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\title{Astigmatism among other Refractive Errors in Children of Southern Sri Lanka}
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             \author[1]{Saman  Wimalasundera}

             \affil[1]{  Faculty of Medicine, University of Ruhuna, Sri Lanka}

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\date{\small \em Received: 8 April 2015 Accepted: 3 May 2015 Published: 15 May 2015}

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\begin{abstract}
        


The main goal of this study was to find the problem of astigmatism among children with refractive errors who are were in the age group of 3 â??" 14 years. A two stage screening process was envisaged and 5649 children were screened to find visual abnormalities and other defects. Of them, 1233 (21. 8%) were selected for second stage screening. The total ophthalmological manifestations found were 7.8% (78/1000). The analysis of different morbidities included refractive errors 6. 2% and other eye diseases 1. 6%. Among refractive errors 2.3% were unilateral and 3.9% were bilateral involvement. The prevalence of simple myopia was 1.65% and of hypermetropia was 0.95%. Yhe astigmatism found was 1.5% unilaterally out of 2.3 of total unilateral refractive errors. Bilateral astigmatism was 2.1% out of 3. 9% of total bilateral refractive errors. Findings indicate the existence of more astigmatic errors among Sri Lankan children either unilaterally or bilaterally.

\end{abstract}


\keywords{refractive errors, astigmatism, simple myopia, hypermetropia, screening.}

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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
ne important major disease condition that leads to visual failure and related symptoms such as headache, and asthenopia include refractive errors of light rays entering the eyes.\par
The refraction of light means, when the rays of light travels through air, and enter a denser transparent medium the speed of light is reduced and the light rays proceed at a different angle (bending of rays) the light is hence called refracted. The ray of light, if incident perpendicularly to the denser medium, it does not bend but only reduces the speed.The refraction power of the light is derived from the index of refraction of various parts of the eye through which light passes in to the eye.\par
When the light from an object reaches the eye it has to pass the cornea, aqueous humor, crystalline lens and vitreous humor to get at the retina where the stimulus of light ray is converted to neuro-electrical impulses. \hyperref[b0]{(Andcea 1987)} The curvature of the cornea and the lens play an important role in the refraction of the light. The cornea contributes approximately two thirds of the refractive power and the lens contributes about one third of the refractive power of the eye. The cornea has the index of refraction of 1. 376 and lens has the average of 1.41.The total power of the eye does not equal to the sum of the power of the cornea and the lens because they are separated at aqueous and vitreous interfaces and it is around + 58 diopters. The curvature of the human lens could be altered using the circular cilliary muscle and its refractive state could be actively changed according to the need.\par
When the refraction of the eye does not take place accurately to focus the rays on to the macula area of the retina, the condition is called the refractive error (AMETROPIA). In an eye with a refractive error the parallel light rays that come in to the eye will therefore focus in front or behind the plane of the retina when the eye's optical system is at rest. This process will result in the blurring of the image. In a schematic eye a 0.3mm shift in the focal place needs a correction of one diopter.\par
The optical system described above assumed to have spherical structures. That means all meridians of curved structures have equal spheroidal surfaces. Many optical systems in the eye are however are not so and resembles a toric surface. In a toric surface the curvature varies in different meridians. In such instances the light rays passing through steep meridians will be more deflected than rays which pass through flatter meridians. This is a complicated process and will result in defocusing the part of the object from which the light rays pass in to the eye through anomalous meridian. This condition is called Astigmatism.\par
Corneal toricity is the cause of most of the Astigmatism. Astigmatism could be simple myopic or hypermetropic depending on where the ammetropic rays get their focal point. If the part of the rays is focused in front of the retina, it is called myopic astigmatism. When part of the rays is focused behind, it is called hypermetropic stigmatism. When only one meridian is ammetropic (either myopic or hypermetropic) it is called simple myopic or hypermetropic astigmatism.In the mixed type of astigmatism one principal meridian is myopic type and the other one is hypermetropic type. When both meridians are ammetropic, it is called compound astigmatism. If both meridians are hypermetropically deviated differently it is called compound hypermetropic astigmatism and if the same entity happens myopically the condition is called compound myopic astigmatism. In mixed type of astigmatism one meridian becomes hypermetropic whilst the other is myopic.\par
Astigmatism is again classified as regular or irregular. In the regular type the principal meridian are ninety degrees apart. (Perpendicular to each other). In irregular astigmatism the principal meridians are not perpendicular. Most astigmatisms are regular type. (Gary Heitingod) (Jackson ans Finlay 1985)\par
Refractive errors among children could be easily detected and treated. Delay in seeking treatment lead to significant ocular morbidity including amblyopia, low vision and poor quality of life (Resinikoff 2004) Having recognized the importance of the prevention of low vision, the 66th world health assembly initiated a global action plan for 2014 -2019 to promote universal eye health. This plan requests member states to take measures to reduce avoidable visual impairement by 25\% by the year 2019 (WHO 2013) \hyperref[b2]{(Deborah 1985)} Astigmatism can be corrected with special type of lenses called toric lenses. In a toric lens one meridian is more curved than all other meridians. The meridian of least curvature and greatest curvature are always at right angles in a toric lens. Toric lenses can be plus lenses (to correct hypermetropic astigmatism)or minus lenses (to correct myopic astigmatism) Toric lenses are called sphero-cylinders, in which the power of the lens act only perpendicular to its axis.\par
Clinically people with astigmatism experience headache, fatigue of eyes after work, eye strain and blurred vision at distances. These symptoms may not necessarily due to astigmatism only but exclusion of astigmatism is important in people with such symptoms. 
\section[{II.}]{II.}\par
Objective of the Study 1. To find the prevalence of astigmatism among school children and its different types. 
\section[{a) Study setting}]{a) Study setting}\par
One of the health unit areas of Galle(Bop-Poddala) district was selected for this study. All children of 3 -14 years were taken as study subjects.\par
b) The study design\par
The study design included three stages. In stage one the primary visual screening at schools, pre schools and in the community was done. The positive cases difficult cases, refusals and absentees were re screened at stage two screening in the field. The selected cases from second screening were referred to a third stage complete ophthalmological examination for diagnostic and treatment purposes at a well equipped eye clinic.\par
Primary and secondary screening of children was done by trained, medically qualified doctors with the help of the chief investigator in the field. The third stage examination was done by the ophthalmic qualified principal investigator. The health department field staff helped in other activities like finding subjects from the community, schools and pre schools. 
\section[{III.}]{III.} 
\section[{Results}]{Results} 
\section[{a) Coverage of subjects}]{a) Coverage of subjects} 
\section[{Screening of children}]{Screening of children} 
\section[{Schools}]{Schools}\par
Pre schools /community    IV. 
\section[{Discussion}]{Discussion}\par
The main aim of this study was to highlight the astigmatism in Sri Lankan children including other types of refractive errors. Uncorrected refractive errors can hamper the performance at schools and lead to various symptoms such as headache, pain in the eyes and aesthenopic symptoms.\par
A study among children aged 5 -17 years from Asia, Afro America, Hispanics and Whiles revealed that Asians had the highest age and sex adjusted prevalence of myopia (18.5\%) and astigmatism (33.6\%) (Kleinstein, Lee, and Zadnik 2003)\par
A study conducted among 7 -15 years old children (N = 44.4) in a rural population of India showed that the couse of visual impairement is mainly refractive errors and it was 61\%.  {\ref (Dandona et al 2002)} Another study done in Hydrabad India in children aged 3 -18 years revealed astigmatism of 10.3\% (Kalikirani, Naduvilath, Bantal and Dandora 1997). \hyperref[b8]{Seimon (2005)} analysed the prescriptions issued by over 150 optometrists that includes children <15 years over a period of one year and found that 5612 children had sought correction for all kinds of refractive errors.\par
In this study the total sample of children between 3-14 years was 5649, representing the children of same age group living in southern Sri Lanka. Of them1233 (21.8\%) were selected for further second stage screening using the Snellen's chart and direct examination of the anterior segment. Those selected cases included the first stage screen failures and the difficult to screen cases. For the second stage 98\% of referred cases attended and of them 512 children were qualified for the third stage examination. After the examination, 439 cases were confirmed having an ophthalmological diagnosis, giving a prevalence of 7.8\% (78/1000).\par
The analysis of different disease conditions gave the prevalence of Refractive errors of 6,2\%(62/1000) and other eye conditions of 1.6\% (16/1000).Table \hyperref[tab_0]{1}.\par
The analysis of the distribution of Refractive errors showed 2.3\% (23/1000)of unilateral involvement and 3.9\%(39/1000) of bilateral refractive errors in children.-Tables2, 3, \& 4.\par
The prevalence of total simple myopia (bilateral and unilateral) was 1.65\% (16.5 / 1000). Simple hypermetropia 0.95 (?.1.0\% or 10 / 1000)\par
The astigmatism in children is the main concern of this paper and the the analysis showed a prevalence of unilateral Astigmatism of 1.5\% or 15/1000 compared to total unilateral refractive errors of 23/ 1000 in children. The prevalence of bilateral astigmatism was 21/1000 compared to total unilateral refractive errors of 39/1000.In the calculation In the calculation of total Astigmatism, the average of bilateral similar types were considered-Table  {\ref 5}.\par
The average Astigmatism calculated was 59.0\%of all Refractive errors and the most prevalent form of Astigmatism in school children was found to be Myopic Astigmatism, which amounts to 45.7\% of all refractive errors. As a prevalence the Myopic Astigmatism alone was 2.8\% (28/ 1000 )either unilaterally or bilaterally in school children in southern Sri Lanka making it the most common form of refractive error.\par
This study highlights that the refractive errors constitute a considerable amount of visual problems among children. Among all refractive errors in Sri Lankan children Astigmatism constitute a bulk. Although Sri Lanka has a well established primary health care system, the burden of refractive errors implies that further consideration in to the issue of screening is needed.\begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.45146520146520147\textwidth}P{0.3985347985347985\textwidth}}
School children year 1 -9\tabcellsep Pre school children\\
Total No 6685*\tabcellsep Total No 934**\\
Number attended for screening\tabcellsep Number attended755\\
(74.8\%) 5001\tabcellsep (80.8\%)\\
Excluded (Above 15yr) 38 (0.57\%)\tabcellsep Excluded 69 (7.4\%) (inability\\
\tabcellsep to check VA\\
Included to study 4963 (74.2\%)\tabcellsep Included to study 686 (73.4)\end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.33260869565217394\textwidth}P{0.1108695652173913\textwidth}P{0.12934782608695652\textwidth}P{0.27717391304347827\textwidth}}
Distribution\tabcellsep Eye\tabcellsep \tabcellsep Prevalence\\
Unilateral\tabcellsep Right\tabcellsep 40\tabcellsep 0.7\%\\
\tabcellsep Left\tabcellsep 88\tabcellsep 1.6\%\\
Bilateral\tabcellsep \tabcellsep 223\tabcellsep 3.9\%\\
Total\tabcellsep \tabcellsep 351\tabcellsep 6.2\%\\
\tabcellsep \tabcellsep eyes\tabcellsep \end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.387752808988764\textwidth}P{0.09932584269662921\textwidth}P{0.09168539325842696\textwidth}P{0.04202247191011236\textwidth}P{0.047752808988764044\textwidth}P{0.028651685393258425\textwidth}P{0.0649438202247191\textwidth}P{0.08786516853932584\textwidth}}
\tabcellsep \multicolumn{4}{l}{Different types -unilateral involvements}\tabcellsep \tabcellsep \tabcellsep \\
Types of refractive errors\tabcellsep \tabcellsep \multicolumn{2}{l}{involvements}\tabcellsep \tabcellsep \tabcellsep Total\tabcellsep Prevalen\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep ce\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep N=5649\\
\tabcellsep \tabcellsep Right\tabcellsep Left\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep No\tabcellsep \%\tabcellsep No\tabcellsep \%\tabcellsep No\tabcellsep \%\tabcellsep \\
Simple myopia\tabcellsep 8\tabcellsep 20.5\tabcellsep 23\tabcellsep 25.8\tabcellsep 31\tabcellsep 24.2\tabcellsep 0.5\\
Simple Hypermetropia\tabcellsep 9\tabcellsep 23.5\tabcellsep 7\tabcellsep 7.9\tabcellsep 16\tabcellsep 12.5\tabcellsep 0.3\\
Myopic Astigmatism\tabcellsep 16\tabcellsep 41.0\tabcellsep 51\tabcellsep 57.3\tabcellsep 67\tabcellsep 52.3\tabcellsep 1.2\\
Hypermetropic Astigmatism\tabcellsep 2\tabcellsep 5.1\tabcellsep 1\tabcellsep 1.1\tabcellsep 3\tabcellsep 2.3\tabcellsep 0.05\\
Compound Myopic Astigmatism\tabcellsep -\tabcellsep \tabcellsep 2\tabcellsep 2.2\tabcellsep 2\tabcellsep 1.6\tabcellsep 0.04\\
Compound Hypermetropic\tabcellsep 2\tabcellsep 5.1\tabcellsep 1\tabcellsep 1.1\tabcellsep 3\tabcellsep 2.3\tabcellsep 0.05\\
Astigmatism\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Mixed Astigmatism\tabcellsep 2\tabcellsep 5.1\tabcellsep 4\tabcellsep 4.5\tabcellsep 6\tabcellsep 4.7\tabcellsep 0.11\\
Total\tabcellsep 39\tabcellsep 100\tabcellsep 89\tabcellsep \tabcellsep 128\tabcellsep 100\tabcellsep \\
Prevalence (N=5649)\tabcellsep \tabcellsep 0.7\%\tabcellsep 1.6\%\tabcellsep \tabcellsep \tabcellsep \tabcellsep 2.3\%\end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.38387096774193546\textwidth}P{0.09069478908188584\textwidth}P{0.05694789081885855\textwidth}P{0.05483870967741935\textwidth}P{0.06116625310173697\textwidth}P{0.05272952853598015\textwidth}P{0.06538461538461539\textwidth}P{0.08436724565756824\textwidth}}
\tabcellsep \multicolumn{3}{l}{Bilateral involvements}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Type\tabcellsep Right\tabcellsep \tabcellsep Left\tabcellsep \tabcellsep \tabcellsep Total\tabcellsep Preval\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep ence\\
\tabcellsep N0\tabcellsep \%\tabcellsep N0\tabcellsep \%\tabcellsep N0\tabcellsep \%\tabcellsep \%\\
Simple myopia\tabcellsep 64\tabcellsep 28.7\tabcellsep 66\tabcellsep 29.6\tabcellsep 130\tabcellsep 29.1\tabcellsep 1.15\\
Simple Hypermetropia\tabcellsep 41\tabcellsep 18.4\tabcellsep 34\tabcellsep 15.2\tabcellsep 75\tabcellsep 16.8\tabcellsep 0.65\\
Myopic Astigmatism\tabcellsep 83\tabcellsep 37.2\tabcellsep 91\tabcellsep 40.8\tabcellsep 174\tabcellsep 39.0\tabcellsep 1.55\\
Hypermetropic Astigmatism\tabcellsep 9\tabcellsep 4.0\tabcellsep 10\tabcellsep 4.5\tabcellsep 19\tabcellsep 4.3\tabcellsep 0.15\\
Compound Myopic Astigmatism\tabcellsep 17\tabcellsep 7.6\tabcellsep 14\tabcellsep 6.3\tabcellsep 31\tabcellsep 7.0\tabcellsep 0.25\\
Compound Hypermetropic Astigmatism\tabcellsep -\tabcellsep -\tabcellsep 1\tabcellsep 0.4\tabcellsep 1\tabcellsep 0.2\tabcellsep 0.01\\
Mixed Astigmatism\tabcellsep 9\tabcellsep 4.0\tabcellsep 7\tabcellsep 3.1\tabcellsep 16\tabcellsep 3.6\tabcellsep 0.15\\
Total\tabcellsep 223\tabcellsep 100\tabcellsep 223\tabcellsep 100\tabcellsep \multicolumn{2}{l}{446 eyes}\tabcellsep \\
Prevalence (N=5649)\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{3.9\%}\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_3}Table 4 :}\end{figure}
 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[Dandona R Dandona et al.]{b1}\label{b1} 	 		\textit{},  		 			L Dandona R Dandona 		,  		 			M Srinivas 		,  		 			P Sahare 		,  		 			S Narsaiah 		,  		 			S R Mun 		.  	 	 		\textit{Pokhrael GP and Ellwein LB visual Sciences}  		43  (3)  p. .  	 
\bibitem[Crs and Finlay ()]{b4}\label{b4} 	 		\textit{) the eye in general practice},  		 			Jackson Crs 		,  		 			R D Finlay 		.  		1985. Edinburgh, London cherchil Livingstone.  	 	 (th ed) 
\bibitem[Deborah ()]{b2}\label{b2} 	 		 			Pavan -Langston Deborah 		.  		\textit{Manual of ocular diagnoses and therapy Asian edition},  				1985. p. .  	 
\bibitem[Draft action plan for the prevention of avoidable blindness and visual impairement ()]{b9}\label{b9} 	 		\textit{Draft action plan for the prevention of avoidable blindness and visual impairement},  		 \url{http://apps.who.int/gb/ebwha/pdftiles/EB132/B132.9.enpdf}  		2013. 2014. 2019.  	 
\bibitem[Gary Heiting or www]{b3}\label{b3} 	 		\textit{Gary Heiting or www},  		 	 	 (allabout vision.com) 
\bibitem[Resnikoff et al. ()]{b7}\label{b7} 	 		‘Global magnitude of visual impairement caused by uncorrected refractive errors in 2004’.  		 			S Resnikoff 		,  		 			D Pascolini 		,  		 			S P Mariotti 		,  		 			G P Pokharel 		.  	 	 		\textit{Bull world health org}  		2008. 86  (1)  p. .  	 
\bibitem[Kleinstien et al. ()]{b6}\label{b6} 	 		‘refractive error and ethnicity in children’.  		 			R N Kleinstien 		,  		 			R J Lee 		,  		 			K Zadnik 		.  	 	 		\textit{Arch. Ophthalmology}  		2003. 121 p. .  	 
\bibitem[Seimon ()]{b8}\label{b8} 	 		\textit{the distribution of refractive errors in Sri Lankan children. The journal of the college of ophthalmologists of Sri Lanka},  		 			R Seimon 		.  		2005. 11 p. .  	 
\bibitem[Andcea (1987)]{b0}\label{b0} 	 		\textit{The refractive errors in children. The paediatric clinics of north Americavol},  		 			C Andcea 		.  		December 1987. 34 p. .  	 
\bibitem[Kalkivayi et al. ()]{b5}\label{b5} 	 		‘visual impairement in school children in southern’.  		 			V Kalkivayi 		,  		 			T J Naduvisath 		,  		 			A K Bansal 		,  		 			L Dandora 		.  	 	 		\textit{India Indian J. ophthalmology}  		1997. 45 p. .  	 
\end{bibitemlist}
 			 		 	 
\end{document}
