Ophthalmology Volume 115, Number 9, September 2008, p 1642-43
Refractive Error in Myanmar
Dear Editor:
Gupta et al(1) report adult refractive data from a rural population from relatively peaceful, central Myanmar, concluding that these ethnic Burmese frequently are myopic and have relatively mild astigmatism. The distribution of astigmatism axis was not reported. Obtaining accurate data on refractive error from other ethnic groups may be more complex, particularly the Karen State of that country, which has been in a state of civil war for more than 40 years.(2)
Vision screening and eye examination clinics in parts of the Karen State in December 2007 were organized by the private relief organization Free Burma Rangers. Acuity screening and photo screening were offered to more than 1200 Karen children and adults. Similar to the findings of Gupta et al, spectacles were almost nonexistent, despite noble earlier efforts in that region.(3)
In our Karen children, the most common cause of blindness was corneal opacity resulting from land mines or untreated keratitis. Three percent had mild to moderate refractive amblyopia, usually associated with astigmatism but rarely high hyperopia. Forty percent of our subjects older than 35 years failed distance acuity testing, 10% because of cataract and corneal opacity. From 223 manifest refractions, the mean spherical equivalent±standard deviation was 0.5±1.8, and the mean cylinder±standard deviation was 0.9±0.4 diopters. Ninety percent of the astigmatism was against-the-rule (plus cylinder within 20° of 180). The Karen people seem to have latent hyperopia with frequent against-the-rule astigmatism.
We wonder whether Dr Gupta also found against-the-rule astigmatism in the rural population near Mandalay. Donated spectacles from groups like the Lions Clubs in America(4) poorly represent the astigmatism of the Karen people.
ROBERT W. ARNOLD, MD
ANDREW W. ARNOLD
Anchorage, Alaska
References
1. Gupta A, Casson RJ, Newland HS, et al. Prevalence of refractive
error in rural Myanmar: the Meiktila Eye Study. Ophthalmology
2008;115:26 –32.
2. Mills EJ, Singh S. Health, human rights, and the conduct of
clinical research within oppressed populations. Global Health
2007;3:10.
3. Vincent JE. Simple spectacles for adult refugees on the
Thailand-Burma border. Optom Vis Sci 2006;83:803–10.
4. Guzowski M, Wang JJ, Rochtchina E, et al. Five-year refractive
changes in an older population: the Blue Mountains Eye
