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  1. Gilbert CE, Ellwein LB, Refractive Error Study in Children Study Group
    Invest Ophthalmol Vis Sci, 2008 Mar;49(3):877-81.
    PMID: 18326706 DOI: 10.1167/iovs.07-0973
    Data on the prevalence and causes of functional low vision (FLV) in adults and children are lacking but are important for planning low-vision services. This study was conducted to determine the prevalence and causes of FLV among children recruited in eight population-based prevalence surveys of visual impairment and refractive error from six countries (India [2 locations]; China [2 locations]; Malaysia, Chile, Nepal, and South Africa).
  2. Morgan IG, Rose KA, Ellwein LB, Refractive Error Study in Children Survey Group
    Acta Ophthalmol, 2010 Dec;88(8):877-84.
    PMID: 19958289 DOI: 10.1111/j.1755-3768.2009.01800.x
    PURPOSE: To determine the natural end-point for refractive development during childhood.

    METHODS: Cycloplegic (1% cyclopentolate) autorefraction was performed on 38, 811 children aged 5 and 15 in population-based samples at eight sites in the Refractive Error Study in Children (RESC). Refractions (right eye) were categorized as myopic (≤-0.5 D), emmetropic (>-0.5 to ≤+0.5 D), mildly hyperopic (>+0.5 to ≤+2.0 D and hyperopic (>+2.0 D).

    RESULTS: At five sites (Jhapa - rural Nepal, New Delhi - urban India, Mahabubnagar - rural India, Durban - semi-urban South Africa and La Florida - urban Chile), there was <20% myopia by age 15. Mild hyperopia was the most prevalent category at all ages, except for Mahabubnagar where emmetropia became the marginally most prevalent category at ages 14 and 15. At the other sites (Gombak - semi-urban Malaysia, Shunyi - semi-rural China and Guangzhou - urban China), there was substantial (>35%) myopia by age 15. At these sites, mild hyperopia was the most prevalent category during early childhood, and myopia became the predominant category later. In Gombak district and Guangzhou, emmetropia was a minor category at all ages, with myopia increasing as mild hyperopia decreased. In Shunyi district, emmetropia was the most prevalent category over the ages 11-14.

    CONCLUSION: Emmetropia was not the predominant outcome for refractive development in children. Instead, populations were predominantly mildly hyperopic or substantial amounts of myopia appeared in them. This suggests that mild hyperopia is the natural state of refractive development in children and that emmetropia during childhood carries the risk of subsequent progression to myopia.

  3. Goh PP, Abqariyah Y, Pokharel GP, Ellwein LB
    Ophthalmology, 2005 Apr;112(4):678-85.
    PMID: 15808262 DOI: 10.1016/j.ophtha.2004.10.048
    To assess the prevalence of refractive error and visual impairment in school-age children in Gombak District, a suburban area near Kuala Lumpur city.
  4. Saw SM, Goh PP, Cheng A, Shankar A, Tan DT, Ellwein LB
    Br J Ophthalmol, 2006 Oct;90(10):1230-5.
    PMID: 16809384
    To compare the prevalences of refractive errors in Malay, Chinese and Indian children in Malaysia and Singapore.
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