Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Ophthalmology
Published in: BMC Ophthalmology 1/2017

Open Access 01-12-2017 | Research article

Evidence for the need for vision screening of school children in Turkey

Authors: Serap Azizoğlu, Sheila G. Crewther, Funda Şerefhan, Ayla Barutchu, Sinan Göker, Barbara M. Junghans

Published in: BMC Ophthalmology | Issue 1/2017

Login to get access

Abstract

Background

In many countries, access to general health and eye care is related to an individual’s socioeconomic status (SES). We aimed to examine the prevalence of oculo-visual disorders in children in Istanbul Turkey, drawn from schools at SES extremes but geographically nearby.

Methods

Three school-based vision screenings (presenting distance visual acuity, cover test, eye assessment history, colour vision, gross stereopsis and non-cycloplegic autorefraction) were conducted on 81% of a potential 1014 primary-school children aged 4–10 years from two private (high SES) schools and a nearby government (low SES) school in central Istanbul. Prevalence of refractive errors and school-based differences were analysed using parametric statistics (ANOVA). The remaining oculo-visual aspects were compared using non-parametric tests.

Results

Of the 823 children with mean age 6.7 ± 2.2 years, approximately 10% were referred for a full eye examination (8.2% and 16.3% of private/government schools respectively). Vision had not been previously examined in nearly 22% of private school children and 65% of government school children. Of all children, 94.5% were able to accurately identify the 6/9.5 [LogMAR 0.2] line of letters/shapes with each eye and 86.6% the 6/6 line [LogMAR 0], while 7.9% presented wearing spectacles, 3.8% had impaired colour vision, 1.5% had grossly impaired stereo-vision, 1.5% exhibited strabismus, 1.8% were suspected to have amblyopia and 0.5% had reduced acuity of likely organic origin. Of the 804 without strabismus, amblyopia or organic conditions, 6.0% were myopic ≤ − 0.50DS, 0.6% hyperopic ≥ + 2.00DS, 7.7% astigmatic ≥1.00 DC and 6.2% anisometropic ≥1.00DS.

Conclusions

The results highlight the need for general vision screenings for all children prior to school entry given the varied and different pattern of visual problems associated with lifestyle differences in two populations raised in the same urban locale but drawn from different socioeconomic backgrounds.
Appendix
Available only for authorised users
Literature
1.
Tielsch JM, Sommer A, Katz J, Quigley H, Ezrine S. Socioeconomic status and visual impairment among urban Americans. Baltimore eye survey research group. Arch Ophthalmol. 1991;109(5):637–41.CrossRefPubMed
2.
Newacheck PW, Halfon N. Preventive care use by school-aged children: differences by socioeconomic status. Pediatrics. 1988;82:462–8.PubMed
3.
Berkman L. Kawachi I. New York: Social Epidemiology; 2000.
4.
Lesser C, Cunningham P. Access to care: is it improving or declining? Data Bull (Cent Stud Health Syst Change). 1997;1:1–2.
5.
6.
American Academy of Pediatrics. Eye examination in infants, children, and young adults by pediatricians. Pediatrics. 2003;111:902–7.CrossRef
7.
8.
Baltussen R, Naus J, Limburg H. Cost-effectiveness of screening and correcting refractive errors in school children in Africa, Asia, America and Europe. Health Policy. 2009;89:201–15.CrossRefPubMed
9.
Caca I, Cingu A, Sahin A, Ari S, Dursun M, Dag U, Balsak S, Alakus F, Yavuz A, Palanci Y. Amblyopia and refractive errors among school-aged children with low socioeconomic status in southeastern Turkey. J Pediatr Ophthalmol Strabismus. 2013;50:37–43.CrossRefPubMed
10.
Gursoy H, Basmak H, Yaz Y, Colak E. Vision screening in children entering school: Eskisehir, Turkey. Ophthalmic Epidemiol. 2013;20:232–8.CrossRefPubMed
11.
Polat S, Akyol N. The prevalance of amblyopia and allergic eye disease in second year primary school students (original in Turkish). Türkiye Klinikleri Tıp Bilimleri Dergisi. 2003;23:213–9.
12.
Unsal A, Ayranci U, Tozun M. Vision screening among children in primary schools in a district of western Turkey. An epidemiological study. Pak J Med Sci. 2009;25:976–81.
13.
Pan C-W, Ramamurthy D, Saw S-M. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt. 2012;32:3–16.CrossRefPubMed
14.
Saw S-M, Gazzard G, Shih-Yen EC, Chua W-H. Myopia and associated pathological complications. Ophthalmic Physiol Opt. 2005;25:381–91.CrossRefPubMed
15.
Azizoglu S, Junghans BM, Barutchu A, Crewther SG. Refractive errors in students from middle eastern backgrounds living and undertaking schooling in Australia. Clin Exp Optom. 2011;94:67–75.CrossRefPubMed
16.
Junghans B, Kiely PM, Crewther DP, Crewther SG. Referral rates for a functional vision screening among a large cosmopolitan sample of Australian children. Ophthalmic Physiol Opt. 2002;22:10–25.CrossRefPubMed
17.
Junghans BM, Crewther SG. Prevalence of myopia among primary school children in eastern Sydney. Clin Exp Optom. 2003;86:339–45.CrossRefPubMed
18.
Rose K, Younan C, Morgan I, Mitchell P. Prevalence of undetected ocular conditions in a pilot sample of school children. Clin Exp Ophthalmol. 2003;31:237–40.CrossRefPubMed
19.
Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, Mitchell P. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115:1279–85.CrossRefPubMed
20.
Sherwin JC, Reacher MH, Keogh RH, Khawaja AP, Mackey DA, Foster PJ. The association between time spent outdoors and myopia in children and adolescents: a systematic review and meta-analysis. Ophthalmology. 2012;119:2141–51.CrossRefPubMed
21.
Pai AS, Wang JJ, Samarawickrama C, Burlutsky G, Rose KA, Varma R, Wong TY, Mitchell P. Prevalence and risk factors for visual impairment in preschool children the Sydney paediatric eye disease study. Ophthalmology. 2011;118:1495–500.CrossRefPubMed
22.
Rahi JS, Cumberland PM, Peckham CS. Myopia over the lifecourse: prevalence and early life influences in the 1958 British birth cohort. Ophthalmology. 2011;118:797–804.CrossRefPubMed
23.
Xu L, Wang Y, Jonas J. Level of education associated with ophthalmic diseases. The Beijing eye study. Graefe's arch. Clin Exp Ophthalmol. 2010;248:49–57.CrossRef
24.
25.
Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive error study in children: sampling and measurement methods for a multi-country survey.[comment]. Am J Ophthalmol. 2000;129:421–6.CrossRefPubMed
26.
27.
Gibson G, Davies L. Clinical Evaluation of the Nidek ARK-530A Auto Refractor/Keratometer. In: In: Optometry Today. London: Association of Optometrists, UK; 2008. p. 48–51.
28.
Kulp MT, Ying GS, Huang J, Maguire MG, Quinn G, Ciner EB, Cyert L, Orel-Bixler D, Moore B. Accuracy of Noncycloplegic Retinoscopy, Retinomax autorefractor and SureSight vision screener for detecting significant refractive errors. I. Invest Ophthalmol Vis Sci. 2014;55:1378–85.CrossRefPubMedPubMedCentral
29.
Williams C, Miller L, Northstone K, Sparrow JM. The use of non-cycloplegic autorefraction data in general studies of children's development. Br J Ophthalmol. 2008;92:723–4.CrossRefPubMed
30.
Nastri G, Perugini GC, Savastano S, Polzella A, Sbordone G. The evolution of refraction in the fixing and the amblyopic eye. Doc. Ophthalmologica. 1984;56:265–74.CrossRef
31.
Davidson S, Quinn GE. The impact of pediatric vision disorders in adulthood. Pediatrics. 2011;127:334–9.CrossRefPubMed
32.
Zhao J, Pan X, Sui R, Munoz SR, Sperduto RD, Ellwein LB. Refractive error study in children: results from Shunyi District, China. Am J Ophthalmol. 2000;129:427–35.CrossRefPubMed
33.
Colburn JD, Morrison DG, Estes RL, Li C, Lu P, Donahue SP. Longitudinal follow-up of hypermetropic children identified during preschool vision screening. JAAPed Ophthalmol. Strabismus. 2010;14:211–5.
34.
Schmucker C, Grosselfinger R, Riemsma R, Antes G, Lange S, Lagrèze W, Kleijnen J. Effectiveness of screening preschool children for amblyopia: a systematic review. BMC Ophthalmol. 2009;9:3–3.CrossRefPubMedPubMedCentral
35.
Cumurcu T, Düz C, Gündüz A, Doğanay S. [The prevalence and distribution of refractive errors in elementary school children in area of Malatya] English abstract. İnönü Üniversitesi Tıp Fakültesi Dergisi. 2011;18:145–8.
36.
Ergin A. Eye screening results at te primary schools in Kirikkale [English abstract]. T Klin J Med Sci. 2011;21:166–72.
37.
Webber AL, Wood J. Amblyopia: prevalence, natural history, functional effects and treatment. Clin Exp Optom. 2005;88:365–75.CrossRefPubMed
38.
39.
McKean-Cowdin R, Cotter SA, Tarczy-Hornoch K, Wen G, Kim J, Borchert M, Varma R. Multi-ethnic pediatric eye disease study G. Prevalence of amblyopia or strabismus in asian and non-Hispanic white preschool children: multi-ethnic pediatric eye disease study. Ophthalmology. 2013;120:2117–24.CrossRefPubMedPubMedCentral
40.
Cotter SA, Varma R, Tarczy-Hornoch K, McKean-Cowdin R, Lin J, Wen G, Wei J, Borchert M, Azen SP, Torres M, et al. Risk factors associated with childhood strabismus: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology. 2011;118:2251–61.CrossRefPubMedPubMedCentral
41.
Ying GS, Maguire MG, Cyert LA, Ciner E, Quinn GE, Kulp MT, Orel-Bixler D, Moore B. Prevalence of vision disorders by racial and ethnic group among children participating in head start. Ophthalmology. 2014;121:630–6.CrossRefPubMed
42.
Hudak DT, Magoon EH. Poverty predicts amblyopia treatment failure. JAAPed Ophthalmol. Strabismus. 1997;1:214–5.
43.
Majeed M, Williams C, Northstone K, Ben-Shlomo Y. Are there inequities in the utilisation of childhood eye-care services in relation to socio-economic status? Evidence from the ALSPAC cohort. Br J Ophthalmol. 2008;92:965–9.CrossRefPubMed
44.
Tarczy-Hornoch K, Varma R, Cotter SA, McKean-Cowdin R, Lin JH, Borchert MS, Torres M, Wen G, Azen SP, Tielsch JM, et al. Risk factors for decreased visual acuity in preschool children: the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology. 2011;118:2262–73.CrossRefPubMedPubMedCentral
45.
Sun J, Zhou J, Zhao P, Lian J, Zhu H, Zhou Y, Sun Y, Wang Y, Zhao L, Wei Y, et al. High prevalence of myopia and high myopia in 5060 Chinese university students in ShanghaiMyopia and high myopia in shanghai students. Invest Ophthalmol Vis Sci. 2012;53:7504–9.CrossRefPubMed
46.
Lin LL, Shih YF, Hsiao CK, Chen CJ. Prevalence of myopia in Taiwanese schoolchildren: 1983 to 2000. Ann Acad Med Singap. 2004;33:27–33.PubMed
47.
Seet B, Wong TY, Tan DT, Saw SM, Balakrishnan V, Lee LK, Lim AS. Myopia in Singapore: taking a public health approach. Br J Ophthalmol. 2001;85:521–6.CrossRefPubMedPubMedCentral
48.
49.
Junghans BM, Crewther SG. Little evidence for an epidemic of myopia in Australian primary school children over the last 30 years. BMC Ophthalmol. 2005;5:1.CrossRefPubMedPubMedCentral
50.
French AN, Morgan IG, Burlutsky G, Mitchell P, Rose KA. Prevalence and 5- to 6-year incidence and progression of myopia and hyperopia in Australian schoolchildren. Ophthalmology. 2013;120:1482–91.CrossRefPubMed
51.
Onal S, Toker E, Akingol Z, Arslan G, Ertan S, Turan C, Kaplan O. Refractive errors of medical students in Turkey: one year follow-up of refraction and biometry. Optom Vis Sci. 2007;84:175–80.CrossRefPubMed
52.
53.
Krause U, Krause K, Rantakallio. sex Differences in refraction errors up to the age of 15. Acta Ophthalmol. 1982;60:917–26.CrossRef
54.
Morgan I, Rose K. How genetic is school myopia? Prog Retina Eye Res. 2005;24:1–38.CrossRef
55.
Lim H, Yoon J, Hwang S-S, Lee S. Prevalence and associated sociodemographic factors of myopia in Korean children: the 2005 third Korea National Health and nutrition examination survey (KNHANES III). Jap. J Ophthalmol. 2012;56:76–81.CrossRef
56.
Xiang F, He M, Morgan IG. The impact of parental myopia on myopia in Chinese children: population-based evidence. Optom Vis Sci. 2012;89:1487–96.CrossRefPubMed
57.
Uzma N, Kumar BS, Khaja Mohinuddin Salar BM, Zafar MA, Reddy VD. A comparative clinical survey of the prevalence of refractive errors and eye diseases in urban and rural school children. Can J Ophthalmol. 2009;44:328–33.CrossRefPubMed
58.
59.
Yekta A, Fotouhi A, Hashemi H, Dehghani C, Ostadimoghaddam H, Heravian J, Derakhshan A, Yekta R, Behnia M, Khabazkhoob M. Prevalence of refractive errors among schoolchildren in shiraz. Iran Clin Ex Ophthalmol. 2010;38:242–8.
60.
61.
Cotter SA. Management of childhood hyperopia: a pediatric optometrist's perspective. Optom Vis Sci. 2007;84:103–9.CrossRefPubMed
62.
Kulp MT, Ciner E, Maguire M, Moore B, Pentimonti J, Pistilli M, Cyert L, Candy TR, Quinn G, Ying G-S. Uncorrected hyperopia and preschool early literacy: results of the vision in preschoolers–hyperopia in preschoolers (VIP-HIP) study. Ophthalmology. 2016;123:681–9.CrossRefPubMedPubMedCentral
63.
Vilela MA, Pellanda LC, Fassa AG, Castagno VD. Prevalence of asthenopia in children: a systematic review with meta-analysis. J Pediatr. 2015;91:320–5.CrossRef
64.
Attebo K, Ivers R, Mitchell P. Refractive errors in an older population: the Blue Mountains eye study. Ophthalmology. 1999;106:1066–72.CrossRefPubMed
65.
Wang Q, Klein BE, Klein R, Moss SE. Refractive status in the beaver dam eye study. Invest Ophthalmol Vis Sci. 1994;35:4344–7.PubMed
66.
Suryakumar R, Bobier WR. The manifestation of noncycloplegic refractive state in pre-school children is dependent on autorefractor design. Optom Vis . 2003;80:578–586.
67.
Stark L, Strang N, Atchison D. Dynamic accommodation response in the presence of astigmatism. J Opt Soc Am. 2003;20:2228–36.CrossRef
68.
Read SA, Vincent SJ, Collins MJ. The visual and functional impacts of astigmatism and its clinical management. Ophthalmic Physiol Opt. 2014;34:267–94.CrossRefPubMed
69.
Prabakaran S, Dirani M, Chia A, Gazzard G, Fan Q, Leo SW, Ling Y, Au Eong KG, Wong TY, Saw SM. Cycloplegic refraction in preschool children: comparisons between the hand-held autorefractor, table-mounted autorefractor and retinoscopy. Ophthalmic Physiol Opt. 2009;29:422–6.CrossRefPubMed
70.
Fotouhi A, Hashemi H, Khabazkhoob M, Mohammad K. The prevalence of refractive errors among schoolchildren in Dezful, Iran. Br J Ophthalmol. 2007;91:287–92.CrossRefPubMed
71.
Jamali P, Fotouhi A, Hashemi H, Younesian M, Jafari A. Refractive errors and amblyopia in children entering school: Shahrood, Iran. Optom Vis Sci. 2009;86:364–9.CrossRefPubMed
72.
Ostadimoghaddam H, Fotouhi A, Hashemi H, Yekta A, Heravian J, Rezvan F, Ghadimi H, Rezvan B, Khabazkhoob M. Prevalence of the refractive errors by age and gender: the Mashhad eye study of Iran. Clin Exp Ophthalmol. 2011;39:743–51.CrossRefPubMed
73.
Rezvan F, Khabazkhoob M, Fotouhi A, Hashemi H, Ostadimoghaddam H, Heravian J, Azizi E, Khorasani AA, Yekta AA. Prevalence of refractive errors among school children in northeastern Iran. Ophthalmic Physiol Optics. 2012;32:25–30.CrossRef
74.
75.
Hashemi H, Fotouhi A, Mohammad K. The age- and gender-specific prevalences of refractive errors in Tehran: the Tehran eye study. Ophthalmic Epidemiol. 2004;3:213–25.CrossRef
76.
Kleinstein RN, Jones LA, Hullett S, Kwon S, Lee RJ, Friedman NE, Manny RE, Mutti DO, JA Y, Zadnik K, et al. Refractive error and ethnicity in children. Arch Ophthalmol. 2003;121:1141–7.CrossRefPubMed
77.
HM W, Seet B, Yap EP, Saw SM, Lim TH, Chia KS. Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore. Optom Vis Sci. 2001;78:234–9.
78.
Jin P, Zhu J, Zou H, Lu L, Zhao H, Li Q, He X. Screening for significant refractive error using a combination of distance visual acuity and near visual acuity. PLoS One. 2015;10:e0117399.CrossRefPubMedPubMedCentral
79.
Luo HD, Gazzard G, Liang Y, Shankar A, Tan DT, Saw SM. Defining myopia using refractive error and uncorrected logMAR visual acuity >0.3 from 1334 Singapore school children ages 7–9 years. Br J Ophthalmol. 2006;90:362–6.CrossRefPubMedPubMedCentral
80.
81.
Aksit N. Educational reform in Turkey. Int J. Dev. 2007;27:129–37.
82.
Turacli ME, Aktan SG, Duruk K. Ophthalmic screening of school children in Ankara. Eur J Ophthalmol. 1995;5:181–6.PubMed
83.
Plainis S, Moschandreas J, Nikolitsa P, Plevridi E, Giannakopoulou T, Vitanova V, Tzatzala P, Pallikaris IG, Tsilimbaris MK. Myopia and visual acuity impairment: a comparative study of Greek and Bulgarian school children. Ophthalmic Physiol Opt. 2009;29:312–20.CrossRefPubMed
84.
Ostadimoghaddam H, Fotouhi A, Khabazkhoob M, Heravian J, Yekta A. Prevalence and risk factors of refractive errors among school children in Masshad, 2006-2007. Iranian. J Ophthalmol. 2008;20:3–9.
85.
Gao L, Zhuo X, Kwok AK, Yu N, Ma L, Wang J. The change in ocular refractive components after cycloplegia in children. Jpn J Ophthalmol. 2002;46:293–8.CrossRefPubMed
86.
Ludlum W, Weinberg S, Twarowski C, Ludlum D. Comparison of cycloplegic and non-cycloplegic ocular component measurement in children. Am J Optom Arch Am Acad Optom. 1972;49:805–18.CrossRef
87.
Young FA, Leary GA, Box RA, Harris E, Baldwin WR, West DC, Johnson C. Comparison of cycloplegic and non-cycloplegic refractions of Eskimos. Am J Optom Arch Am Acad Optom. 1971;48:814–25.CrossRefPubMed
88.
Fotedar R, Rochtchina E, Morgan I, Wang JJ, Mitchell P, Rose KA. Necessity of cycloplegia for assessing refractive error in 12-year-old children: a population-based study. Am J Ophthalmol. 2007;144:307–9.CrossRefPubMed
89.
London NJ, Carden SM, Good WV. Paradoxical myopic shift following cycloplegia in retinopathy of prematurity patients: a case series. Cases J. 2009;2:8970.CrossRefPubMedPubMedCentral
Metadata
Title
Evidence for the need for vision screening of school children in Turkey
Authors
Serap Azizoğlu
Sheila G. Crewther
Funda Şerefhan
Ayla Barutchu
Sinan Göker
Barbara M. Junghans
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Ophthalmology / Issue 1/2017
Electronic ISSN: 1471-2415
DOI
https://doi.org/10.1186/s12886-017-0618-9

Other articles of this Issue 1/2017

BMC Ophthalmology 1/2017 Go to the issue

Research article

Efficacy and safety of conbercept as a primary treatment for choroidal neovascularization secondary to punctate inner choroidopathy

Research article

Visual outcome following bilateral non-arteritic anterior ischemic optic neuropathy: a systematic review and meta-analysis

Case report

Portable OCT-assisted surgical treatment of intracorneal pre-Descemet epithelial cyst: a case report

Research article

Bacterial profile of ocular infections: a systematic review

Research article

Awareness and knowledge of glaucoma and associated factors among adults: a cross sectional study in Gondar Town, Northwest Ethiopia

Case report

Hemorrhagic hypopyon as presenting feature of intravascular lymphoma, a case report