4th World Conference on

Applied Sciences, Engineering& Technology

24-26 October 2015, Kumamoto University, Japan

Study of refractive errors among medical students of Melaka

Manipal Medical College at Manipal in India
JESSICA S D1, SUREKHA R KAMATH2, ALWIN FOO JAR JUN2, YUGANESH CHANDRASEGAR2
1
Department of Microbiology, Melaka Manipal Medical College, Manipal University, Manipal, India
2
Department of Physiology, Melaka Manipal Medical College, Manipal University, Manipal, India
Melaka Manipal Medical College, Manipal University, Manipal, India
Email: surekharkamath@yahoo.com
Abstract: Refractive error is a defect in the optical system of the eye which prevents light from being brought
to a single point focus on the retina, thus reducing the normal vision.The most common types of refractive error
are myopia, hypermetropia and astigmatism. The aim of our study was to determine the different types of
refractory errors among medical students of 18 21 years of age. We also aimed at finding out the various
factors influencing the occurrence of refractory errors among medical students. In this study, the first year and
second year medical students (n=360) of Melaka Manipal Medical College, Manipal Campus were included. A
questionnaire with closed and open ended questions was used in the study. Students were asked to respond to
the questionnaire after taking their informed consent. The study population comprised of 360 students, out of
which 257 (71%) had refractive error. Our study showed that the females (41.3%) had higher prevalence of
refractory errors when compared to males (30%) of the same age group. Among the family members of the
students with refractive errors, the parents of majority of the students had refractory errors. Myopia was most
common among all the refractive errors. However, astigmatism was least in this study group. Majority of the
students had identified their refractive error during primary (40%) and secondary (29%) school levels. Since
students work often with computers, smartphones and several others near work activities, there is higher chance
of developing refractive errors. In conclusion, our study indicated that hereditary and environmental factors
could have led to the development of refractive errors in these students.

Keywords: Refractive Error, Medical Students, Prevalence, Myopia, Astigmatism

Introduction:
Refractive error is a defect in the optical system of the
eye which prevents light from being brought to a
single point focus on the retina, thus reducing normal
vision (William F.Ganong, 2005). Refractive errors
are second most cause of blindness in developing
countries such as India and also one of the commonest
reason for patients to visit an ophthalmologist (Govt.
of lndia, Annual Report, 2004). There are 180 million
visually disabled people in world out of whom 45
million people are blind. Keeping this scenario in
mind, WHO launched a global initiative VISION
2020- RIGHT TO SIGHT, in the year 1999. The
objective was to eliminate avoidable blindness by the
year 2020. Integration of vision screening for health
issues is thus recommended by World Health
Organization (WHO, 2000). Health habits formed at
young age will be carried to adult age, old age and
even to next generation. Poor vision in students has a
negative influence on their future life as it affects
productive performance in education thus in long term
affecting the economic burden of the country (WHO,
1997).
Students usually do not complain of defective vision
and may not even be aware of the condition. They try
to adjust the problem of defective vision by sitting in
front row of benches or holding the books close to
their eyes thus accommodating the eyes. The earliest
signs of refractive errors are strainful eyes with or
without redness by evening, accompanied with
watering or headache or both (Khurana A.K., 2006).
In rural areas such complaints by the children to
parents or teachers go unnoticed due to lack of
awareness. Thus signifying the importance of early
detection and treatment of ocular problems to prevent
future blindness. Effective methods of vision
screening in school children are therefore useful in
detecting the correctable causes of decreased vision,
especially refractive errors (Afroz A Khan., et al.,
2005). In a similar manner medical students are
affected by various refractory errors like myopia,
hypermetropia and astigmatism (Matta S, et al., 2005).
Timely detection and intervention can tremendously
improve students potential during his or her formative
years. The objective of the present study was to
determine the prevalence of refractory errors among
medical students of Melaka Manipal Medical College,
Manipal, India. We also aimed at finding out the major
type of refractory errors among students and also the
various factors influencing the refractive errors in
these students.
Materials and Methods:
The prevalence of refractive errors among the first and
second year medical students (n=360) of Melaka
Manipal Medical College, Manipal, India was
assessed using a questionnaire. These Medical
students belonged to Chinese, Malay and Indians in
ethnicity. The number of students with refractive
errors was 257. The age group of these medical

WCSET 2015019 Copyright 2015 BASHA RESEARCH CENTRE. All rights reserved
 JESSICA S D, SUREKHA R KAMATH, ALWIN FOO JAR JUN, YUGANESH CHANDRASEGAR

students was between 18-21 years of which 108 were

males and 149 were females. A questionnaire with
closed and open ended questions was prepared and Table 4- Age of acquiring refractive errors
administered to the students (n=257) who were using No. of students % among the
spectacles. Students were asked to respond to the Age in years
(n=257) cases
questionnaire after taking their informed consent. All 5 years 13 5%
these students responded back and data was collected
and statistically analysed. 6-10 years 102 40%
Results and Discussion: 11-16 years 75 29%
The study population comprised of 360 students, out
of which 257 (71%) had refractive error. These 17-21 years 18 26%
medical students were of three different ethnicities
(Table1) Chinese, Malay and Indians. Added to this as In our study, the number of students whose single
our students belong to Chinese ethnicity there is an parent had refractive error (Table 5) was 47(18%),
increased risk of refractive error (Wong T.Y., et al., whereas the number of students with both parents
2000). Our study showed that the (Table 2) females having refractive error was 124 (48%). This indicates
(41.3%) had higher prevalence of refractive errors that the family history of refractive error has an
when compared to males (30%) of the same age group increasing incidence. There is strong evidence that
(18-21) this supports several previous studies. A study genetic factors play a part in the aetiology of refractive
conducted by Seema Sharma et al which found out errors (Zadnik K., et al., 1994).Though there is strong
that prevalence of refractive error was 23.7% in girls genetic predisposition to refractive error, our study
and only 12.2% in boys (Sharma S., et al., 2009). found that the number of students who acquired
Similar results were found by Tay MT et al in their refractive error over the years was significantly higher
study on young Singaporeans (Tay M.T., et al., 1992). when compared to their younger years. Surprisingly,
86 (34%) of the students had refractive errors inspite
Table 1- Number of students according to races in the of their parents not having any refractive error.
study group
Table 5- Refractive errors: Relation between parents
Races No. of students (n=360)
and students
Chinese 171 (47.5%)
Number of single parents having 47 (18%)
Malay 104 (28.8%)
refractive error
Indian 85 (23.6%) Number of both parents having 124 (48%)
Table 2- Gender of the study group refractive error
Nmber % in the Number of parents not having 86 (34%)
No. of refractive error
among the study
Gender students
cases group Table 6- Methods of correction among the students
(n=360)
(n=257) (n=360) with refractive errors
Male 148 108 30% Number of students using spectacles 68%
Female 212 149 41.3%
Number of students using lenses 17.5%
Myopia (170) was found to be common refractive
error (Table 3) followed by hypermetropia (55) and Number of students using both 14.5%
astigmatism (32). Similar pattern of prevalence was
observed among several studies (Matta S, et al., 2005, In our study 68% of the students with refractive errors
Saw S.M., etal., 1996). Majority of the students had used spectacle as a correction method (Table 6) when
the highest rate of refractive errors (Table 4) during compared to 17.5% of the students who used contact
primary (6-10years: 40%) and secondary school levels lens. This indicates that spectacles usage is preferred
(11-16years: 29%). Other studies highlighted the over contact lenses as a correction method. However,
association of myopia with number of years of 30% of the students who were required to use the
schooling (Tay M.T., et al., 1992). correction method were not regularly using the
spectacles which are a great concern as it will worsen
Table 3- Distribution of type of refractive errors the refractive error. Although more than 90% of
among cases and the study group participants were aware of eye laser/Lasik surgery as a
% in the correction method yet only 29% of them preferred to
% among
No. of study undergo surgery.
Type the cases
students group
(n=257)
(n=360)
Myopia 170 80.9% 47.2%
Hypermetropia 55 10.53% 15.27%
Astigmatism 32 8.57% 8.8%

Proceedings of the 4th World Conference on Applied Sciences, Engineering and Technology
24-26 October 2015, Kumamoto University, Japan, ISBN 13: 978-81-930222-1-4, pp 043-045
 Study of refractive errors among medical students of Melaka Manipal Medical College at Manipal in India
Table 7- Environmental factors contributing to
refractive errors
Factors >1hr 1-2 hrs < 3 hrs
Average usage
of laptop
(including 34% 42% 24%
gaming and
studies) daily
Never Seldom Often
Electronic
gadget which
22% 42% 36%
emit light , in
dark
Studying under
30% 55% 15%
dim light
From our questionnaire study we found out that
environmental factors do play a role in refractive
errors especially among the adolescents and young
adults (Kinye B., et al., 2000). Some of these
environmental factors (Table 7) which we identified
were, hours of usage of laptop and electronic gadgets
for studies and social interaction by students. As
students use dim light for studies we surveyed its
impact on refractive errors. Our results clearly
indicates among the students with refractive errors
24% used Laptop for more than three hours daily.
Whereas, 36% of them often used electronic gadgets.
15% of the students with refractive errors were found
to study under dim light which is quiet alarming as it
may contribute to worsening of the refractive error,
although 58% of them were aware of the negative
impact of reading in dim light.
Conclusion:
Myopia was more prevalent refractive error among the
medical students. Our study indicated a strong
predisposition of age, gender and heredity which was
associated with refractive errors. In this era of smart
phones and high tech gadgets and tech savvy youth
who are frequently using these gadgets, the worsening
of already present refractive error as well as
development of a new refractive error is of concern.
Therefore, prevention of refractive error may almost
be impossible yet suitable knowledge of these
refractive errors and their environmental risk factors
may contribute to reduction in the number of cases.
Not only knowledge but also application of the
appropriate correction methods should be our long-
term goal in the society to avoid worsening of the
refractive errors. Thus, our study indicated that
hereditary and environmental factors could have led to
the development of refractive errors in these students.
Proceedings of the 4th World Conference on Applied Sciences, Engineering and Technology
24-26 October 2015, Kumamoto University, Japan, ISBN 13: 978-81-930222-1-4, pp 043-045
References:
[1] William F.Ganong.,(2005) Review of Medical
Physiology 22nd Edition, 2005, pp 156
[2] Govt. of lndia (2004) Annual Report 2003-2004
Ministry of Health and Family Welfare, New
Delhi, 2005.
[3] World Health Organization. WHO, (2000).
Preventing blindness in children: report of
WHO/IAPB scientific meeting. Programme for
the Prevention of Blindness and Deafness, and
International Agency for Prevention of Blindness.
Geneva, 2000
[4] World Health Organization (1997) Elimination
of avoidable visual disability due to refractive
error Report of an informal planning meeting
WHO/PBL/00.79, 1997, pp: 6-10.
[5] Khurana A.K., Text book of ophthalmology
(2006) 3rd ed. New Delhi, New Age International
Publisher, 2006, pp 52-59.
[6] Afroz A Khan., A.R. Nasti,M.,, Ayoub Dar.,
Shafkat A. Lone.,(2005) Prevalence of refractive
error in school children JK-Practitioner 12(3),
2005, pp 156-159.
[7] Matta S, Matta P, Gupta V, Dev A. (2005)
Refractive errors among adolescents attending
Ophthalmic OPD IndJounComm Medicine,
2006-04 - 2005-06, 31(2)
[8] Wong T.Y., Foster P.J., Hee J., Ng T.P., Tielsch
J.M., Chew S.J., et al., (2000) Prevalence and
risk factors for refractive errors in an adult
Chinese population in Singapore Invest
Ophthalmol Vis Sci,41, pp 324.
[9] Sharma S., Vashisht B.M., Kalhan M., Goel M.,
(2009) Magnitude of Refractive Errors among
school children in a rural block of Haryana The
Internet Journal of Epidemiology. 2009, 6(2).
DOI: 10.5580/1e5f
[10] Tay M.T., Au Eong K.G., Ng C.Y., Lim
M.K.,(1992) Myopic & educational attainment in
421116 young Singaporean males Ann Acad
Med, Singapore, 1992,21, pp 785-91.
[11] Saw S.M., Katz J., Schein O.D., Chew S.J., Chan
T.K.,(1996) Epidemiology of myopia
Epidemiol Rev. 1996, 18, pp 175187.
[12] Zadnik K., Satariano W.A., Mutti D.O., Sholtz
R.I., Adams A.J.,(1994) The effect of parental
history of myopia on children's eye size JAMA,
1994, 271, pp 1323-7.
[13] Kinye B., Midelfast A, Jacobsen G, et al, (2000)
The influence of near work on development of
myopia among university students. a three year
longitudinal study among engineering students in
Norway. ActaOphthalmolScand 2000, 78, pp 26-
9.