title: Risk factors for astigmatism in the Vision in Preschoolers Study.
abstract: OBJECTIVE
  To determine demographic and refractive risk factors for astigmatism in the Vision in Preschoolers Study.
  
  
  METHODS
  Three- to 5-year-old Head Start preschoolers (N = 4040) from five clinical centers underwent comprehensive eye examinations by study-certified optometrists and ophthalmologists, including monocular visual acuity testing, cover testing, and cycloplegic retinoscopy. Astigmatism was defined as the presence of greater than or equal to +1.5 diopters (D) cylinder in either eye, measured with cycloplegic refraction. The associations of risk factors with astigmatism were evaluated using the odds ratio (OR) and its 95% confidence interval (CI) from logistic regression models.
  
  
  RESULTS
  Among 4040 Vision in Preschoolers Study participants overrepresenting children with vision disorders, 687 (17%) had astigmatism, and most (83.8%) had with-the-rule astigmatism. In multivariate analyses, African American (OR, 1.65; 95% CI, 1.22 to 2.24), Hispanic (OR, 2.25; 95% CI, 1.62 to 3.12), and Asian (OR, 1.76; 95% CI, 1.06 to 2.93) children were more likely to have astigmatism than non-Hispanic white children, whereas American Indian children were less likely to have astigmatism than Hispanic, African American, and Asian children (p < 0.0001). Refractive error was associated with astigmatism in a nonlinear manner, with an OR of 4.50 (95% CI, 3.00 to 6.76) for myopia (≤-1.0 D in spherical equivalent) and 1.55 (95% CI, 1.29 to 1.86) for hyperopia (≥+2.0 D) when compared with children without refractive error (>-1.0 D, <+2.0 D). There was a trend of an increasing percentage of astigmatism among older children (linear trend p = 0.06). The analysis for risk factors of with-the-rule astigmatism provided similar results.
  
  
  CONCLUSIONS
  Among Head Start preschoolers, Hispanic, African American, and Asian race as well as myopic and hyperopic refractive error were associated with an increased risk of astigmatism, consistent with findings from the population-based Multi-ethnic Pediatric Eye Disease Study and the Baltimore Pediatric Eye Disease Study. American Indian children had lower risk of astigmatism.
authors.affiliation: *MS †PhD ‡OD §OD, MS ∥OD, PhD **MD, MSCE Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (JH, MGM, G-SY); Pennsylvania College of Optometry, Salus University, Elkins Park, Pennsylvania (EC); College of Optometry, The Ohio State University, Columbus, Ohio (MTK); College of Optometry, Northeastern State University, Tahlequah, Oklahoma (LAC); The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (GEQ); School of Optometry, University of California at Berkeley, Berkeley, California (DO-B); and New England College of Optometry, Boston, Massachusetts (BM).
authors.forename: Jiayan
authors.initials: J
authors.lastname: Huang
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Maguire
authors.forename: Elise
authors.initials: E
authors.lastname: Ciner
authors.forename: Marjean Taylor
authors.initials: MT
authors.lastname: Kulp
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Cyert
authors.forename: Graham E
authors.initials: GE
authors.lastname: Quinn
authors.forename: Deborah
authors.initials: D
authors.lastname: Orel-Bixler
authors.forename: Bruce
authors.initials: B
authors.lastname: Moore
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
mesh_terms: D001251:Astigmatism / Q000208:ethnology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000208:ethnology*; D008297:Male; D009216:Myopia / Q000208:ethnology*; D016017:Odds Ratio; D012307:Risk Factors; D014787:Vision Tests
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