INTRODUCTION:-

Adolescence is a transitional phase of Growth and development between childhood and adulthood. As age is the most convenient way of defining adolescence, recent WHO guidelines ¹define adolescents as those between age of 10 – 19 years. Adolescence is characterised by most rapid development in all aspects including the physical psychological as well as social aspects.

It is an intense and stressful developmental period.Nowadays change in our lifestyle has affected the adolescent development too.Between 10 and 19 yr of age, children undergo rapid changes in body size, shape, physiology, and psychologic and social functioning.

The changes can be classified as: ²

}  BIOLOGIC

}  COGNITIVE AND MORAL

}  SEXUAL

}  PSYCHOSOCIAL CHANGES IN THE EYE  ³

AXIAL LENGTH:

As all other body parts, eyes also increase in size during adolescence. Mainly there occurs a change in axial length of the eye ball. At birth the eye is hypermetropic. At 4 years , eyes are 78% of its adult size. After that they increase in size slowly till 20 yrs. If an insult occurs during the development that the eyes fail to slow down its pace of growth, it leads to Myopia or short-sightedness of various degrees. But in some, hypermetropia persists during adolescence.

     CORNEAL CURVATURE:

At birth cornea is spherical .as the curvature varies with age, with the rule astigmatism occurs in   68% at 4 years and in 95% at 7 years. As age advances, astigmatism disappears or even reverts to against the rule astigmatism.

      PSYCHOSOCIAL CHANGES WHICH INFLUENCE OCULAR HEALTH:

Psychosocial changes such as impulsiveness in nature and risk taking behaviour also are seen in this age group. And most adolescents report peer pressure to   take risks.

Peer group also affect their views about cosmetics that some like to wear glasses while some, do not.

LIFESTYLE CHANGES:

According to the US CDC, an average child spends about 8 hrs a day watching electronic screens. Gadget use among kids increases with age.The use of desktop, laptop, tablets, smartphones and electronic reading devices has become ubiquitous.By increasing use of computers, mobile phones and other electronic gadgets, more and more youngsters are getting eye strain. They also don’t pay attention to things like posture, screen distance and brightness which adversely affect their vision and health.

Computer vision syndrome ¹¹ is reported in those using electronic screens for >2 hours daily.Apart from symptoms like dry eyes burning sensation  double vision and blurring of vision, people also c/o neck and back pain.

Digital eye strain refers to physical discomfort after computer use of more than 2 hours a day. Both the terms are more or less the same. More than 76.5% of American children below 18 years report using digital devices >2hrs a day and 55.6% report their children experience symptoms of computer vision syndrome after >2 hrs of screen time.

The other condition found at a higher probability are the infectious conditions of the eye as the adolescents will not be much conscious about their hygiene and might be handling their body without much care. Another problem is the eye hazards caused by cosmetics when used improperly especially in contact lens users.

In this study, we are focusing on the ocular morbidity in adolescents to find out the pattern of ocular conditions in adolescents attending Giridhar eye institute Kochi, a tertiary eye care centre over a period of 6 months starting from July 2017.

The main ocular issues as we suspect to encounter in this study are Refractive errors , Squint, Ocular injuries, Allergic and Infective Conjunctivitis, Amblyopia, Blepharitis, Congenital problems, malignancies etc. We are also trying to assess the prevalence of gadget use among adolescents included in this study.

REVIEW OF LITERATURE:-

Dr.Renubedie et al in IOSR journal ⁴ studied the Prevalence of ocular morbidity among school children (10-18yrs) in Ajmer city. Ocular morbidity was detected in 15.98% and 5% students had more than one ocular disorders. Males were 40.23% and females were 59.77%. They also found out that according to age, 13-15 year age group had significantly more ocular morbidity(50.5%).The most common ocular morbidity among them was refractive errors(86.59%)followed by conjunctival nevus: 3.86% and conjunctivitis: 3.4%

Another study was by Deshpande et. al. in National journal of community medicine ⁵ which studied the Prevalence of ocular morbidities among school children in rural area of North Maharashtra in India. They studied school going adolescents. The study concluded that ocular morbidities were observed in 27.65% of students and the commonest cause of ocular morbidity was refractive errors with a prevalence of 10.12%, Vit A deficiency was the second most common cause.Blepharitis, chalazion, stye, ptosis were the next common conditions

Adegbehingbe B et.al.in Ghana med journal 2005 ⁶, Screening of adolescents for eye diseases in Nigerian high schools.Allergic conjunctivitis was the most prevalent 49% of the entire group. Next prevalent was Refractive errors-22.5% and Glaucoma was diagnosed in 1.3%.

Prajapati P et al article in online journal of health and allied sciences⁷ in january 2010.Studied Prevalence of ocular morbidity among school adolescents of gandhinagar district, gujarat. The study analysed that prevalence of ocular morbidity among school adolescents was 13%(7.8%boys ,5.6% in girls).Refractive error was the most common ocular morbidity 40% both among boys and girls and 30% had vitamin A deficiency. They also analysed that various factors like illiterate parents, low socioeconomic status and malnutrition were significantly associated with ocular morbidity.

Mortazavi SM, Mortazavi SA, Paknahad M.⁸ studied Association between Exposure to Smartphones and Ocular Health in Adolescents In Ophthalmic epidemiology. 2016 Jan . The study concluded that higher prevalence rates of ocular symptoms  were observed in groups with greater exposure to smart phones.A higher duration of exposure to smart phones was associated with a higher likelihood of having multiple ocular symptoms.

Kozeis, N. (2009).⁹  Impact  of computer use on children’s vision.  Hippokratia, 13(4), 230–231.The study analysed that extensive viewing of the computer screen can lead to eye discomfort, fatigue, blurred vision and headaches, dry eyes and other symptoms of eyestrain. These symptoms may be caused by poor lighting, glare, an improper work station set-up, vision problems of which the person was not previously aware.

Kwok SW, Lee PH, Lee RL. .¹⁰ 2017 Feb 18  Studied  Smart device use and perceived physical and psychosocial outcomes among Hong Kong adolescents In International journal of environmental research and public health;14(2):205. In the study, data from 960 adolescents aged 10-19 were analyzed. Nearly 86% of the sample use smart device daily. The one-week prevalence of perceived sleep deprivation, eye discomfort, musculoskeletal discomfort, family conflict and cyberbullying victimization related to smart device use were nearly 50%, 45%, 40%, 20% and 5% respectively. More than 25% of the respondents were at risk of negative outcomes related to smart device activities for more than 1 h per day, browsing and gaming on at least 4 days per week and watching TV/movies and posting on more than 2 days per week. Their patterns of smart device activities may put a significant number of them at risk of negative outcomes.

AIMS AND OBJECTIVES:-

AIM :-

}  To study the pattern of ocular morbidity in adolescents attending Giridhar eye institute , kochi, a tertiary care eye centre in Kerala, a cross sectional study.

OBJECTIVES:-

}  To assess the pattern of ocular morbidity in adolescents attending our hospital over a period of 1 year or  >900 participants.

}  To assess the prevalence of use of electronic gadgets among the studied adolescents.

MATERIAL AND METHODS:-

• Study area: Giridhar Eye Institute , Kochi
• Study population: adolescents 10-19 years attending the OPD/ED
• Inclusion criteria: All patients between the age of 10-19 years
• Exclusion criteria: all other age groups
• Study design: Cross sectional study
• Sample size: >900 participants
• Study duration: 1 year (July 2017 to June 2018)

METHODOLOGY:-

• Details about every adolescent patient attending the clinics, i.e. between the ages of 10-19 years, are taken into the study.
• The history and diagnosis of patients  over a period of 1 year are noted and relevant clinical examinations pertaining to each case were done accordingly according to our electronic medical records by Tata consultancy services version 3.20 (The study proforma is attached).
• Finally analysis is done as to get the pattern of ocular morbidity among them and also to find the prevalence of adolescents using electronic gadgets.

STATISTICAL METHODS:-

• Data obtained from patients were recorded and analysed using Microsoft Excel
• Results of categorical variables are reported as counts and percentages.
• Chi square test and Fishers exact test will be used to find the differences between categorical variables.

REFERENCES:

1.      Blum, R., W., & Nelson-Nmari, K. (2004). The health of young people in a global context. Journal of Adolescent Health, 35, 402-418.

2.      Richard  E., Md. Behrman (Editor), Robert M., Md. Kliegman (Editor), Hal B., Md. Jenson (Editor) By W B Saunders Co. Nelson Textbook of Pediatrics 17th edition. Philadelphia, (May 2003): 128-132

3.      David abrams. DukeElder’s Practice Of Refraction (10Th Edition)},1983. Publisher:Elsevier (A Division of Reed Elsevier India Pvt. Limited): 45-66.

4.      Dr.RenuBedi, Dr. Dinesh Kumar Bedi, Dr. Nizamuddin Dr. Charushila Dudule Dr. Rashmi Gupta,Dr. Sanjeev Sharma.Prevalence of ocular morbidity among school children in Ajmer city.IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 10 Ver.VII (Oct. 2015), PP 20-25 www.iosrjournals.org DOI: 10.9790/0853-141072025 www.iosrjournals.org

5.      Deshpande Jayant D, MalathiK. Prevalence of ocular morbidities among school children in rural area of North Maharashtra in India. National Journal Of Community Medicine Vol. 2 Issue 2, July- sept 2011.

6.      Adegbehingbe BO, OladehindeMK, MajemgbasanTO, Onakpoya HO and OsagiedeEO . Screening of Adolescents for eye diseases in Nigerin High schools. Ghana Med. J. 2005 December; 39 (4) :138-142.

7.      Prajapati P, Oza J, Prajapati J, Kedia G, Chudasama RK. Prevalence of ocular morbidity among school adolescents of Gandhinagar district, Gujarat. Online Journal of Health and Allied Sciences. 2011 Jan 20;9(4)

8.      Mortazavi SM, Mortazavi SA, Paknahad M. Association between Exposure to Smartphones and Ocular Health in Adolescents. Ophthalmic epidemiology. 2016 Jan 1;23(6):418-.

9.      Kozeis, Nikos. (2009). Impact of computer use on children’s vision. Hippokratia. 13. 230-1.

10.  Kwok SW, Lee PH, Lee RL. Smart device use and perceived physical and psychosocial outcomes among Hong Kong adolescents. International journal of environmental research and public health. 2017 Feb 18;14(2):205.

11.  Blehm C, Vishnu S, Khattak A. et al. Computer vision syndrome: a review. Surv Ophthalmol. 2005;50(3):253–6