title: Refractive error and visual impairment in school-age children in Gombak District, Malaysia.
abstract: OBJECTIVE
  To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city.
  
  
  METHODS
  Population-based, cross-sectional survey.
  
  
  METHODS
  Four thousand six hundred thirty-four children 7 to 15 years of age living in 3004 households.
  
  
  METHODS
  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.
  
  
  METHODS
  Distance visual acuity and cycloplegic refraction.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ophthalmology, Hospital Selayang, Selangor, Malaysia.
authors.forename: Pik-Pin
authors.initials: PP
authors.lastname: Goh
authors.forename: Yahya
authors.initials: Y
authors.lastname: Abqariyah
authors.forename: Gopal P
authors.initials: GP
authors.lastname: Pokharel
authors.forename: Leon B
authors.initials: LB
authors.lastname: Ellwein
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000453:epidemiology*; D014786:Vision Disorders / Q000453:epidemiology*; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*