Prevalence of Refractive Error among Preschool Children in an Urban Population: The Baltimore Pediatric Eye Disease Study

Giordano, Lydia; Friedman, David S.; Repka, Michael X.; Katz, Joanne; Ibironke, Josephine; Hawes, Patricia; Tielsch, James M.

doi:10.1016/j.ophtha.2008.12.030

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Volume 116, Issue 4 , Pages 739-746.e4, April 2009

Prevalence of Refractive Error among Preschool Children in an Urban Population: The Baltimore Pediatric Eye Disease Study

Lydia Giordano
- Dana Center for Prevention Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
David S. Friedman, MD, MPH, PhD
- Dana Center for Prevention Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Correspondence: David S. Friedman, MD, MPH, PhD, Wilmer Eye Institute, Wilmer 120, 600 North Wolfe Street, Baltimore, MD 21210
Michael X. Repka, MD
- Zanvyl Krieger Pediatric Ophthalmology and Adult Strabismus Service, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
Joanne Katz, ScD
- Dana Center for Prevention Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Josephine Ibironke, OD
- Dana Center for Prevention Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Zanvyl Krieger Pediatric Ophthalmology and Adult Strabismus Service, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
Patricia Hawes, MS, COMT, CRA
- Dana Center for Prevention Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
James M. Tielsch, PhD
- Dana Center for Prevention Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Received 25 June 2008; received in revised form 29 October 2008; accepted 9 December 2008. published online 25 February 2009.

Available online: February 25, 2009.

Purpose

To determine the age-specific prevalence of refractive errors in white and African-American preschool children.

Design

The Baltimore Pediatric Eye Disease Study is a population-based evaluation of the prevalence of ocular disorders in children aged 6 to 71 months in Baltimore, Maryland.

Participants

Among 4132 children identified, 3990 eligible children (97%) were enrolled and 2546 children (62%) were examined.

Methods

Cycloplegic autorefraction was attempted in all children with the use of a Nikon Retinomax K-Plus 2 (Nikon Corporation, Tokyo, Japan). If a reliable autorefraction could not be obtained after 3 attempts, cycloplegic streak retinoscopy was performed.

Main Outcome Measures

Mean spherical equivalent (SE) refractive error, astigmatism, and prevalence of higher refractive errors among African-American and white children.

Results

The mean SE of right eyes was +1.49 diopters (D) (standard deviation [SD] = 1.23) in white children and +0.71 D (SD = 1.35) in African-American children (mean difference of 0.78 D; 95% confidence interval [CI], 0.67–0.89). Mean SE refractive error did not decline with age in either group. The prevalence of myopia of 1.00 D or more in the eye with the lesser refractive error was 0.7% in white children and 5.5% in African-American children (relative risk [RR], 8.01; 95% CI, 3.70–17.35). The prevalence of hyperopia of +3 D or more in the eye with the lesser refractive error was 8.9% in white children and 4.4% in African-American children (RR, 0.49; 95% CI, 0.35–0.68). The prevalence of emmetropia (<−1.00 D to <+1.00 D) was 35.6% in white children and 58.0% in African-American children (RR, 1.64; 95% CI, 1.49–1.80). On the basis of published prescribing guidelines, 5.1% of the children would have benefited from spectacle correction. However, only 1.3% had been prescribed correction.

Conclusions

Significant refractive errors are uncommon in this population of urban preschool children. There was no evidence for a myopic shift over this age range in this cross-sectional study. A small proportion of preschool children would likely benefit from refractive correction, but few have had this prescribed.