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Child Development and Refractive Errors in Preschool Children

Ibironke, Josephine O.*; Friedman, David S.; Repka, Michael X.; Katz, Joanne§; Giordano, Lydia*; Hawse, Patricia; Tielsch, James M.

Optometry & Vision Science:
doi: 10.1097/OPX.0b013e318204509b
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Purpose. Many parents are concerned about their child's development. The purpose of this study is to determine whether parental concerns about overall development are associated with significant refractive errors among urban preschool children.

Methods. A cross-sectional population-based study was conducted to evaluate the prevalence of ocular disorders in white and African American children aged 6 through 71 months in Baltimore, Maryland. A comprehensive eye examination with cycloplegic refraction was performed. Parental concerns about development were measured with the Parents' Evaluation of Developmental Status screening tool. Of 2546 eligible children 2381 (93.5%), completed the refraction and the parental interview.

Results. Parental concerns about development were present in 510 of the 2381 children evaluated [21.4%; 95% confidence intervals (CI): 9.8 to 23.1]. The adjusted odds ratios [OR] of parental concerns with hyperopia [≥3.00 diopters (D)] was 1.26 (95% CI: 0.90 to 1.74), with myopia (≥1.00 D) was 1.29 (95% CI: 0.83 to 2.03), with astigmatism (≥1.50 D) was 1.44 (95% CI: 1.08 to 1.93) irrespective of the type of astigmatism, and with anisometropia (≥2.00 D) was 2.61 (95% CI: 1.07 to 6.34). The odds of parental concerns about development significantly increased in children older than 36 months with hyperopia ≥3.00 D, astigmatism ≥1.50 D, or anisometropia ≥2.00 D.

Conclusions. Parental concerns about general developmental problems were associated with some types of refractive error, astigmatism ≥1.50 D and anisometropia ≥2.00 D, in children aged 6 to 71 months. Parental concerns were also more likely in children older than 36 months with hypermetropia, astigmatism, or anisometropia. Parental concerns were not associated with myopia. Because of the potential consequences of uncorrected refractive errors, children whose parents have expressed concerns regarding development should be referred for an eye examination with cycloplegic refraction to rule out significant refractive errors.

Author Information







Dana Center for Prevention Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine (JOI, DSF, JK, LG, PH, JMT), Department of International Health, Johns Hopkins Bloomberg School of Public Health (DSF, JK, JMT), and Zanvyl Krieger Pediatric Ophthalmology and Adult Strabismus Service, Wilmer Eye Institute, Johns Hopkins School of Medicine (JOI, MXR), Baltimore, Maryland.

This study was supported by the National Eye Institute, National Institutes of Health, grant number EY14483.

The authors have no proprietary or commercial interest in any materials discussed in the article.

Received October 13, 2009; accepted September 10, 2010.

David S. Friedman; Wilmer Eye Institute, Wilmer 120; 600 North Wolfe Street; Baltimore, Maryland 21287; e-mail:

© 2011 American Academy of Optometry