Visual impairment among urban female school students of Surat

Sir,

I read with interest the article by Basu et al., on the Spectrum of visual impairment among urban female school students of Surat.[1] I congratulate the authors for addressing an important public health issue.

I have few comments on the article.

The study was conducted among the schoolgoing children between aged 7 and 15 years of age. While conducting such a type of study, it is important to obtain consent from the parents rather than from the participants.

The study followed the definition of myopia as difficulty in seeing distant objects and hyperopia as difficulty in seeing close objects.

The authors should have considered myopia and hypermetropia in the form of measured objective refraction.

Methodology states that children with uncorrected visual acuity of 20/40 or worse in either eye underwent cycloplegia. What was done with those children having eyesight 20/40-20/20? The authors states that students with good eyesight (20/70 or better) had reported ophthalmic symptoms. It is important to exclude refractive error in these children by relaxing accommodation. By doing so, the authors could have registered more children with refractive error.

In the results (as well as in abstract) section, the authors state that astigmatism was present in 18 (0.04%) children out of 457 children having defective vision. The percentage of astigmatism should have been 3.94% to make the overall percentage of refractive error 100%.

It was strange to note that no child has strabismus or amblyopia. At the same time, the authors mention in the results section that of all the spectacles users, in 29.73%, the correction was not adequately done and the resultant eyesight was not found to be with the best possible corrections. Does this mean that few girls had amblyopia?