Abstract
Background
To compare the prevalence of refractive (RA), corneal (CA), and internal astigmatism (IA) in Hong Kong children and adults and evaluate the role of IA in compensating for total astigmatism and its relations to myopic traits.
Methods
The Hong Kong Children Eye Study is a population-based cross-sectional study. Totally 3704 school children (mean age 7.5 ± 1.0 years) and 5577 adults (mean age 41.1 ± 7.5 years), who were their parents, were recruited. Cycloplegic and non-cycloplegic refractive cylinders were obtained from children and adults, respectively. Spearman correlation was applied to detect associations between astigmatism, ocular biometrics, refraction, and lens power. Astigmatism compensation factor (CF) was derived from the power vector analysis J0 and J45.
Results
The prevalence of RA (≤−1.0 D), CA (≥+1.0 D) and IA (≥+1.0 D) was 21.9%, 63.9%, and 9.9% in children, and 30.9%, 39.5%, and 23.7% in adults respectively. The mean RA, CA and IA values in children and adults were −0.69 ± 0.66 D, +1.14 ± 0.61 D, +0.62 ± 0.32 D, and −0.80 ± 0.74 D, +0.97 ± 0.69 D, and +0.76 ± 0.43 D, respectively. In adults and children, IA was negatively correlated with axial length (p < 0.0001), but positively correlated with spherical values and equivalent (p < 0.0001), suggesting an association of astigmatism with myopic traits. A greater proportion of children exhibited compensation by IA than adults in J0 (86.6% vs. 66.0%, p < 0.0001) and J45 components (55.5% vs. 41.7%, p < 0.0001).
Conclusions
Chinese children in Hong Kong exhibit a higher prevalence of RA and CA than in other cities. Children displayed a greater compensation by IA than adults, suggesting an age-related attenuation of IA compensation. IA is associated with myopic traits.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
Data availability
All data generated or analyzed during this study are included in this published article.
References
Hashemi H, Fotouhi A, Yekta A, Pakzad R, Ostadimoghaddam H, Khabazkhoob M. Global and regional estimates of prevalence of refractive errors: systematic review and meta-analysis. J Curr Ophthalmol. 2018;30:3–22.
Pascual M, Huang J, Maguire MG, Kulp MT, Quinn GE, Ciner E, et al. Risk factors for amblyopia in the vision in preschoolers study. Ophthalmology. 2014;121:622–629 e621.
Margines JB, Huang C, Young A, Mehravaran S, Yu F, Mondino BJ, et al. Refractive errors and amblyopia among children screened by the UCLA Preschool Vision Program in Los Angeles County. Am J Ophthalmol. 2020;210:78–85.
Harvey EM. Development and treatment of astigmatism-related amblyopia. Optom Vis Sci. 2009;86:634–639.
Cakir B, Aksoy NO, Ozmen S, Bursali O, Celik E, Horozoglu F. Corneal topography, anterior segment and high-order aberration assessments in children with ≥2 diopter astigmatism. Int Ophthalmol 2020;40:1461–1467.
Kam KW, Yung W, Li GKH, Chen LJ, Young AL. Infectious keratitis and orthokeratology lens use: a systematic review. Infection. 2017;45:727–735.
Chow SSW, Chow LLW, Lee CZ, Chan TCY. Astigmatism correction using SMILE. Asia Pac J Ophthalmol (Philos). 2019;8:391–396.
Fan DS, Lai C, Lau HH, Cheung EY, Lam DS. Change in vision disorders among Hong Kong preschoolers in 10 years. Clin Exp Ophthalmol. 2011;39:398–403.
Wu L, Weng C, Xia F, Wang X, Zhou X. Internal astigmatism and its role in the growth of axial length in school-age children. J Ophthalmol. 2018;2018:1686045.
Yam JC, Tang SM, Kam KW, Chen LJ, Yu M, Law AK, et al. High prevalence of myopia in children and their parents in hong kong chinese population: the Hong Kong Children Eye Study. Acta Ophthalmol 2020.
Cheung CY, Li J, Yuan N, Lau GYL, Chan AYF, Lam A, et al. Quantitative retinal microvasculature in children using swept-source optical coherence tomography: the Hong Kong Children Eye Study. Br J Ophthalmol 2018.
Wong ES, Zhang XJ, Yuan N, Li J, Pang CP, Chen L, et al. Association of optical coherence tomography angiography metrics with detection of impaired macular microvasculature and decreased vision in amblyopic eyes: the Hong Kong Children Eye Study. JAMA Ophthalmol 2020;138:858–865.
Yuan N, Li J, Tang S, Li FF, Lee CO, Ng MPH, et al. Association of secondhand smoking exposure with choroidal thinning in children aged 6 to 8 years: the Hong Kong Children Eye Study. JAMA Ophthalmol 2019;137:1406–1414.
Tang SM, Kam KW, French AN, Yu M, Chen LJ, Young AL, et al. Independent influence of parental myopia on childhood myopia in a dose-related manner in 2055 trios: the Hong Kong Children Eye Study. Am J Ophthalmol 2020;218:199–207.
Thibos LN, Wheeler W, Horner D. Power vectors: an application of Fourier analysis to the description and statistical analysis of refractive error. Optom Vis Sci. 1997;74:367–375.
Wang Z, Huang D, Chen X, Zhu H, Sun Q, Wang Y, et al. Preschool children exhibit evident compensatory role of internal astigmatism in distribution of astigmatism: the Nanjing Eye Study. Invest Ophthalmol Vis Sci. 2019;60:73–81.
Table 1A: Population by Age and Sex Group. Census and Statistics Department. Available at: https://www.censtatd.gov.hk/en/web_table.html?id=1A#. Accessed 29/3/2022, 2022.
Tong L, Saw SM, Carkeet A, Chan WY, Wu HM, Tan D. Prevalence rates and epidemiological risk factors for astigmatism in Singapore school children. Optom Vis Sci. 2002;79:606–613.
Shih YF, Hsiao CK, Tung YL, Lin LL, Chen CJ, Hung PT. The prevalence of astigmatism in Taiwan schoolchildren. Optom Vis Sci. 2004;81:94–98.
Hashemi H, Asharlous A, Khabazkhoob M, Yekta A, Emamian MH, Fotouhi A. The profile of astigmatism in 6-12-year-old children in Iran. J Optom. 2020;14:58–68.
Sandfeld L, Weihrauch H, Tubaek G, Mortzos P. Ophthalmological data on 4.5- to 7-year-old Danish children. Acta Ophthalmol. 2018;96:379–383.
Wang M, Cui J, Shan G, Peng X, Pan L, Yan Z, et al. Prevalence and risk factors of refractive error: a cross-sectional study in Han and Yi adults in Yunnan, China. BMC Ophthalmol. 2019;19:33.
Vitale S, Ellwein L, Cotch MF, Ferris FL 3rd, Sperduto R. Prevalence of refractive error in the United States, 1999-2004. Arch Ophthalmol. 2008;126:1111–119.
Twelker JD, Miller JM, Sherrill DL, Harvey EM. Astigmatism and myopia in Tohono O’odham Native American children. Optom Vis Sci. 2013;90:1267–1273.
Fan DS, Rao SK, Cheung EY, Islam M, Chew S, Lam DS. Astigmatism in Chinese preschool children: prevalence, change, and effect on refractive development. Br J Ophthalmol. 2004;88:938–941.
Huynh SC, Kifley A, Rose KA, Morgan I, Heller GZ, Mitchell P. Astigmatism and its components in 6-year-old children. Invest Ophthalmol Vis Sci. 2006;47:55–64.
Huynh SC, Kifley A, Rose KA, Morgan IG, Mitchell P. Astigmatism in 12-year-old Australian children: comparisons with a 6-year-old population. Invest Ophthalmol Vis Sci. 2007;48:73–82.
Sanfilippo PG, Yazar S, Kearns L, Sherwin JC, Hewitt AW, Mackey DA. Distribution of astigmatism as a function of age in an Australian population. Acta Ophthalmol. 2015;93:e377–385.
Twelker JD, Mitchell GL, Messer DH, Bhakta R, Jones LA, Mutti DO, et al. Children’s ocular components and age, gender, and ethnicity. Optom Vis Sci. 2009;86:918–935.
Liu Y, Cheng Y, Zhang Y, Zhang L, Zhao M, Wang K. Evaluating internal and ocular residual astigmatism in Chinese myopic children. Jpn J Ophthalmol. 2017;61:494–504.
Asharlous A, Hashemi H, Jafarzadehpur E, Mirzajani A, Yekta A, Nabovati P, et al. Does astigmatism alter with cycloplegia? J Curr Ophthalmol. 2016;28:131–136.
Wang Z, Tong H, Hao Q, Chen X, Zhu H, Huang D, et al. Risk factors for astigmatic components and internal compensation: the Nanjing Eye Study. Eye (Lond). 2021;35:499–507.
Park CY, Oh JH, Chuck RS. Predicting ocular residual astigmatism using corneal and refractive parameters: a myopic eye study. Curr Eye Res. 2013;38:851–861.
Artal P, Benito A, Tabernero J. The human eye is an example of robust optical design. J Vis. 2006;6:1–7.
Acknowledgements
The authors would like to acknowledge Ms. Mandy Pui Har Ng for her tremendous contributions to the Hong Kong Children Eye Study.
Funding
This study was supported in part by the General Research Fund (GRF), Research Grants Council, Hong Kong (14111515 and 14103419 [JCY]); Collaborative Research Fund (C7149-20G [JCY]); Health and Medical Research Fund (HMRF), Hong Kong (5160836, [LJC] and 07180826 [XJZ]), and the Direct Grants of the Chinese University of Hong Kong, (4054193 [LJC] and 4054121 & 4054199 [JCY] and 4054634 [XJZ]); the Innovation and Technology Fund (7010590 [JCY]), the UBS Optimus Foundation Grant 8984 (JCY); the Centaline Myopia Fund [JCY]; the Lim Por-yen Eye Genetics Research Centre; the CUHK Jockey Club Children’s Eye Care Programme, and the CUHK Jockey Club Myopia Prevention Programme.
Author information
Authors and Affiliations
Contributions
JCY, KKW, and ASH conceived the idea. KKW, ASH, and RCY performed data interpretation, and data analysis and wrote the manuscript. YZ performed data collection, extraction, and streamlined data analysis. XZ, YMW, SLL, LJC, ALY, CCT, and CPP critically revised the manuscript. JCY supervised the work and critically revised the manuscript. All authors have read and approved the final manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Kam, K.W., Chee, A.S.H., Tang, R.C.Y. et al. Differential compensatory role of internal astigmatism in school children and adults: The Hong Kong Children Eye Study. Eye 37, 1107–1113 (2023). https://doi.org/10.1038/s41433-022-02072-9
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41433-022-02072-9
