|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 3 | Page : 384-385
Prevalence and risk factors for refractive errors in Kerala
OU Mallika1, KR Reesha2, S Jainy3, MS Sunil4
1 Department of Ophthalmology, Government TD Medical College, Alappuzha, Kerala, India
2 Little Flower Hospital and Research Centre, Angamaly, Kerala, India
3 Deparment of Ophthalmology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
4 Deparment of Ophthalmology, Regional Institute of Ophthalmology, Thiruvananthapuram, Kerala, India
|Date of Submission||27-May-2021|
|Date of Acceptance||29-May-2021|
|Date of Web Publication||08-Dec-2021|
O U Mallika
Department of Ophthalmology, Government TD Medical College, Alappuzha, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mallika O U, Reesha K R, Jainy S, Sunil M S. Prevalence and risk factors for refractive errors in Kerala. Kerala J Ophthalmol 2021;33:384-5
I wish to bring to your attention the high prevalence of refractive errors in the state of Kerala in South India. Refractive errors in schoolchildren are a common and treatable public health concern that has long-term implication of the vision and overall development of children. Several studies from 4 districts of Kerala have reported a prevalence of refractive errors that range from 15% to 30% and suboptimal use of spectacles.,,,,,, The reported prevalence is much higher than 7.5% prevalence of refractive errors reported by Agarwal et al. in their meta-analysis of 59 quality assessed studies from India. The significantly higher prevalence of refractive errors in schoolchildren of Kerala is a matter of grave concern. The fact that no studies from Kerala were included in the meta-analysis is also a matter of grave concern.
It is possible that the higher prevalence of refractive errors, especially myopia that is the most common refractive error, is associated with environmental risks. The association of myopia with increased near work at early ages, higher educational level of children and parents, higher socioeconomic status, and intelligence is recognized. Kerala is a highly literate state with an almost 100% school participation rate among children. There is also an increased use of digital devices for learning and recreation, working on computers, playing video games, and watching content in handheld devices. Smartphones are affordable and easily available and used often for work and leisure. The possible association with environmental factors is supported by a previous study that reported an urban-rural difference in the prevalence of refractive errors.
The importance of refractive errors is acknowledged by the Kerala Society of Ophthalmic Surgeons (KSOS) association that has started Baladarshan, a program to sensitize the schools regarding refractive errors and improve the early detection of refractive errors in children. However, we feel more must be done. The high school participation rate provides us with the opportunity to obtain reliable data on refractive errors from all districts and to provide appropriate services. More high-quality studies must be conducted preferably using standardized methods to ascertain age-specific prevalence, incidence, and risk factors and to plan for appropriate service delivery. High-quality research is essential to find the annual proportion of newly detected refractive errors and the dropout rates for the use of spectacles or contact lenses. Newer interventions for the management of high myopia and refractive errors are available and must be evaluated. The centrally sponsored school vision screening program of NPCB must integrate with the state's Sarva Shiksha Abhiyan program, and there must be mandatory regular school-based vision screening of all children using age-appropriate visual acuity tests. It is also necessary to complement visual acuity testing with assessments of functional vision in children particularly in children with development and neurocognitive delays. The high prevalence of refractive errors is a challenge that must be addressed to preserve the long-term ocular health of our future generations. The association of KSOS is uniquely placed and must play a leadership role to develop clinical and research and service delivery protocols and guidelines to address refractive errors of schoolchildren in Kerala.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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