Rajiv Gandhi University of Health Sciences, Karnataka s1

Place: Bellary Date: 15.11.2011

From, Dr. MADHURA . M. KHANAPUR POST GRADUATE Student M.S. Ophthalmology Department of Ophthalmology VIMS, Bellary. To, The PRINCIPAL Vijayanagar Institute of Medical Sciences Bellary THROUGH PROPER CHANNEL Respected Sir,

SUB: Acceptance of registration and forwarding of my dissertation topic In accordance with the above cited subject, I , the undersigned studying in P.G. Course in M.S. Ophthalmology has been allotted the dissertation topic “PREVALENCE OF REFRACTIVE ERRORS AMONG SCHOOL CHILDREN AGED BETWEEN 7- 15 YRS IN BELLARY CITY”, under the guidance of Dr. YOGESH R.B. Associate professor, Department of Ophthalmology, VIMS. Bellary. I request you to kindly forward the dissertation topic in the prescribed form to the university for approval. Thanking you, Yours faithfully

Signature of the guide [Dr. MADHURA M KHANAPUR]

Dr.YOGESH R B Associate professor Department of Ophthalmology VIMS,Bellary. Place: Bellary Date: 15.11.2011

From, The Professor & Head, Department of Ophthalmology, VIMS, Bellary.

To , The Registrar, Rajiv Gandhi University of Health Sciences, Bangalore.

THROUGH PROPER CHANNEL Respected Sir,

As per the regulations of the University for Registration of Dissertation topic, the following Post Graduate Student in MS-Ophthalmology has been allotted the dissertation topic as follows by the official registration committee of all qualified and eligible guides of Dept of Ophthalmology.

NAME TOPIC GUIDE DR. MADHURA. M. PREVALENCE OF DR. YOGESH .R .B KHANAPUR REFRACTIVE ERRORS Associate Professor Post Graduate Student in M.S. AMONG SCHOOL CHILDREN Department of Dept. of Ophthalmology, AGED BETWEEN 7-15 YEARS Ophthalmology, VIMS, Bellary. IN BELLARY CITY VIMS, Bellary.

Therefore, I kindly request you to communicate the acceptance of the Dissertation topic allotted to the PG student at an early date. Thanking you,

Signature of the guide: Yours faithfully,

(Dr. G. PAVAN) Dr.YOGESH . R . B Professor and Head Associate professor Department of Ophthalmology Dept of Ophthalmology, VIMS, Bellary. VIMS, Bellary. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,KARNATAKA

ANNEXURE II

SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate And Address(in DR. MADHURA. M. KHANAPUR block letter) POST GRADUATE STUDENT IN M.S. OPHTHALMOLOGY VIMS, BELLARY-583104 2. Name of the institution VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES, BELLARY. 583104 3. Course of study and subject MEDICAL. M.S in OPHTHALMOLOGY 4. Date of admission to course 1. 10. 2011 Prevalence of refractive errors among 5. Title of the topic school children aged between 7-15yrs in Bellary city.

6 BRIEF RESUME OF THE INTENDED WORK

6.1 Need for the study

In emmetropia (normal vision), parallel light rays meeting eye are focused on the retina to form a circle of least diffusion. In the presence of a refractive error, the light rays get focused in front or behind the retina causing blurred vision, thus reducing normal vision. (8).

Un corrected refractive errors are an important cause of visual impairment and the proportion of children who are blind or visually impaired due to refractive errors can be used to asses the level of eye care services in a country.

In a study in India, 5.1 % children in schools had a visual acuity of less than 6/12 in the better eye. At least 2000 children /million population have refractive errors greater than -1.00D in both eyes. Prevalence of blindness (< 6/60-1/60, < 1/60-pl, npl) is estimated to be 0.8/1000 children in the age group of 0-15 yrs. Currently there are estimated 270,000 blind children in India . About 13% of Indian population is in the age Group of 10-15yrs.

Refractive errors are the second major cause of blindness in India and children form the main age Groups requiring attention to refractive errors, because of the high prevalence of myopia, hypermetropia, and astigmatism.   The School going age years are formative for children in determining their physical, intellectual and behavioural development. Hence poor vision in child hood affects the performance in school and has a negative influence on their development and maturity. This warrants early detectation and treatment of refractive errors to prevent disability.

Diagnosis and treatment of refractive errors is relatively simple and easiest way to reduce impaired vision. Population based data concerning prevalence on refractive errors in children are not readily available in India .There have been lot of work done and data available in the area of refractive errors in other countries but only little is reported for Indian population.

In view of importance of detecting the refractive error in school children an effort is going to be made in this study, to find the extent of problem of refractive errors among school children in Bellary city.

6.2 Review of Literature:

1. A study done by sharma seema,B.M.vashisht, on magnitude of refractive errors among school children in a rural block of Haryana-The International Journal of epidemiology 2009 Vol 6 no.2,reported that out of 1265 children (6-15yrs) ,172 children(13.6%) were found to have defective vision(<6/9). Myopia in one eye -22(1.74%), in both eyes-131(10.36%).Hyperopia in one eye-2(0.16%), in both eyes-17(1.34). myopia, Hyperopia, astigmatism in girls were more (23.7%) than in boys(12.2%). Myopia and astigmatism was more in higher age gps and prevalence of hyperopia was more in lower age gps. (1)

2. A study conducted by Trividi.v.et al(1) in rural and urban area of Gujarat in the year 2006 reported that 66% of urban children and 8.5% of rural children had visiual impairment as acause of refractive error and prevalence of myopia(in the age group b/w 7-15yrs) is 4.1% and 7.4% in rural and urban area respectively and prevalence of hypermetropia( in the age gp 7- 15yrs) is 0.78% and 7.7% in urban and rural area respectively. (2)

3. A study by mohammad khalaj, mohammadreja gasemi ,dept of public health, Qaswin medical university, Qazvin-Iran on prevalence of refractive error and visiual impairment in school children b/w 7-15yrs in the city of Qazvin north iran, from oct-2002 –sep 2008 for 5913 school children. Of 5903 students 7-15yrs old, girls=59% and boys=41%.myopia-655,hyperopia- 12.46%,Astigmatism=16.1% and Amblyopia-6.37%. myopia > in girls(60%. And in boys=40%. There was age related shift in refractive error from hyperopia in younger children toward myopia in older(55% in 15yrs old).(3)

4. A study conducted by Sonam sethi, G.p kartha vol.25,no:4 (2000-10-2000-12) from sep 1997 to march 1998 in the school children(7-15yrs) of Ahmedabad city reported that 25.32% of students were found to be having refractive errors.Of these 47% were female &53% were boys.Myopissssa was seen in 63.5%,Hypermetropia in 11.2% and Astigmatism in 20.4%. (4)

5. A study by Lin L L, Shih Y F, Tsai C B, conducted a study among school children in Taiwan in 1995 reported that :myopia rate was from 12% at the age of 6yrs, increased to 56%at the age of 12yrs, then to 76%at the age of 15yrs.the mean refractive status became myopic at the age of 9yrs ,then increased to -3.92D ingirls and -2.71D in boys at the age of 18yrs.The prevalence and degree of myopia in girls was more severe than in boys.

6. Health Journal-Prevalence of refractive error and low vision and among school children in Cairo Egypt, between 7-14 years: the study revealed prevalence of refractive error (< 6/12) among school children was 20.1%, low vision (< 6/18) was 12.5%. Refractive error was more in girls (21.4%) than in boys 13.6%. (5)

6.3 OBJECTIVES OF STUDY:

1. To study the prevalence of refractive error among children between ages of 7-15yrs in selected schools of Bellary city. 2. To study the refractive errors in association with age & sex. 7. MATERIALS AND METHODS :

7.1 Source of data: School children in the city of Bellary is chosen for this study. There are approximately 150 school in bellary city. Out of which 10 primary school and 10 high schools are randomly selected for the study. Students in the age group 7-15 year will be included in the study for the period of 10 months from June 2012 – March 2013.

The students will be screened with the help of Snellens E-chart applying the following inclusion and exclusion criteria.

Inclusion Criteria: 1. All children in the selected schools of bellary city b/w 7-15 yrs (both boys and girls) will be included in the study. 2. The students present on day of visit were included in the study.

Exclusion Criteria: 1. All diseases of the eye which are responsible for reduced optical activity other than refractive errors such as corneal opacity, opacity of lens, choroid and retinal disorders will be excluded. All the diseases of the posterior segment. 2. Students absent on the day of school examinatuion.

7.2 METHOD OF COLLECTION OF DATA : INCLUDING THE SAMPLING PROCEDURE IF ANY

This is a cross sectional and time bound study in which random cluster sampling among schools in Bellary city will be done. All the children b/w 7-15yrs of age in the selected schools will be examined for visual impairment. SAMPLE SIZE : Assuming a 20% prevalence of refractive errors based on a pilot study and considering 95% confidence limit, 2% permissible error, sample size is 1600 school children which includes males and females during the study period of 10 months from June 2012 – March 2013.

PARAMETERS USED : Prevalence of refractive error like myopia, hyperopia, astigmatism and Age, sex.

STATISTICAL ANALYSIS : Chi Square test and percentages.

7.3 Does the study require any investigations or interventions to be conducted on patients or interventions to be conducted on patients or other humans or animals? If so please describe briefly.

Yes ,the study requires the following investigations like:

1. Anterior segment examination. 2. Both distant and near vision. 3. Test for ocular motility. 4. Refraction with and without mydriatics. 5. Fundus examination. 6. Keratometry. 7. A scan when necessary.

7.4 Has the ethical clearance has been obtained from your institution in case of 7.3? Yes, ethical clearance has been obtained from the VIMS institutional ethical committee (IEC), VIMS, Bellary. LIST OF REFERENCES:

1. Magnitude of refractive errors among school children in a rural block of Haryana. Sharma Seema, B.M. Vashist, Dept. of Community Medicine, PGIMS. International Journal of Epidemiology 2009;Vol.6:2.

2. Bhatt, Janardhanl, Trivedi, Vevik, Sundeep, Prevalence of refractive error in children (age pp 7-15 years) of rural & urban area of Gujarath; A population based study. Journal of Applied basic medical sciences, 2006,8(1);128-135.

3. Prevalence of refractive errors in primary school children (7-15 years) of Qazwin city; Mohammed Khalaj, Mohammadeza Gasemi, European Journal of Scientific research ISSN. 1450-260 x Vol.28 no.2 (2009), pp.174-185.

4. Sethi s, Kartha G. P, prevalence of refractive errors in school children of Ahamedabad city. Ind J conn med 2000;25;181-83.

5. Prevalence of refractive error and low vision among school children in Cairo, Egypt. Bhel Bayommy, A sad, A.H Choudhury. Memorial Institute of Opthalmic research, Cairo, Egypt. Regional office for eastern Mediterranean WHO, Cairo, Egypt. June- 2007.

6. Duke-Elder (1963) : Accommodation & refraction-hypermetropia. London Churchill Livingston pp. 39-45.

7. Arnol MC (2001): epidemiology of ametropia: Introduction to refraction. Optom vis, sci, 70:351-63.

8. LP Agarwal, errors of refractions, principles of optics and refraction-3 edi. Pg.99.

9. Signature of candidate

10. Remarks of guide

11. Name & Designation : (in block letters)

11.1 Guide Dr. YOGESH R B Associate Professor Department of ophthalmology VIMS,Bellary.

11.2 Signature of guide

11.3 Co-guide if any

11.4 Signature

11.5 Head of the department Dr.G.PAVAN Professor and Head Department of ophthalmology, VIMS, Bellary.

11.6 Signature

12 12.1 Remarks of chairman and Principle

12.2 Signature