Refractive errors in a large dataset of French children: the ANJO study

www.nature.com/scientificreports OPEN Refractive errors in a large dataset of French children: the ANJO study Rébecca Guillon‑Rolf1,2, Leslie Grammatico‑Guillon3, Nicolas Leveziel4, Francois Pelen5, Eve Durbant2,6, Jimmy Chammas2,6 & Raoul K. Khanna 2,7,8* Undetected refractive errors (REs) in children can lead to irreversible vision loss. This study aimed to show the proportions of REs in French children using cycloplegic refraction. Multicentre crosssectional retrospective study including children with cycloplegic refraction and without associated ocular conditions from 2015 to 2018 in French eye clinics. The following data were collected: age, symptoms of eye strain, best-corrected visual acuity (BCVA), cycloplegic refraction. The analysis included 48,163 children (mean age: 7.75 years, range: 2 to 12 years). The proportion of each RE was as follows: emmetropia (− 0.50 < Spherical Equivalent (SE) ≤  + 2.0; 58.3%), hyperopia (+ 2.0 < SE ≤ +5; 17.2%), myopia (− 6 ≤ SE ≤− 0.50; 15.5%), high myopia (SE < − 6; 0.5%), high hyperopia (SE >  + 5; 3.6%), mixed astigmatism (4.9%). Anisometropia (SE difference ≥ 1.5) was found in 5.0%. Functional amblyopia in children attending primary school (aged over 6 years) was encountered in 2.7%. Symptoms of eye strain were frequent (70%) but not specific to any RE. REs are frequently found in French children and may remain undetected in the absence of symptoms of eye strain. Few studies have investigated REs in children using cycloplegic refraction, which has been shown to be the gold standard for RE assessment. Undetected refractive errors (REs) remain a major cause of visual impairment w orldwide1. Because of unequal access to care, screening for REs, prescriptions, and manufacture of corrective optical lenses may not be available in developing countries, and to a lesser extent, in developed countries. According to the World Health Organisation, 12 million children between 5 and 15 years of age have visual impairment caused by uncorrected R Es2. Visual impairment is a major risk factor for amblyopia in these children, demonstrating the need to detect and manage REs during early childhood. The prevalence of REs varies considerably worldwide. A review of 23 articles on REs in the Middle East concerning children under 15 years of age reported the following prevalence for each RE: myopia: 4% (spherical equivalent (SE) ≤ − 0.5 dioptres D); hyperopia: 8% (without cycloplegia, SE ≥  + 2.0 D), astigmatism: 15% (cylinder ≥ 0.75 D)3. In reality, this prevalence is inconsistent across countries owing to variable access to care, ethnic origin (i.e. higher prevalence of myopia in Asiatic children4–6), and environmental factors (i.e. higher prevalence of myopia in subjects with low outdoor/indoor activity ratios7 and in urban areas8,9). Age is also an important factor as it has an influence on the growth of the eye and the emmetropisation phenomenon. For instance, hyperopia decreases as age increases, with a prevalence of 5% at age 7, 2 to 3% between ages 9 and 14, and 1% at age 159. Studies vary worldwide on the use of cycloplegia to analyse the prevalence of REs. It is now well known that RE measurements are unreliable without cycloplegia, especially in children. Morgan et al. stated that cycloplegic refraction should be considered the gold standard for epidemiological s tudies10. Hashemi et al. highly recommends cycloplegic refraction for RE evaluation, especially in paediatric c ases10–12. This study aimed to show the proportions of REs in French children using cycloplegic refraction. The secondary objective was to evaluate the prevalence of amblyopia. 1 Department of Ophthalmology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France. 2ANJO, Association Nationale Des Jeunes Ophtalmologistes, Centre Hospitalier National des 15-20, 28, Rue de Charenton, 75012 Paris, France. 3Department of Medical Information, Centre Hospitalier Régional Universitaire, Bretonneau Hospital, Tours, France. 4Department of Ophthalmology, Centre Hospitalier Universitaire, Poitiers, France. 5Point Vision Centre, Paris, France. 6Department of Ophthalmology, Centre Hospitalier Universitaire, Reims, France. 7Neurogénétique et Physiopathologie Neuronale, iBrain, INSERM, U1253, Université de Tours, Tours, France. 8Department of Ophthalmology, Centre Hospitalier Régional Universitaire, Bretonneau Hospital, Tours, France. *email: Scientific Reports | (2022) 12:4069 | https://doi.org/10.1038/s41598-022-08149-5 1 Vol.:(0123456789) www.nature.com/scientificreports/ Spherical equivalent (Dioptres) Sphere (S, Dioptres) Cylinder (C, Dioptres) SE >  + 5 S≥0 |C| ≤ |S| Hyperopiaa + 2.00 < SE ≤+5 S≥0 |C| ≤ |S| Emmetropia − 0.50 < SE ≤ +2.00 Myopiab − 6 ≤ SE ≤− 0.50 S≤0 High myopia <−6 S≤0 High hyperopia Mixed astigmatism |C| ≤ 1.50 S≥0 |C| > |S| and |C| > 1.5 Table 1.  Classification of refractive errors. Absolute value * Negative cylinder notation was used to apply this classification. a Including hyperopia and hyperopic astigmatisms. b Including myopia and myopic astigmatisms, SE spherical equivalent. Methods Study framework. This is a multicentre cross-sectional retrospective study including French children aged 2 to 12 years. Clinical data were collected from January 2015 to December 2018 from seven eye clinics (Versailles, Antony, Créteil, Poitiers, Troyes, Lyon Montrochet, Nice) considered as primary care centres and dedicated to REs. Appointments are mainly given online. First, patients are evaluated by an orthoptist who asks the parents for any general or ophthalmological personal history and then performs a best-corrected visual acuity (BCVA) assessment. Second, the ophthalmologist performs slit-lamp and fundus examination. All children are examined using cycloplegic drops as recommended by the French Association for Paediatric Ophthalmology and Strabismus. The exclusion criteria were as follows: children over 12 years of age, which corresponds to the mean age of puberty in France13; consultations with a possibility of ocular disorder (e.g. retinal pathology, cataract, dyschromatopsia); missing autorefraction data; absence of cycloplegia; ophthalmic symptoms other than those of eye strain (e.g. red eye, painful eye, ophthalmic pruritus, ptosis). This study was approved by the Ethics Committee of the French Society of Ophthalmology (Institutional Review Board: 0008855) and was conducted in accordance with the ethical principles of the Declaration of Helsinki. Data were anonymized for study purposes. Informed consent was not required for this study according to French law. Database composition and characteristics. The following data were extracted automatically from each patient data file (Ophtix© software, OPHTEL®): demographic characteristics including age at examination, any ophthalmological medical history, symptoms of eye strain (blurry vision, asthenopia, headache), the use of cycloplegic drops (cyclopentolate, Skiacol©, A (...truncated)