gombak District is overwhelmingly caused by myopia, with a particularly high prevalence among children of Chinese ethnicity. Eye health education and screening may help address the unmet need for refractive correction.

Topics: Adolescent; Child; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Prevalence; Refraction, Ocular; Refractive Errors; Vision Disorders; Visual Acuity; Visually Impaired Persons

A cross sectional study was conducted to assess the level of awareness and knowledge of common eye diseases (cataract, glaucoma, diabetic retinopathy and refractive errors) among 473 academic staff (non-medical faculties) of University Malaya. The awareness of cataract was in 88.2%, diabetic retinopathy in 83.5%, refractive errors in 75.3% and glaucoma in 71.5% of the study population. The knowledge about all the above common eye diseases was moderate, except presbyopia which was poor. Multivariate analysis revealed that females, older people, and those having family history of eye diseases were significantly more aware and more knowledgeable about the eye diseases. Health education about eye diseases would be beneficial to seek early treatment and prevent visual impairment in the society.

Topics: Adult; Awareness; Cataract; Cross-Sectional Studies; Diabetic Retinopathy; Eye Diseases; Family Health; Female; Glaucoma; Humans; Knowledge; Malaysia; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Refractive Errors; Surveys and Questionnaires; Universities

A national eye survey was conducted in 1996 to determine the prevalence of blindness and low vision and their major causes among the Malaysian population of all ages.. A stratified two stage cluster sampling design was used to randomly select primary and secondary sampling units. Interviews, visual acuity tests, and eye examinations on all individuals in the sampled households were performed. Estimates were weighted by factors adjusting for selection probability, non-response, and sampling coverage.. The overall response rate was 69% (that is, living quarters response rate was 72.8% and household response rate was 95.1%). The age adjusted prevalence of bilateral blindness and low vision was 0.29% (95% CI 0.19 to 0.39%), and 2.44% (95% CI 2.18 to 2.69%) respectively. Females had a higher age adjusted prevalence of low vision compared to males. There was no significant difference in the prevalence of bilateral low vision and blindness among the four ethnic groups, and urban and rural residents. Cataract was the leading cause of blindness (39%) followed by retinal diseases (24%). Uncorrected refractive errors (48%) and cataract (36%) were the major causes of low vision.. Malaysia has blindness and visual impairment rates that are comparable with other countries in the South East Asia region. However, cataract and uncorrected refractive errors, though readily treatable, are still the leading causes of blindness, suggesting the need for an evaluation on accessibility and availability of eye care services and barriers to eye care utilisation in the country.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Blindness; Cataract; Child; Child, Preschool; Cluster Analysis; Female; Health Surveys; Humans; Infant; Infant, Newborn; Malaysia; Male; Middle Aged; Prevalence; Refractive Errors; Sex Distribution; Vision, Low

The prevalence of ocular abnormalities was studied in 165 children from a Malaysian school for the deaf. Ninety-five children (57.6%) had one or more ocular abnormalities. Rubella retinopathy was the commonest form of ocular abnormality (35.2%). Refractive errors were found in 23 children (13.9%). Refractive errors in the rubella group were significantly more common than in the non-rubella group of deaf children (p < 0.001) (chi 2 test). Thirteen children had congenital anomalies causing significantly impaired vision. Ophthalmological examination of deaf children helps in the detection of cases with rubella eye signs and thus helps to identify the cause of deafness. Since deaf children are at greater risk of visual and ocular abnormalities, periodical ophthalmological examination should be carried out in these children.

Topics: Adolescent; Child; Deafness; Eye Abnormalities; Female; Humans; Malaysia; Male; Prevalence; Refractive Errors; Rubella Syndrome, Congenital; Schools

A cross-sectional study of 753 Melanesian children in Vanuatu and 904 Malay children in Malaysia included measurement of refractive error and ocular dimensions. All children were between the ages of 6 and 17 years. The prevalence of myopia in Malay children was 4.3% at 7-8 years and 25.6% at 15-16 years with corresponding figures of 0.8% and 4.3% for Melanesian children. The range of refractive error was greater for Malay children at all ages. Mean refractive error for Malay children showed greater hypermetropia, together with a shorter axial length at 6 years, than Melanesian children, but at 17 years the situation reversed and Malay children had more myopia and longer axial lengths than their Melanesian counterparts.

Topics: Adolescent; Age Factors; Anthropometry; Child; Cross-Sectional Studies; Eye; Female; Humans; Hyperopia; Malaysia; Male; Myopia; Refractive Errors; Vanuatu

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cross-Sectional Studies; Female; Health Education; Humans; Malaysia; Male; Middle Aged; Refractive Errors; Vision Disorders

Topics: Adolescent; Adult; Aged; Asian People; Child; Child, Preschool; China; Humans; Hyperopia; India; Malaysia; Middle Aged; Myopia; Refractive Errors

Topics: Adolescent; Adult; Age Factors; Astigmatism; Child; Child, Preschool; Contact Lenses; Female; Humans; Malaysia; Male; Middle Aged; Refractive Errors