Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 59516

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : NC05 - NC08 Full Version

Clinical Profile of Refractive Errors Associated with Screen Time in Children Aged 5-15 Years in a Tertiary Care Hospital of Southern India during COVID Pandemic: A Prospective Study


Published: October 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56373.17089
Navneeth Servey, NVN Prasanna Bharathi, M Radhika, B Hyndavi, B Srividya

1. Assistant Professor, Department of Ophthalmology, ESIC Medical College and Hospital, Hyderabad, Telangana, India. 2. Senior Resident, Department of Ophthalmology, ESIC Medical College and Hospital, Hyderabad, Telangana, India. 3. Professor, Department of Ophthalmology, ESIC Medical College and Hospital, Hyderabad, Telangana, India. 4. Senior Resident, Department of Ophthalmology, ESIC Medical College and Hospital, Hyderabad, Telangana, India. 5. Optometrist, Department of Ophthalmology, ESIC Medical College and Hospital, Hyderabad, Telangana, India.

Correspondence Address :
Dr. NVN Prasanna Bharathi,
E-507, Fresh Living Apartments, Madhapur, Hyderabad, Telangana, India.
E-mail: bharathi.mbbs@gmail.com

Abstract

Introduction: Refractive errors cannot be prevented, but it is important to detect them early to improve the quality of life and prevention of blindness. Refractive errors screening in children during Coronavirus disease-2019 (COVID-19) pandemic was difficult task as they were high-risk group. Increased near activity due to online classes and smart devices usage may increase the uncorrected refractive errors. The study emphasises on the refractive errors screening during COVID pandemic.

Aim: To study the clinical profile of refractive errors of the children aged 5-15 years in a tertiary care hospital in COVID pandemic in association with screen time, outdoor activity, type of gadget, amblyopia and educational status of mother.

Materials and Methods: This was a hospital based prospective analytical study conducted in children 5-15 years attending the Ophthalmology Outpatient Department of ESIC Medical College and Hospital, Telangana, India, from May to October 2021. Children were screened for refractive errors and compared with the refractive errors data of different children of same age referred from Paediatric Outpatient Department and who attended to Ophthalmology Outpatient Department for regular eye checkup in prepandemic time. Unaided visual acuity of all children were measured with the help of Snellen’s chart. Children with refractive errors underwent cycloplegic retinoscopy followed by postmydriatic test. Screen time and outdoor activity duration were recorded. Interpretation and analysis of obtained results was carried out using Statistical Package for Social Sciences version 22.0 for descriptive statistics. Non parametric tests like Pearson Chi-square test were used to express the qualitative data. Data with p-value less than 0.05 was considered statistically significant.

Results: A total of 790 children were screened out of which 358 (45.3%) presented with refractive error when compared with the prepandemic prevalence 276 (34.9%) out of 790 children screened, presented with the refractive error. A total of 118 (33%) of the children presented with increased blink rate associated with increased screen time and dry eye. Rate of progression of more than 1D was observed in 44 (12.29%) of which myopia 28 (7.8%), astigmatism 10 (2.7%) and hypermetropia 6 (1.6%) in six months. A total of 286 (79.8%) children presented with myopia and 24 (6.7%) presented with hypermetropia, 48 (13.4%) presented with astigmatism. A total of 258 (72.06%) presented with screen time for four to seven hours and 32 (8.9%) children presented with amblyopia.

Conclusion: Refractive errors increased due to smart classes in schools or use of laptops, television viewing, computers or mobiles. Hence, this reinforces the need to screen all the school going children and children with the history of gadgets use.

Keywords

Amblyopia, Blinking, Coronavirus disease-2019, Outdoor activity, Prevalence, Progression

Refractive errors- myopia, hyperopia and astigmatism cause blurred vision due to an inability to focus images on the retina. Uncorrected refractive errors in long run may cause harmful consequences for children, since vision is developed in the first years of life. Refractive errors cannot be prevented, but it is important to detect them early (1). Global data shows uncorrected refractive errors (43%) are the leading cause of visual impairment followed by unoperated cataract (33%) and glaucoma (2%) (2). The prevalence of blindness in children in India is estimated to be 0.8/1000 children in the age group of 0-15 years [3,4]. COVID pandemic and lockdown led to the restricted movement of public. Parents due to the fear of COVID contact avoided screening of children’s refractive errors and follow-up of already diagnosed refractive errors. Prevalence of refractive errors increased during COVID-19 pandemic due to increased screen time, restricted outdoor activity and lack of screening (5). As refractive errors are effectively treated by simple visual aids, the amount and pattern of refractive errors need to be discovered and treated, to improve the quality of life and prevention of blindness.

Keeping this in mind, the proposed study was conducted to determine the clinical profile of refractive errors in children aged 5-15 years in association with increased screen time, decreased outdoor activity, increased blink rate, amblyopia, literacy of mother and compared prevalence of refractive errors before and during COVID pandemic in Employees State Insurance Corporation Medical college and Hospital, in Telangana region in South India.

Material and Methods

This was a hospital based prospective analytical study conducted in Ophthalmology Outpatient Department (OPD), in ESIC Medical College and Hospital in Hyderabad, India, in children 5-15 years from May to October 2021. The study was conducted after getting approval from Institutional Ethical Clearance (Approval number ESICMC/SNR/IEC-F296/05-2021, version no V01) and informed consent from the parents and guardians of the children screened.

Sample size calculation: was done by using the formula:

n=Z2×pxq/(d)2 with P as estimated mean prevalence of refractive errors, which was 24%.

where, Z1-a=standard normal deviant at 95% confidence level i.e.1.96, p=prevalence=24%, q=100-p=76, d=absolute precision of 3%.

N=1.962×24×76/32=778

Allowing a 2% non response rate the sample size was 778+12=790. A total of 790 children were screened for refractive error.

Inclusion criteria: Children of 5-15 years of age with refractive error 0.50 D or more were included and prior consent for examination was taken from parent or guardian of every child.

Exclusion criteria: Children below five years of age, those with ocular abnormalities of keratoconus, vernal keratoconjunctivitis, other systemic disorders and children with media opacities, history of intraocular surgery were excluded.

Study Procedure

Clinical profile and prevalence of refractive errors in children aged 5-15 years presenting to tertiary care hospital during COVID pandemic was studied and compared with pre-COVID times, prevalence of refractive errors in association with variables like age, sex, screen time of the children, education status of mother was studied. All the children presenting with diminished vision, blurring, headache, increased blinking and asthenopic symptoms were studied. Relevant personal and family history was taken. Every child underwent a standard routine eye examination. Visual acuity was measured at 6 m by an optometrist, using a digital vision algorithm of the minimum angle of resolution chart and was recorded as the smallest line read with one or no errors after converting it to Snellen equivalent. Hirschberg corneal reflex test was done in all cases. Extraocular movements, cover test and pupillary reaction was assessed in all the cases. Pupils were dilated with two drops of 1% cyclopentolate and one drop of 0.8% tropicamide +5% phenylephrine, administered five minutes apart. Light reflex and pupil dilation were evaluated after 45 minutes. Refraction was performed by an optometrist, regardless of visual acuity using a streak retinoscope and postmydriatic test was performed.

Children with uncorrected visual acuity of 6/9 or worse in either eye examined using a slit lamp and the fundus was evaluated with the help of an indirect ophthalmoscope. Amblyopia was defined as unilateral or bilateral subnormal vision, atleast two lines less than normal or two lines less than the fellow eye in unilateral cases. On the basis of unaided visual acuity, visual impairment was graded as mild (VA 6/6 to 6/12), moderate (VA 6/18 to 6/36) and severe (VA 6/60 to less than 6/60) (6). Refractive errors were classified according to the standard definitions as myopia, hypermetropia and astigmatism. Prevalence of magnitude of refractive errors during COVID pandemic was compared with magnitude data of refractive errors recorded at one time of different children of same age group attending to Ophthalmology OPD. Before pandemic, If the child needed spectacles after the examination, prescription of glasses along with the spectacles was provided free of cost and hence, the prevalence of refractive errors during pre-COVID times were compared with their prevalence in the present study.

Statistical Analysis

Interpretation and analysis of obtained results was carried out using Statistical Package for Social Sciences (SPSS) version 22.0 for descriptive statistics. Non parametric tests like Pearson Chi-square test were used to express the qualitative data. Data with p-value less than 0.05 was considered statistically significant.

Results

A total of 790 children were screened out of which 358 (45.3%) presented with refractive error when compared with the prepandemic magnitude data of prevalence of refractive errors in 790 children screened, 276 (34.9%) children presented with the refractive error in the hospital. A 10% increase in refractive errors were observed (Table/Fig 1). In 358 children with refractive error 160 (44.6%) were males and 198 (55.4%) were females (Table/Fig 2). In the study average number of children presented in 13-15 years were 144 (40.1%). A total of 38 (10.61%) children had family history of refractive error and 320 (89.38%) children were without family history. In the study 44 (12.29%) children had past history of spectacles with refractive error and 314 (87.70%) were newly diagnosed with refractive error (Table/Fig 2). In the study 162 (45.2%), mild refractive error, 118 (32.9%) moderate refractive error, 78 (21.7%) severe refractive error was observed. Total 264 (33%) of the children presented with blinking symptom related to increased screen time. The (Table/Fig 3) showed no significant association of refractive errors with gender. However, significant association was observed between age and refractive errors (Table/Fig 4). Mothers of 194 (54.18%) children with refractive error were literate and 164 (45.81%) mothers were illiterate (Table/Fig 5).

Among the refractive errors more number of children presented with myopia 286 (79.8%), followed by astigmatism 48 (13.4%) and hypermetropia 24 (6.7%). Rate of progression of more than 1D was observed in 44 (12.29%), whereas myopia 28 (7.8%), astigmatism 10 (2.7%) and hypermetropia 6 (1.3%) in six months during pandemic. In the study, out of 358 children, 32 (8.9%) children presented with amblyopia and 326 (91.1%) children refractive error was correctable with the spectacles, counseling about working distance, posture, short breaks during online school hours, use of large screen and treated with lubricating eye drops for screen time induced dry eyes. Prepandemic prevalence of refractive errors in 790 children was observed in 276 (34.9%) children. A total of 219 (79.3%) children had myopia, 35 (12.6%) had astigmatism, 22 (7.9%) had hypermetropia. A 10% increase in prevalence of refractive error was observed from prepandemic prevalence of refractive error.

The (Table/Fig 6) depicts the type of gadget used by the children. In the study children who presented during COVID pandemic with screen time >7 hours was 74 (20.67%) (Table/Fig 7). A total of 639 (81%) of the children used mobile, 119 (15%) used laptop, 23 (3%) used Television (TV), 9 (1%) used i-pads to attend online classes during pandemic.

Discussion

Myopia is on the rise, partially due to increased screen time in current pandemic-induced reliance on virtual classrooms and partially because of restricted outdoor activity. About (32%) prevalence rate of refractive errors has been reported among school children of age 3-18 years from South India (7). In the study, female students (55.4%) were affected more than males (44.6%) as in Pradhan N et al., (8). In a population based study done by Dulani N and Dulani H, in Jaipur, Rajasthan, in which female preponderance was seen (9). Other population based studies done by Pavithra MB et al., in Bangalore and Prema N, in Tamil Nadu also reported that females are more affected by refractive errors (10),(11). The possible cause of this difference may be unawareness of the needs of female child or inhibition with spectacle usage in females. In the study, prevalence of myopia, astigmatism, hypermetropia in 5-15 years children was 79.8%, 13.45% and 6.7% respectively. Many studies done in several countries throughout the world including India reported myopia as the most common refractive error (12),(13). High rate of refractive errors in the present study population can also be attributed to different lifestyles or living conditions like watching TV for long hours or using computers due to covid pandemic and online classes, restricted outdoor activity.

In the study, mother’s literacy rate of children with the refractive error is high compared to the children of illiterate mothers. This can be explained by the fact that the children from families led by parents with higher levels of education have more emphasis on studies, entail near work, which in turn could cause early detection of refractive error. In the present study, 72.06% children had three to seven hours of screen exposure per day, followed by 20.67% of children had >7 hours and 7.2% of children had <3 hours of screen exposure. This explains that outdoor restricted activity and increased indoor mobile, laptop, TV., I-pad usage in COVID pandemic. In the current study, out of 358 children with the refractive error 8.9% were found to have amblyopic children belonged to 5-10 years’ age group similar to the study of Rajput VK et al., which is more than the result of Mittal S et.al study (6),(14). Due to COVID pandemic parents avoided eye screening in children with the fear of COVID contact in the children. Hence, this reinforces the need to screen all the school going children and children with the history of gadgets use .

Limitation(s)

The present study compared only magnitude of prevalence of refractive errors before and during pandemic. It was about increased refractive errors during pandemic which is associated with increased screen time, restricted outdoor activity, increased blinkrate, increased smart phone, tablet and laptop usage. Study was conducted in small sample size in a tertiary hospital and the results cannot be attributed to large community. Further studies are needed to find an association and follow-up of refractive errors.

Conclusion

Refractive errors increased due to online classes from school or use of laptops, television viewing and computers or mobiles. On time diagnosis can prevent complications like amblyopia, strabismus and dry eyes. Regular eye examination of children and further emphasising the need of daily spectacle wearing can lead to better prognosis. Parents, children, teachers, paediatricians awareness, education and active involvement can reduce avoidable blindness due to uncorrected refractive errors in this COVID pandemic.

Acknowledgement

The authors are very thankful to the Dean of the hospital for helping to conduct this study and acknowledge entire Ophthalmology Department,Optometrists, Paediatric Department, patients, for their help and cooperation in the study.

References

1.
Heus P, Verbeek JH, Tikka C. Optical correction of refractive error for preventing and treating eye symptoms in computer users. The Cochrane database of systematic reviews. 2018;4(4).CD009877. [crossref] [PubMed]
2.
WHO. Blindness and vision impairment. Available at: https://web.archive. org/web/20150512062236/http://www.who.int/mediacentre/factsheets/ fs282/en/.
3.
Wang J, Li Y, Musch DC, Wei N, Qi X 3, Ding G, et al. Progression of Myopia in School-Aged Children After COVID-19 Home Confinement. JAMA Ophthalmol. 2021;139(3):293-300. Doi:10.1001/jamaophthalmol. 2020.6239. [crossref] [PubMed]
4.
A Study on Childhood Blindness, Visual Impairment and Refractive Errors in East Delhi. New Delhi: Community Ophthalmology Section, RP Centre, AIIMS; 2001.
5.
Alvarez-Peregrina C, Martinez-Perez C, Villa-Collar C, Andreu-Vázquez C, Ruiz-Pomeda A, Sánchez-Tena MÁ, et al. Impact of COVID-19 Home Confinement in Children's Refractive Errors. Int J Environ Res Public Health. 2021;18(10):5347. Doi: 10.3390/ijerph18105347. PMID: 34067888; PMCID: PMC8156137. [crossref] [PubMed]
6.
Mittal S, Maitreya A, Dhasmana R. Clinical profile of refractive errors in children in a tertiary care hospital of Northern India. Int J Community Med Public Health. 2016;3(5):1189-94. [crossref]
7.
Kallklvayl V, Naduvllath TJ, Bansal AK, Dandona L. Visual impairment in school children in southern India. Ind J Ophthalmol. 1997;45(2):129-34.
8.
Pradhan N, Sachdeva A, Goel T, Bhola B, Jha D. Prevalence of refractive errors among school children of 6-12- years of age group and reason for not using spectacles even after correction. Int J Res Med Sci. 2018;6(3):798-01. [crossref]
9.
Dulani N, Dulani H. Prevalence of refractive errors among school children in Jaipur, Rajasthan. Int J Sci Study. 2014;2(5):52-55.
10.
Pavithra MB, Maheshwaran R, Rani Sujatha MA. A study on the prevalence of refractive errors among school children of 7-15 years age group in the field practice areas of a medical college in Bangalore. Int J Med Sci Public Health. 2013;2(3):641-45. [crossref]
11.
Prema N. Prevalence of refractive error in school children. Indian J.Sci.Technol. 2011;4(9):1160-18. [crossref]
12.
Dandona R, Dandona L, Srinivas M, Sahare P, Narsaiah S, Munoz SR, et al. Refractive error in children in a rural population in India. Invest Ophthalmol Vis Sci. 2002;43(3):615-22.
13.
Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive error study in children: Sampling and measurement methods for a multi-country survey. Am J Ophthalmol. 2000;129(4):421-26. [crossref] [PubMed]
14.
Rajput VK, Shetty N, Raut P.Epidemiology, Clinical Profile and pattern of refractive error in newly diagnosed cases of refractive error in paediatric population visiting a tertiary eye care center. J Clin Ophthalmol Res. 2021;9(2):67-70. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/56373.17089

Date of Submission: Mar 15, 2022
Date of Peer Review: May 10, 2022
Date of Acceptance: Aug 18, 2022
Date of Publishing: Oct 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 26, 2022
• Manual Googling: Jun 15, 2022
• iThenticate Software: Aug 16, 2022 (23%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com