Ocular biometry, refraction and time spent outdoors during daylight in Irish schoolchildren

Background: Previous studies have investigated the relationship between ocular biometry and spherical equivalent refraction in children. This is the first such study in Ireland. The effect of time spent outdoors was also investigated. Methods: Examination included cycloplegic autorefraction and non-contact ocular biometric measures of axial length, corneal radius and anterior chamber depth from 1,626 children in two age groups: six to seven years and 12 to 13 years, from 37 schools. Parents/guardians completed a participant questionnaire detailing time spent outdoors during daylight in summer and winter. Results: Ocular biometric data were correlated with spherical equivalent refraction (axial length: r = −0.64, corneal radius: r = 0.07, anterior chamber depth: r = −0.33, axial length/corneal radius ratio: r = −0.79, all p \u3c 0.0001). Participants aged 12–13 years had a longer axial length (6–7 years 22.53 mm, 12–13 years 23.50 mm), deeper anterior chamber (6–7 years 3.40 mm, 12–13 years 3.61 mm), longer corneal radius (6–7 years 7.81 mm, 12–13 years 7.87 mm) and a higher axial length/corneal radius ratio (6–7 years 2.89, 12–13 years 2.99), all p \u3c 0.0001. Controlling for age: axial length was longer in boys (boys 23.32 mm, girls 22.77 mm), and non-White participants (non-White 23.21 mm, White 23.04 mm); corneal radius was longer in boys (boys 7.92 mm, girls 7.75 mm); anterior chamber was deeper in boys (boys 3.62 mm, girls 3.55 mm, p \u3c 0.0001), and axial length/corneal radius ratios were higher in non-White participants (non-White 2.98, White 2.94, p \u3c 0.0001). Controlling for age and ethnicity, more time outdoors in summer was associated with a less myopic refraction, shorter axial length, and lower axial length/corneal radius ratio. Non- White participants reported spending significantly less time outdoors than White participants (p \u3c 0.0001). Conclusion: Refractive error variance in schoolchildren in Ireland was best explained by variation in the axial length/corneal radius ratio with higher values associated with a more myopic refraction. Time spent outdoors during daylight in summer was associated with shorter axial lengths and a less myopic spherical equivalent refraction in White participants. Strategies to promote daylight exposure in wintertime is a study recommendation

The association between time spent on screens and reading with myopia, premyopia and ocular biometric and anthropometric measures in 6- to 7-year-old schoolchildren in Ireland

Purpose More time spent on near tasks has consistently been associated with the promotion of myopia. The World Health Organization advises limiting daily screentime to less than 2 h for children aged five and over. This study explored the relationship between time spent on screens and reading/writing with refractive status, ocular biometric and anthropometric factors in 6-to 7-year- olds in Ireland. Methods Participants were 723 schoolchildren (377 boys [51.8%]), mean age 7.08 (0.45) years. The examination included cycloplegic autorefraction (1% cyclopentolate hydrochloride), ocular biometry (Zeiss IOLMaster), height (cm) and weight (kg). Screentime and reading/writing time were reported by parents/legal guardians by questionnaire. Myopia (≤−0.50D) and premyopia (\u3e−0.50D ≤ 0.75D) risk assessments were performed using logistic regression, and multivariate linear regression was used to analyse continuous variables. Results Reported daily screentimes were 31% \u3c1 h, 49.5% 1–2 h, 15.6% 2–4 h and 3.9% \u3e4 h. Reading/writing times were 42.2% frequently, 48.0% infrequently and 9.8% seldom/never. Linear regression, controlling for age and ethnicity, revealed \u3e2 h/day on screens was associated with a more myopic spherical equivalent [β = −1.15 (95% confidence intervals {CIs}: 1.62–0.69, p \u3c 0.001)], increased refractive astigmatism (β = 0.29, CI: 0.06–0.51, p = 0.01), shorter corneal radius (β = 0.12, CI: 0.02–0.22, p = 0.02), higher axial length/corneal radius (β = 0.06, CI: 0.03–0.09, p \u3c 0.001), heavier weight (β = 1.60, CI: 0.76–2.45, p \u3c 0.001) and higher body mass index (BMI) (β = 1.10, CI: 0.28–1.12, p \u3c 0.001). Logistic regression, controlling for age and ethnicity, revealed daily screentime \u3e2 h was associated with myopia (OR = 10.9, CI: 4.4–27.2, p = 0.01) and premyopia (OR = 2.4, CI: 1.5–3.7, p \u3c 0.001). Frequent reading/writing was associated with screentime ≤2 h/day (OR = 3.2, CI: 1.8–5.8, p \u3c 0.001). Conclusion Increased screentime was associated with a more myopic refraction, higher axial length/corneal radius ratio, increased odds of myopia, premyopia, higher degrees of astigmatism, increased weight, BMI and decreased reading/writing time. Dedicated education programmes promoting decreased screentime in children are vital to prevent myopia and support eye and general health

School performance and undetected and untreated visual problems in schoolchildren in Ireland; a population-based cross-sectional study

This study explored the association between children’s vision and their school academic progress as reported by parents/guardians. Participants were 1,612 schoolchildren (722 6-7-year-olds, 890 12-13-year-olds) in randomly selected schools in Ireland. In advance of data collection, parents/guardians reported school performance as (a) much better than classmates (high-performance) (b) about the same as classmates (average-performance) (c) not as well as classmates (low-performance). Measurements included logMAR monocular visual acuities (with spectacles if worn, and pinhole) in the distance (3 m) and near (40 cm); the amplitude of accommodation; stereoacuity, colour vision assessment, and cyclopleged autorefraction. Controlling for confounders, children presenting with visual impairment (vision poorer than 0.3logMAR (6/12) in the ‘better eye’), amblyopia (‘lazy eye’), uncorrected refractive error (hyperopia ≥+3.50D and astigmatism ≥1.50DC), reduced for age ability to adjust focus from distance to near tasks (accommodation), impaired three-dimensional vision (stereoacuity), and defective colour vision were more likely to report low-performance in school. The majority of low-performing participants (68%) did not have an eye examination within the 12 months before data collection. Children with academic performance challenges ought to have a comprehensive eye examination, to detect potential vision problems for early intervention minimising any negative impact they may have on educational outcomes

Risk factors associated with myopia in schoolchildren in Ireland

Aim To examine the demographic and social factors associated with myopia in schoolchildren in Ireland. Methods Thirty-seven schools participated, representing a mix of urban and rural schools and schools in socioeconomically disadvantaged and non-disadvantaged areas in Ireland. Examination included cyclopleged autorefraction (1% cyclopentolate hydrochloride). Height and weight of participants were measured. Parents filled in a participant’s lifestyle questionnaire, including questions on daily screen time use and daylight exposure. Myopia was defined as spherical equivalent ≤−0.50 D. Results Data from 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), were examined. Myopia prevalence was significantly higher in children aged 12–13 years old (OR=7.7, 95%CI 5.1 to 11.6, p\u3c0.001) and significantly associated with non-white ethnicity (OR=3.7, 95% CI 2.5 to 5.3, p\u3c0.001). Controlling for age group and ethnicity, myopia prevalence was also significantly linked with height (p\u3c0.001) and higher in participants in the following groups: using screens \u3e3 hours per day (OR=3.7, 95% CI 2.1 to 6.3, p\u3c0.001), obesity (OR=2.7, 95% CI 1.9 to 3.9, p\u3c0.001), sedentary lifestyle (OR=2.9, 95% CI 1.9 to 4.4, p\u3c0.001), frequently reading/writing (OR=2.2, 95% CI 1.4 to 3.5, p=0.001), less daylight exposure during summer time (OR=5.00, 95% CI 2.4 to 10.3, p\u3c0.001), spring season births (OR=1.9, 95% CI 1.1 to 3.3, p=0.02), paternal history of myopia (OR=2.4, 95% CI 1.8 to 3.3, p\u3c0.001) and bottle fed for the first three months of life (OR=1.7, 95% CI 1.3 to 2.5, p=0.02). Conclusions The associations found between myopia prevalence in schoolchildren in Ireland and demographic and lifestyle factors suggest that longitudinal research investigating the associations between myopia prevalence and these factors may be beneficial in advising preventative public health programmes

Risk factors associated with myopia in schoolchildren in Ireland

Aim To examine the demographic and social factors associated with myopia in schoolchildren in Ireland. Methods Thirty-seven schools participated, representing a mix of urban and rural schools and schools in socioeconomically disadvantaged and non-disadvantaged areas in Ireland. Examination included cyclopleged autorefraction (1% cyclopentolate hydrochloride). Height and weight of participants were measured. Parents filled in a participant’s lifestyle questionnaire, including questions on daily screen time use and daylight exposure. Myopia was defined as spherical equivalent ≤−0.50 D. Results Data from 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), were examined. Myopia prevalence was significantly higher in children aged 12–13 years old (OR=7.7, 95%CI 5.1 to 11.6, p\u3c0.001) and significantly associated with non-white ethnicity (OR=3.7, 95% CI 2.5 to 5.3, p\u3c0.001). Controlling for age group and ethnicity, myopia prevalence was also significantly linked with height (p\u3c0.001) and higher in participants in the following groups: using screens \u3e3 hours per day (OR=3.7, 95% CI 2.1 to 6.3, p\u3c0.001), obesity (OR=2.7, 95% CI 1.9 to 3.9, p\u3c0.001), sedentary lifestyle (OR=2.9, 95% CI 1.9 to 4.4, p\u3c0.001), frequently reading/writing (OR=2.2, 95% CI 1.4 to 3.5, p=0.001), less daylight exposure during summer time (OR=5.00, 95% CI 2.4 to 10.3, p\u3c0.001), spring season births (OR=1.9, 95% CI 1.1 to 3.3, p=0.02), paternal history of myopia (OR=2.4, 95% CI 1.8 to 3.3, p\u3c0.001) and bottle fed for the first three months of life (OR=1.7, 95% CI 1.3 to 2.5, p=0.02). Conclusions The associations found between myopia prevalence in schoolchildren in Ireland and demographic and lifestyle factors suggest that longitudinal research investigating the associations between myopia prevalence and these factors may be beneficial in advising preventative public health programmes

Prevalence of colour vision deficiency in the Republic of Ireland schoolchildren and associated socio-demographic factors

Clinical relevance: Early screening is essential to counsel schoolchildren with congenital colour vision deficiency (CVD) in determining their future career path and to advise teachers of the impact of CVD on classroom difficulties. Background: Congenital CVD is an X-linked genetic abnormality relatively commonplace in humans. This study aimed to determine the prevalence of congenital CVD in the Republic of Ireland schoolchildren and associated socio-demographic factors. Methods: A total of 1,626 schoolchildren (882 boys and 744 girls), in two age groups (728 aged 6–7 years and 898 aged 12–13 years) were examined from randomly selected schools. Colour vision testing was carried out using the Richmond Hardy-Rand-Rittler pseudoisochromatic test for colour vision (fourth edition); diagnostic plates were used to determine CVD type and extent if participants failed to identify symbols on the screening plates. Results: CVD was detected in 73 boys (8.3 per cent, 95% confidence interval (CI) 6.6–10.3) and in 13 girls (1.8 per cent, 95% CI 1.0–3.1, p \u3c 0.001). As expected, deutan (boys 4.8 per cent, girls 0.8 per cent) was the most common type of CVD, followed by protan (boys 1.7 per cent, girls 0.1 per cent), unclassified red/green CVD (boys 1.2 per cent, girls 0.8 per cent) and then tritan (boys 0.5 per cent). One case of achromatopsia was detected based on failure on all diagnostic plates. Traveller participants (boys 21.0 per cent, girls 8.6 per cent) had a higher CVD prevalence than their White non-Traveller (boys 7.2 per cent, girls 1.0 per cent) and non-White (boys 5.4 per cent, girls 1.1 per cent) counterparts (odds ratio 3.00, 95% CI 1.1–8.1, p = 0.006). In boys, CVD was also associated with twin birth (odds ratio 2.7, 95% CI 1.1–6.7, p = 0.03) and low birthweight (p = 0.04). Conclusion: This investigation of CVD in the Republic of Ireland schoolchildren should alert clinicians to the association between CVD and Traveller ethnicity, twin birth and lower birthweight. The prevalence of CVD found was similar to previous studies involving predominantly White populations and higher among Traveller participants; hence, counselling regarding inherited anomalies in the Traveller community is recommended. Early screening is essential to counsel schoolchildren with CVD in determining their future career path and to advise teachers of the impact of CVD on classroom difficulties

Refractive error and visual impairment in Ireland schoolchildren

Aim To report refractive error prevalence and visual impairment in Republic of Ireland (henceforth \u27Ireland\u27) schoolchildren. Methods The Ireland Eye Study examined 1626 participants (881 boys, 745 girls) in two age groups, 6–7 years (728) and 12–13 years (898), in Ireland between June 2016 and January 2018. Participating schools were selected by stratified random sampling, representing a mix of school type (primary/postprimary), location (urban/rural) and socioeconomic status (disadvantaged/advantaged). Examination included monocular logarithm of the minimum angle of resolution (logMAR) presenting visual acuity (with spectacles if worn) and cycloplegic autorefraction (1% Cyclopentolate Hydrochloride). Parents completed a questionnaire to ascertain participants’ lifestyle. Results The prevalence of myopia (spherical equivalent refraction (SER): ≤−0.50 D), hyperopia (SER: ≥+2.00 D) and astigmatism (≤−1.00 DC) among participants aged 6–7 years old was 3.3%, 25% and 19.2%, respectively, and among participants aged 12–13 years old was 19.9%, 8.9% and 15.9%, respectively. Astigmatic axes were predominately with-the-rule. The prevalence of ‘better eye’ presenting visual impairment (≥0.3 logMAR, with spectacles, if worn) was 3.7% among younger and 3.4% among older participants. Participants in minority groups (Traveller and non-white) were significantly more likely to present with presenting visual impairment in the ‘better eye’. Conclusions The Ireland Eye Study is the first population-based study to report on refractive error prevalence and visual impairment in Ireland. Myopia prevalence is similar to comparable studies of white European children, but the levels of presenting visual impairment are markedly higher than those reported for children living in Northern Ireland, suggesting barriers exist in accessing eye care

Visual factors associated with physical activity in schoolchildren

Clinical relevance Physical activity is an essential part of childhood physical and mental development. Recent research identified visual problems associated with a sedentary lifestyle in children in Ireland. Background This study explored the association between visual function in children and their engagement with physical activities outside school. Methods Participants were 1,626 schoolchildren (728 aged 6–7 years, 898 old 12–13 years) in randomly selected schools in Ireland. Before data collection, parents/legal guardians of participants completed a standardised questionnaire reporting physical activity as no activity (mostly on screens), light activity (occasional walking/cycling), moderate activity (/week engaged in sports), or regular activity (\u3e3hrs/week been involved in sports). Measurements included logMAR monocular visual acuities (with spectacles and pinhole), in the distance (3 m) and near (40 cm), stereoacuity (TNO stereo-test), cover test, and cycloplegic autorefraction (1% cyclopentolate). Results Controlling for confounders (socioeconomic disadvantage and non-White ethnicity), linear regression analysis revealed presenting distance visual acuity, near visual acuity, and stereoacuity were significantly better amongst participants who reported regular physical activity rather than moderate light or no activity in both 6–7-year-old and 12–13-year-old participants. Absence of clinically-significant refractive error (\u3e−0.50D \u3c 2.00D) was associated with regular physical activity. Participants presenting with visual impairment (better-eye vision \u3c6/12) (odds ratio = 5.78 (2.72–12.29)), amblyopia (pinhole acuity ≤6/12 plus an amblyogenic factor) (odds ratio = 5.66 (2.33–13.76)), and participants at school without their spectacles (odds ratio = 2.20 (1.33–3.63)), were more likely to report no activity. Conclusions Children regularly engaged in physical activities, including sports, had better visual and stereoacuity; and were less likely to need spectacles. No physical activity was associated with visual impairment, amblyopia, and refractive error, and spectacle wear compliance was associated with regular physical activity. Regular physical activity is an essential factor in childhood vision, and addressing visual impairment in children is vital to increasing participation in sports and exercise. Socioeconomically disadvantaged and non-White communities would benefit most from these measures

How Too Much Screen Time Is Changing Children\u27s Eyes?

In recent years, there has been an alarming increase in people with myopia (shortsightedness). Over two generations, myopia rates increased fourfold in Asia and doubled in the UK, with children becoming myopic at younger ages. By 2030, 2.5 billion people may be affected, so finding ways to stop this growing issue is crucial