Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children

Castagno, Victor Delpizzo; Fassa, Anaclaudia Gastal; Carret, Maria Laura Vidal; Vilela, Manuel Augusto Pereira; Meucci, Rodrigo Dalke

doi:10.1186/1471-2415-14-163

BMC Ophthalmology

Table 1 Hyperopia prevalence among children in the analyzed studies

From: Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children

Author (Year)	N	Age range	Hyperopia definition	Response Rate (%)	Prevalence (%)	95% CI	Age specific prevalence (95% CI)
Location	N	Age range	Hyperopia definition	Response Rate (%)	Prevalence (%)	95% CI	Age specific prevalence (95% CI)
			SE
Zhao (2000) [10]	5884	5-15 years	≥ + 2.00 D	95.9	2.7	Not available	Males:
Zhao (2000) [10]			RESC				5 years: 8.8% (2.4 – 15.2)
Shunyi District, China			ca				15 years: less than 2%
							Females:
							5years: 19.6% (8.1 – 31.0)
							15 years: less than 2%
He (2004) [11]	4364	5-15 years	≥ + 2.00 D	86.4	4.6	4.4 – 4.9	5 years: 17.0% (12.8 – 21.3)
He (2004) [11]			RESC				6 years: 10.7% ( 6.4 – 15.1)
Guangzhou, China			ca				7 years: 4.0% (1.3 – 6.7)
							8 years: 7.1% (3.9 – 10.4)
							9 years: 3.8 % (2.0 – 5.6)
							10 years: 4.6% (2.1 – 7.1)
							11 years: 3.5% (1.7 – 5.6)
							12 years: 2.0% (0.5 – 3.6)
							13 years: 3.4 % (1.6 – 5.2)
							14 years: 1.2% (0.3 – 2.1)
							15 years: 0.5% (0.0 – 1.3)
Fan (2004) [12]	7560	5-16 years	≥ + 2.00 D	Not stated	4.0	Not available	Not available
			Right eye
			ca
Hong Koong, China			ca
Zhan (2000) [13]	Xiamen city: 132	6-7 years	≥ + 2.00 D	Not stated	Xiamen city: 3.0	0.8 – 7.8	Not available
	Xiamen		Right eye		Xiamen countryside: 1.9	1.4 – 2.3
	Xiamen		ca		Singapore: 2.7	0.8 – 6.9
Xiamen city, Xiamen Countryside and Singapore, China	countryside: 104
Xiamen city, Xiamen Countryside and Singapore, China	Singapore: 146
Pi (2010) [14]	3070	6-15 years	≥ + 2.00 D	88.50	3.26	2.6 – 3.9	6 years: 9.21% (5.5 – 12.9)
Yong Chuan District, Western China			At last one eye was hyperopic				7 years: 7.7% (4.7 – 10.6)
			At last one eye was hyperopic				8 years: 5.3% (2.9 – 7.7)
			cr				9 years 3.1% (1.3 – 4.9)
							10 years: 3.5% (1.6 – 5.5)
							11 years: 1.2% (0.0 – 2.5)
							12 years: 0.7% (0.0 – 1.6)
							13 years: 0.3% (0.0 – 1.0)
							14 years: 1.1% (0.0 – 2.2)
							15 years: 0.9% (0.0 – 2.1)
He (2007) [15]	2454	12-18 years	≥ + 2.00 D	97.6	1.20	0.8 – 1.6	13 years: 0.9% (0.1 – 3.1)
			RESC				14 years: 1.5 % (0.5 – 2.5)
			ca				15 years: 1.3 % (0.5 – 2.2)
Yangxi County, China							16 years: 1.0% (0.3 – 2.5)
Yangxi County, China							17 years: 0.0
Saw (2006) [16]	Malaysia:	7-9 years	≥ +2.00D	83.3	Malaysia:2.9	1.9 – 3.8	Malaysia (N = 1752)
							7 years: 5.0% (3.0 – 7.0)
							8 years: 2.0% (0.7 – 3.3)
Kuala Lumpur, Malaysia	1752		RESC		Singapore: 1.7	1.2 – 2.4	9 years: 1.6% (0.4 – 2.8)
Singapore	Singapore:1962		ca				Singapore (N = 1962)
							7 years: 2.1% (1.3 – 3.3)
							8 years: 1.9% (1.0 – 3.3)
							9 years: 0.8% (0.2 – 2.1)
Goh (2005) [17]	4634	7-15 years	≥ + 2.00 D	83.8	1.6	1.1 – 2.1	7 years: 5.0% (3.0 – 7.0)
			RESC				8 years: 2.0% (0.7 – 3.3)
			ca				9 years: 1.6% (0.4 – 2.8)
							10 years: 1.4 % (0.1 – 2.6)
							11 years: 0.9 % (0.0 – 2.6)
Gombak District, Malaysia							12 years: 0.6% (0.0 – 1.2)
							13 years: 0.5% (0.0 – 1.1)
							14 years: 0.0
							15 years: 0.9% (0.0 – 1.9)
Pokharel (2000) [18]	5067	5-15 years	≥ + 2.00 D	Not stated	2.1	Not available	Not available
			RESC
			ca
Mechi Zone, Nepal			ca
Gao (2012) [19]	5527	12-14 years	≥ + 2.00 D	89.8	Urban: 1.4	0.1– 1.7	Urban:
			At last one eye was hyperopic		Rural: 0.4	0.2 – 0.6	12 years: 0.7% (0.4 – 1.0)
			At last one eye was hyperopic				13 years: 0.7% (0.4 – 0.9)
Phnom Penhn and Kandal Provinces, Cambodia			cr				14 years: 0.8% (0.3 – 1.3)
Casson (2012) [20]	2899	6-11 years	≥ + 2.00 D	87.0	2.8	1.9 – 3.7	6 years: 3.1% (1.7 – 5.1)
			RESC				11years: 1.1% (0.3 – 2.9)
			cr
Vientiane Province, Lao PDR			cr
Murthy (2002) [21]	6447	5-15 years	≥ + 2.00 D	92	7.4	6.0 – 8.8	5 years: 15.6 % (11.0 – 20.2)
			RESC
			cr
New Delhi, India							6 years: 13.0% (9.1 – 16.8)
							7 years: 10.7% (7.0 – 14.2)
							8 years: 8.5% (5.9 – 11.2)
							9 years: 6.6% (3.7 – 9.5)
							10 years: 5.2% (2.4 – 8.1)
							11 years: 7.8% (4.7 – 10.8)
							12 years: 5.0% (3.5 – 6.5)
							13 years: 3.3% (1.7 – 4.9)
							14 years: 4.4% (2.4 – 6.5)
							15 years: 3.9% (2.1 – 5.7)
Dandona (2002) [22] Mahabubnagar, Andhra Pradesh, India	4074	7-15 years	≥ + 2.00 D	92.3	0.68	0.4 – 1.0	Rural:
			At last one eye was hyperopic				7 years: 0.7% (0.0 – 1.2)
							8 years: 0.3% (0.0 – 0.8)
							9 years: 0.4% (0.0 – 1.0)
			cr				10 years: 1.2% (0.1 – 2.3)
							11 years: 1.6% (0.4 – 2.8)
							12 years: 0.8% (0.0 – 1.5)
							13 years: 0.6% (0.0 – 1.4)
							14 years: 0.3% (0.0 – 1.1)
							15 years: 1.1% (0.0 – 2.6)
Uzma (2009) [23]	Urban: 1789	7-15 years	≥ + 2.00 D	Not stated	Urban: 3.3	1.8 – 4.8	Urban:
Hyderabad, India	Rural: 1525		At last one eye was hyperopic		Rural: 3.1	1.7 – 4.5	7 years: 4.6% (2.6 – 6.6)
			ca				8 years: 2.0% (0.4 – 3.6)
							9 years: 1.7% (0.8 – 2.6)
							10 years: 1.3% (0.5 – 2.1)
							11 years: 2.2% (0.9 – 3.1)
							12 years: 0.4% (0.0 – 0.8)
							13 years: 0.2% (0.0 – 0.4)
							14 years: 0.0
							15 years: 0.4% (0.0 – 0.8)
							Rural:
							7 years: 9.8% (6.6 – 13.0)
							8 years: 8.1% (5.4 – 10.8)
							9 years: 7.3% ( 3.7 – 10.9)
							10 years: 4.1% (2.1 – 6.1)
							11 years: 3.2% (1.9 – 4.5)
							12 years: 3.2% (1.6 – 4.8)
							13 years: 2.4% (0.9 – 3.9)
							14 years: 0.0
							15 years: 0.0
Fotouhi (2007) [9]	3673	7-15 years	≥ + 2.00 D	96.8	16.6	13.6 – 19.7	7 years: 28.9% (22.6 – 35.2)
Dezful, Iran			RESC				8 years: 22.7% (16.4 – 28.9)
			ca				9 years: 16.7% (12.0 – 21.4)
							10 years: 12.4% (7.9 – 17.0)
							11 years: 12.9% ( 8.3 – 17.5)
							12 years: 16.9% (12.3 – 21.5)
							13 years: 14.1% (10.6 – 17.6)
							14 years: 13.0% (9.8 – 16.1)
							15 years: 10.3% (1.5 – 19.1)
Hashemi (2010) [24]	345	5-10 years	≥ + 2.00 D	Not stated	10	Not available	Not available
Tehran, Iran			Right eye
Tehran, Iran			ca
Ostadimoghaddam (2011) [25] Mashhad, Iran	639	5-15 years	≥ + 2.00 D	Not stated	19.05	15.7 – 22.4	Not available
			At last one eye was hyperopic
			ca
Rezvan (2012) [26]	1551	6-17 years	≥ + 2.00 D	76.8	5.4	4.3 – 6.5	8 years: 6.8% (2.7–11.0)
Bojnourd, Iran			RESC				9 years 8.2% (3.9–12.5)
			ca				10 years: 8.3% (4.1–12.6)
							11 years: 5.6 % (2.0–9.2)
							12 years: 3.8% (1.3–6.2)
							13 years: 2.3% (0.3–4.3)
							14 years: 2.5% (0.3–4.6)
Yekta (2010) [27]	2130	7-15 years	≥ + 2.00 D	87.88	5.04	3.5 – 6.6	7 years: 8.9% (6.1 – 11.8)
Shiraz, Iran			RESC				8 years: 7.7% (1.9 – 13.5)
			ca				9 years: 4.8% (1.6 – 8.1)
							10 years: 7.0% (2.8 – 11.1)
							11 years: 2.1% (0.7 – 5.8)
							12 years: 3.0% (1.2 – 4.8)
							13 years: 2.2% (0.6 – 3.8)
							14 years: 5.9% (0.1 – 11.8)
							15 years: 0.0
Robaei (2005) [28]	1765	6 years	≥ + 2.00 D	Not stated	9.8	Not available	-
			Right eye
			ca
SMS, Sydney, Australia			ca
Ip (2008) [29]	4094	6 years	≥ + 2.00 D	Not stated	-	-	6 years: 13.0% (9.1 – 16.8)
SMS, Sydney, Australia		12 years	Eye with greater refractive error				12 years: 5.0% (3.5 – 6.5)
SMS, Sydney, Australia		12 years	ca				12 years: 5.0% (3.5 – 6.5)
Ip (2008) [30]	2353	11-15 years	≥ + 2.00 D	Not stated	3.5	2.8 – 4.1	Not available
SMS, Sydney, Australia			Both eyes
SMS, Sydney, Australia			ca
Robaei (2006) [31]	2353	12 years	≥ + 2.00 D	75.3	5	Not available	Not available
			Both eyes
			ca
SMS, Sydney, Australia			ca
Grönlund (2006) [32]	143	4-15 years	≥ + 2.00 D	Not stated	9.1md	Not available	Not available
Grönlund (2006) [32]			At last one eye was hyperopic
Gothenburg, Sweden			ca
Laatikainen (1980) [33] Uusimaa County, Finland	822	7-15 years	≥ + 2.00 D	Not stated	9.7	Not available	7 – 8 years: 19.1% (13.0 – 25.1)
			Right eye				7 – 8 years: 19.1% (13.0 – 25.1)
			cr				9 – 10 years: 6.9% (3.5 – 10.3)
							11 – 12 years: 11.7% (7.5 – 15.9)
							14 – 15 years: 3.6% (1.1 – 6.1)
O’Donoghue (2012) [34] Northern Ireland (NICER)	1053	6-7 years	≥ +2.00D	62.0 in children 6–7 years 65.0 in children 12–13 years	26	20 – 33	6-7 years: 26% (20–33)
		6-7 years	≥ +2.00D		14,7	9.9 – 19.4	12-13 years: 14.7% (9.9 – 19.4)
		12-13 years	RESC
		12-13 years	ca
Logan (2011) [35] Birmingham, England (AES)	596	6-7 years	≥ + 2.00 D	Not stated	12.3	8.8–15.7	Not available
		6-7 years	≥ + 2.00 D		5.4	2.8 – 8.0
		12-13 years	Either/both eyes
		12-13 years	ca
Naidoo (2003) [36]	4890	5-15 years	≥ + 2.00 D	87.3	2.6	Not available	5 years: 2.7% (0.6 – 4.8)
			RESC
			ca
Durban area, South Africa							6 years: 2.4% (0.7 – 4.1)
							7 years: 2.8% (0.9 – 4.7)
							8 years: 1.3% (0.1 – 2.6)
							9 years 2.9% (0.1 – 5.7)
							10 years: 3.4% (1.8 – 4.9)
							11 years: 3.5% (1.9 – 5.1)
							12 years: 3.2% (1.2 – 5.1)
							13 years: 2.9% (0.3 – 5.5)
							14 years: 1.9% (0.6 – 3.2)
							15 years: 0.7% (0.0 – 1.8)
Maul (2000) [37]	5303	5-15 years	≥ + 2.00 D	75.8	19.3	Not available	Males:
			RESC				5 years: 22.7% (18.0 – 27.4)
			ca				15 years: 7.1% (3.5 – 10.6)
							Females:
							5years: 26.3% (22.0 – 30.6)
							15 years: 8.9% (3.7 – 14.1)
La Florida, Chile							15 years: 8.9% (3.7 – 14.1)
Czepita (2008) [38]	Urban: 1200	10-14 years	≥ + 1.50 D	Not stated	Urban: 7.1	5.6 – 8.5	Urban (N = 1200):
			Right eye		Rural: 30.8	27.9 – 33.7	10 years: 8.3% (5.2 – 11.3)
			cr				11 years: 4.1% (1.6 – 6.6)
							12 years: 9.9% (5.8 – 14.0)
							13 years: 7.7% (4.3 – 11.1)
							14 years:5.3% (2.2 – 8.3)
							Rural (n = 1006)
							10 years: 33.3% (27.1 – 39.5)
Czeczecin, Poland	Rural:1006						11 years: 28.4% (22.1 – 34.7)
							12 years: 26.9% (20.9 – 32.9)
							13 years: 30.5% (24.4 – 36.5)
							14 years:36.4% (28.7 – 44.1)
Kleinstein (2003) [39] CLEERE Study, USA	2523	5-17 years	≥ + 1.25 D in each meridian	Not stated	12.8	11.5 – 14.1	Not available
			Right eye
			ca
Zadnik (2003) [40]	2583	7-12 years	≥ + 1.25 D^§	Not stated	8.6	Not available	Not available
			Right eye
			ca
CLEERE Study, USA			ca
Dandona (1999) [41]	599	0-15 years	≥ + 1.00 D	Not stated	41.14	24.9 – 58.0	Not available
Dandona (1999) [41]			Eye with higher refractive error
Andhra Pradesh, India			Eye with higher refractive error
Andhra Pradesh, India			cr
Shrestha (2011) [42]	2236	5-16 years	≥ + 1.00 D^†	Not stated	20,3	Not available	Not available
			Either/both eyes
			cr
Jhapa, Nepal			cr
Czepita (2007) [43]	4422	6-18 years	≥ + 1.00 D	Not stated	13.05	Not available	6 years: 36.5% (31.8 – 41.3)
							7 years: 19.2% (15.4 – 22.9)
							8 years: 17.4% (13.8 – 21.0)
							9 years 11.3% (8.3 – 14.3)
							10 years: 11.0% (8.0 – 14.0)
							11 years: 10.9% (8.0 – 14.0)
							12 years: 8.3% (5.6 – 10.9)
							13 years: 11.8% (8.1 – 15.5)
							14 years: 8.2% (5.3 – 11.2)
							15 years: 8.6% (5.4 – 11.8)
							16 years: 2.8% (0.6 – 5.1)
							17 years: 2.5% (0.3 – 4.7)
							18 years: 3.2% (0.7 – 5.7)
			Right eye
			cr
Szczecin, Poland			cr
Vilareal (2003) [44]	1035	12-13 years	≥ + 1.00 D	Not stated	6	Not available	Not available
Vilareal (2003) [44]			ca
Monterrey, Mexico			ca
Vilareal (2000) [45]	1045	12-13 years	≥ + 1.00 D	Not stated	8.4%	Not available	Not available
			Right eye
			cr
Götemborg area Sweden			cr
Hashemi (2004) [46]	412	5-15 years	≥ + 0,50 D	Not stated	78.6	74.6 – 82.6	Not available
			Right eye
			ca
Tehran, Iran			ca
Dandona (2002) [47]	2603	0-15 years	≥ + 0,50 D	Not stated	62.6	57.0 – 68.1	Not available
Dandona (2002) [47]			Eye with higher refractive error
Andhra Pradesh, India			Eye with higher refractive error
Andhra Pradesh, India			cr
Niroula (2009) [48]	964	10-19 years	≥ + 0,50 D^‡	Not stated	1.24	Not available	Not available
			Both eyes
			cr
Pokhara, Nepal

y = years (age); CI: Confidence Interval; SE: mean spherical equivalent; RESC: The Refractive Error Study in Children; ca: cycloplegic autorefraction; cr: cycloplegic retinoscopy.
† study did not mention SE in its definition of hyperopia.
‡ It was considered +0,5 diopter or more spherical power.
§ Define as +1.25 D or more in both meridians.

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