Authors: Tarek A. Bin Yameen, Myrna Lichter
Author Disclosure Block: T.A. Bin Yameen: None. M. Lichter: None.

Abstract Body:

Purpose: There is a lack of data on vision problems in a paediatric refugee population in Canada. Given the recent arrival of 40,000 Syrian refugees, we performed a cross-sectional, descriptive study to assess the prevalence of visual impairment and unmet eye care needs of Syrian refugee children in Toronto.

Study Design: Five single-day clinics were organized. Enrolment was offered to Syrian refugees registered with resettlement agencies, not for profit organizations, and/or private sponsorship groups.

Methods: Through a structured interview from the accompanying legal guardian, socio-demographics, medical history, subjective visual acuity, and access to eye care information was collected. Comprehensive visual screening, slit-lamp, dilated direct funduscopy, and refractions were performed. Visual acuity data was compared to Canadian prevalence data. χ2 tests were used for statistical analysis.

Results: 526 (65.8%) out of the 800 adults and children offered enrollment participated in the study. 278 paediatric patients were examined. The median age was 8 years (interquartile range (IQR)= 5-11) and 52% were females. Most patients lived outside Syria as refugees for 1 to 5 years (75.5%) and were enrolled in elementary school or less (48.9%). The prevalence of reported uncorrected vision problems was 17.2% for distance vision, 4.7% for near vision, and 0.7% for both distance and near vision, including loss of vision. A majority had not visited an eye specialist in the past year (95.3%) and 25.2% of parents were dissatisfied with their children’s vision. The presenting visual acuity in the better-seeing eye was 20/50 or worse in 5.8% (95% CI, 3.6%- 9.3%). By using pin-hole correction, this improved to 5.5% (95% CI, 3.3%-8.8%). Compared to the Canadian population (0.17%), Syrian refugee children were 32 times more likely to have 20/50 vision or worse (p< 0.01). The most common finding was refractive error in 25.9% (95% CI, 20.9%-31.5%). Six-year old Syrian children were 4 times more likely to suffer from myopia compared to their Canadian counterparts (26.1% v. 6.4%, p< 0.01). The prevalence of non-refractive error was 7.6% (95% CI, 4.7%-11.3%). The most frequent non-refractive errors were cataracts (1.8%), strabismus (1.8%), glaucoma (1.1%), and traumatic corneal scaring (0.07%).

Conclusions: This is the first study to assess ocular health in a paediatric refugee population in Canada. Syrian refugee children have a high prevalence of visual impairment, even when living within a system of universal healthcare. Vision-screening programs and accessible eye clinics may address this need.