Refractive Error Study in Children: Results from Mechi zone, Nepal

PURPOSE: To assess the prevalence of refractive error and vision impairment in school age children in the terai area of the Mechi zone in Eastern Nepa l. METHODS: Random selection of village-based clusters was used to identify a sample of children 5 to 15 years of age. Children in the 25 selected cluste rs were enumerated through a door-to door household survey and invited to v illage sites for examination. Visual acuity measurements, cycloplegic retin oscopy, cycloplegic autorefraction, ocular motility evaluation, and anterio r segment, media, and fundus examinations were done from May 1998 through J uly 1998, Independent replicate examinations for quality assurance monitori ng took place in all children with reduced vision and in a sample of those with normal vision in seven villages. RESULTS: A total of 5,526 children from 3,724 households were enumerated, a nd 5,067 children (91.7%) were examined, The prevalence of uncorrected, pre senting, and best visual acuity 0.5 (20/40) or worse in at least one eye wa s 2.9%, 2.8%, and 1.4%, respectively; 0.4% had best visual acuity 0.5 or wo rse in both eyes. Refractive error was the cause in 56% of the 200 eyes wit h reduced uncorrected vision, amblyopia in 9%, other causes in 19%, with un explained causes in the remaining 16%, Myopia -0.5 diopter or less in eithe r eye or hyperopia 2 diopters or greater was observed in less than 3% of ch ildren. Hyperopia risk was associated with female gender and myopia risk wi th older age. CONCLUSIONS: The prevalence of reduced vision is very low in school age chi ldren in Nepal, most of it because of correctable refractive error. Further studies are needed to determine whether the prevalence of myopia will be h igher for more recent birth cohorts. (Am J Ophthalmol 2000;129:436-444. (C) 2000 by Elsevier Science Inc, All rights reserved.).