Features of ocular morbidity in adolescents attending a tertiary eye care centre in Kerala.

INTRODUCTION:-

 Adolescenceis a transitional phase of Growth and development between childhood andadulthood. As age is the most convenient way of defining adolescence, recentWHO guidelines ¹define adolescents as those between age of 10 – 19 years. Adolescenceis characterised by most rapid development in all aspects including thephysical psychological as well as social aspects.

 Itis an intense and stressful developmental period.Nowadays change in ourlifestyle has affected the adolescent development too.Between 10 and 19 yr ofage, children undergo rapid changes in body size, shape, physiology, andpsychologic and social functioning.

 The changes can be classified as: 2

}  BIOLOGIC

}  COGNITIVEAND MORAL

}  SEXUAL

}  PSYCHOSOCIALCHANGES IN THE EYE  3

 AXIALLENGTH:

 As all other body parts, eyes also increase in sizeduring adolescence. Mainly there occurs a change in axial length of the eyeball. At birth the eye is hypermetropic. At 4 years , eyes are 78% of its adultsize. After that they increase in size slowly till 20 yrs. If an insult occursduring the development that the eyes fail to slow down its pace of growth, itleads to Myopia or short-sightedness of various degrees. But in some,hypermetropia persists during adolescence.

 CORNEAL CURVATURE:

 At birth cornea is spherical .as the curvature varieswith age, with the rule astigmatism occurs in  68% at 4 years and in 95% at 7 years. As age advances, astigmatismdisappears or even reverts to against the rule astigmatism.

 PSYCHOSOCIAL CHANGES WHICH INFLUENCE OCULARHEALTH:

 Psychosocial changes such as impulsiveness in natureand risk taking behaviour also are seen in this age group. And most adolescentsreport peer pressure to   take risks.

Peer group also affect their views about cosmeticsthat some like to wear glasses while some, do not.

 LIFESTYLE CHANGES:

 According to the US CDC, an average child spends about8 hrs a day watching electronic screens. Gadget use among kids increases withage.The use of desktop, laptop, tablets, smartphones and electronic readingdevices has become ubiquitous.Byincreasing use of computers, mobile phones and other electronic gadgets, moreand more youngsters are getting eye strain. They also don’t pay attention tothings like posture, screen distance and brightness which adversely affecttheir vision and health.

 Computervision syndrome 11 is reported in those using electronic screens for>2 hours daily.Apart from symptoms like dry eyes burning sensation  double vision and blurring of vision, peoplealso c/o neck and back pain.

Digital eye strain refers to physical discomfort aftercomputer use of more than 2 hours a day. Both the terms are more or less thesame. More than 76.5% of American children below 18 years report using digital devices>2hrs a day and 55.6% report their children experience symptoms of computervision syndrome after >2 hrs of screen time.

 The other condition found at a higher probability arethe infectious conditions of the eye as the adolescents will not be muchconscious about their hygiene and might be handling their body without muchcare. Another problem is the eye hazards caused by cosmetics when usedimproperly especially in contact lens users.

 In this study, we are focusing on the ocular morbidityin adolescents to find out the pattern of ocular conditions in adolescentsattending Giridhar eye institute Kochi, a tertiary eye care centre over aperiod of 6 months starting from July 2017.

 The main ocular issues as we suspect to encounter inthis study are Refractive errors , Squint, Ocular injuries, Allergic andInfective Conjunctivitis, Amblyopia, Blepharitis, Congenital problems,malignancies etc. We are also trying to assess the prevalence of gadget useamong adolescents included in this study.

 REVIEWOF LITERATURE:-

 Dr.Renubedie et al in IOSR journal 4 studiedthe Prevalence of ocular morbidity among school children (10-18yrs) in Ajmer city.Ocular morbidity was detected in 15.98% and 5% students had more than oneocular disorders. Males were 40.23% and females were 59.77%. They also foundout that according to age, 13-15 year age group had significantly more ocularmorbidity(50.5%).The most common ocular morbidity among them was refractiveerrors(86.59%)followed by conjunctival nevus: 3.86% and conjunctivitis: 3.4%

 Another study was by Deshpande et. al. in National journal of communitymedicine 5 which studied the Prevalenceof ocular morbidities among school children in rural area of North Maharashtrain India. They studied school going adolescents. The study concluded that ocularmorbidities were observed in 27.65% of students and the commonest cause ofocular morbidity was refractive errors with a prevalence of 10.12%, Vit Adeficiency was the second most common cause.Blepharitis, chalazion, stye,ptosis were the next common conditions

 Adegbehingbe B et.al.in Ghana med journal 2005 6, Screening of adolescents for eye diseases inNigerian high schools.Allergic conjunctivitis was the most prevalent 49% of theentire group. Next prevalent was Refractive errors-22.5% and Glaucoma wasdiagnosed in 1.3%.

 Prajapati P et al article in onlinejournal of health and allied sciences7 in january 2010.Studied Prevalenceof ocular morbidity among school adolescents of gandhinagar district, gujarat.The study analysed that prevalence of ocular morbidity among school adolescentswas 13%(7.8%boys ,5.6% in girls).Refractive error was the mostcommon ocular morbidity 40% both among boys and girls and 30% had vitamin Adeficiency. They also analysed that various factors like illiterate parents,low socioeconomic status and malnutrition were significantly associated withocular morbidity.

 Mortazavi SM, Mortazavi SA, Paknahad M.8 studiedAssociation between Exposure to Smartphones and Ocular Health in Adolescents InOphthalmic epidemiology. 2016 Jan . The study concluded that higherprevalence rates of ocular symptoms  wereobserved in groups with greater exposure to smart phones.A higher duration ofexposure to smart phones was associated with a higher likelihood of havingmultiple ocular symptoms.

Kozeis, N. (2009).9  Impact  of computer use on children’s vision.  Hippokratia, 13(4),230–231.The study analysed that extensive viewing of the computer screen canlead to eye discomfort, fatigue, blurred vision and headaches, dry eyes andother symptoms of eyestrain. These symptoms may be caused by poor lighting,glare, an improper work station set-up, vision problems of which the person wasnot previously aware.

 Kwok SW, Lee PH, Lee RL. .10 2017 Feb 18  Studied  Smart device use and perceived physical andpsychosocial outcomes among Hong Kong adolescents In International journal ofenvironmental research and public health;14(2):205. In the study, data from 960adolescents aged 10-19 were analyzed. Nearly 86% of the sample use smart devicedaily. The one-week prevalence of perceived sleep deprivation, eye discomfort,musculoskeletal discomfort, family conflict and cyberbullying victimizationrelated to smart device use were nearly 50%, 45%, 40%, 20% and 5% respectively.More than 25% of the respondents were at risk of negative outcomes related tosmart device activities for more than 1 h per day, browsing and gaming on atleast 4 days per week and watching TV/movies and posting on more than 2 daysper week. Their patterns of smart device activities may put a significantnumber of them at risk of negative outcomes.

 AIMSAND OBJECTIVES**:-**

 AIM:-

}  To study the pattern of ocular morbidity in adolescentsattending Giridhar eye institute , kochi, a tertiary care eye centre in Kerala,a cross sectional study.

 OBJECTIVES:-

} To assess the pattern of ocularmorbidity in adolescents attending our hospital over a period of 1 year or  >900 participants.

} To assess the prevalence of useof electronic gadgets among the studied adolescents.

 MATERIALAND METHODS**:-**

• Study area: Giridhar Eye Institute , Kochi
• Study population: adolescents 10-19 years attending the OPD/ED
• Inclusion criteria: All patients between the age of 10-19 years
• Exclusion criteria: all other age groups
• Study design: Cross sectional study
• Sample size: >900 participants
• Study duration: 1 year (July 2017 to June 2018)

 METHODOLOGY:-

 

• Details about every adolescent patient attending the clinics, i.e. between the ages of 10-19 years, are taken into the study.
• The history and diagnosis of patients  over a period of 1 year are noted and relevant clinical examinations pertaining to each case were done accordingly according to our electronic medical records by Tata consultancy services version 3.20 (The study proforma is attached).
• Finally analysis is done as to get the pattern of ocular morbidity among them and also to find the prevalence of adolescents using electronic gadgets.

 STATISTICAL METHODS:-

• Data obtained from patients were recorded and analysed using Microsoft Excel
• Results of categorical variables are reported as counts and percentages.
• Chi square test and Fishers exact test will be used to find the differences between categorical variables.

 REFERENCES:

 1.      Blum, R., W., & Nelson-Nmari, K. (2004). The health of young peoplein a global context. Journal of Adolescent Health, 35, 402-418.

2.      Richard E., Md. Behrman (Editor), Robert M., Md. Kliegman (Editor), Hal B., Md.Jenson (Editor) By W B Saunders Co. NelsonTextbook of Pediatrics 17th edition. Philadelphia, (May 2003): 128-132

3.      David abrams. DukeElder’s Practice Of Refraction (10ThEdition)},1983. Publisher:Elsevier (A Division of Reed Elsevier India Pvt.Limited): 45-66.

4.      Dr.RenuBedi, Dr. Dinesh Kumar Bedi, Dr. Nizamuddin Dr. Charushila DuduleDr. Rashmi Gupta,Dr. Sanjeev Sharma.Prevalence of ocular morbidity among schoolchildren in Ajmer city.IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 10 Ver.VII (Oct. 2015),PP 20-25 www.iosrjournals.org DOI: 10.9790/0853-141072025 www.iosrjournals.org

5.      Deshpande Jayant D, MalathiK. Prevalence of ocular morbidities amongschool children in rural area of North Maharashtra in India. National JournalOf Community Medicine Vol. 2 Issue 2, July- sept 2011.

6.     Adegbehingbe BO, OladehindeMK, MajemgbasanTO,Onakpoya HO and OsagiedeEO . Screening of Adolescents for eye diseases inNigerin High schools. Ghana Med. J. 2005 December; 39 (4) :138-142.

7.     Prajapati P, Oza J,Prajapati J, Kedia G, Chudasama RK. Prevalence of ocular morbidity among schooladolescents of Gandhinagar district, Gujarat. Online Journal of Health andAllied Sciences. 2011 Jan 20;9(4)

8.     Mortazavi SM, Mortazavi SA,Paknahad M. Association between Exposure to Smartphones and Ocular Health inAdolescents. Ophthalmic epidemiology. 2016 Jan 1;23(6):418-.

9.      Kozeis, Nikos. (2009). Impact of computer use onchildren’s vision. Hippokratia. 13. 230-1.

10.  Kwok SW, Lee PH, Lee RL. Smart device use and perceivedphysical and psychosocial outcomes among Hong Kong adolescents. Internationaljournal of environmental research and public health. 2017 Feb 18;14(2):205.

11.  Blehm C, Vishnu S, Khattak A. et al. Computer vision syndrome: areview. Surv Ophthalmol. 2005;50(3):253–6