Abstract
BackgroundHyperopic undercorrection is a common clinical practice. However, less is known of its effect on the change in refractive errors and emmetropization throughout the later years of childhood.ObjectivesTo evaluate the effect of spectacle correction on the change in refractive errors in hyperopic children less than 12 years of age with or without strabismus.Data ExtractionA retrospective cohort study was performed by a computer based search of the hospital database of patients with hyperopia, accommodative esotropia or exotropia. A total of 150 hyperopic children under 12 years of age were included. Patients were classified into four groups: 1) accommodative esotropia with full correction of hyperopia, 2) exotropia with undercorrection of hyperopia, 3) orthotropia with full correction of hyperopia, 4) orthotropia with undercorrection of hyperopia. The 4 groups were matched by initial age on examination and spherical equivalent refractive errors (SER). The main outcome measure was the change in SER (Diopter/year) in both eyes after two years of follow-up.ResultsAn overall negative shift in SER was noted during the follow-up period in all groups, except for the group with esotropia and full correction. The mean negative shift of hyperopia was more rapid in groups receiving undercorrection of hyperopia with or without strabismus. The amount of undercorrection of hyperopia was positively correlated to the magnitude of decrease in hyperopia in all patients (r = 0.289, P<0.001) and in the subgroup of patients with orthotropia (r = 0.304, P = 0.011). The amount of undercorrection of hyperopia was the only factor associated with a more negative shift in SER (OR, 2.414; 95% CI, 1.202–4.849; P = 0.013).ConclusionsThe amount of undercorrection is significantly correlated to the change in hyperopic refractive errors. Full correction of hyperopia may inhibit emmetropization during early and late childhood.
Highlights
The amount of undercorrection is significantly correlated to the change in hyperopic refractive errors
In this study, we aimed to determine the effect of spectacle correction on the change in hyperopia throughout early and late childhood, by comparing hyperopic children with and without strabismus matched by age and refractive errors, who received different amounts of spectacle correction
Astigmatism was significantly larger in the group with orthotropia compared to the group with esotropia or exotropia (P,0.05 by one-way ANOVA, post-hoc Bonferroni)
Summary
There are two major conflicting ideas in the management of hyperopia, which puts clinicians in a certain dilemma. [1,2] One perspective concerns the theory that eye growth and emmetropization are controlled by visual input. [3,4,5] This gives the idea that spectacle correction of hyperopia may interfere with emmetropization and leave the child with significant hyperopia. [6] The other perspective is that refractive correction of hyperopia may improve visual acuity as well as the accuracy of accommodation. [1,2] the recommended guidelines regarding the threshold for hyperopic correction and optimal amount of correction vary among publications [6,7,8].Previous studies have found conflicting results of the effect of spectacle correction on emmetropization. [9,10,11,12,13] Ingram et al [10] reported that consistently wearing glasses impeded emmetropization up to the age of 42 months in normal children with hyperopia. [10] In contrast, Atkinson et al [11] demonstrated that by the age of 3 years there was no overall difference between children who were treated with partial spectacle correction and those who were not. [11] these studies are limited to patients with strabismus or very young infants, lacking evidence on the changes observed throughout the later years of childhood including the early school years. [9,10,11,12] these studies did not fully include various confounding factors that may affect changes in refractive errors, such as age, initial SER and strabismus [12,13].in this study, we aimed to determine the effect of spectacle correction on the change in hyperopia throughout early and late childhood, by comparing hyperopic children with and without strabismus matched by age and refractive errors, who received different amounts of spectacle correction. Previous studies have found conflicting results of the effect of spectacle correction on emmetropization. [9,10,11,12] these studies did not fully include various confounding factors that may affect changes in refractive errors, such as age, initial SER and strabismus [12,13]. In this study, we aimed to determine the effect of spectacle correction on the change in hyperopia throughout early and late childhood, by comparing hyperopic children with and without strabismus matched by age and refractive errors, who received different amounts of spectacle correction. Less is known of its effect on the change in refractive errors and emmetropization throughout the later years of childhood
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