Hypermetropic Children Research Articles

Refraction dynamics in schoolchildren with congenital partial atrophy of the optic nerve over a ten-year observation period

Introduction. Optic nerve atrophy is a degenerative condition and a prevalent cause of visual impairment, including in children. Data on refractogenesis in schoolchildren with partial atrophy of the optic nerve (PAON) are scarce, with existing literature focusing primarily on the correction of low vision associated with this disorder. Purpose: to assess the refraction dynamics in schoolchildren with congenital PAON over a ten-year observation period.Materials and methods. We conducted a retrospective analysis of refraction changes over a decade among three groups: 1) 47 schoolchildren with PAON, 2) 49 schoolchildren with ametropia without PAON, and 3) 49 schoolchildren without any ophthalmopathology.Results. All groups exhibited a trend towards myopization (р < 0.001). In groups with myopic and emmetropic refractions (without ophthalmopathology at the start), either the emergence or an increase in myopic refraction was noted. In hypermetropic children, a gradual decrease towards emmetropic refraction or a shift to myopic refraction was observed. For myopic schoolchildren using contact lenses and perifocal glasses from the ages of 11–13, myopia progression stabilized, particularly with perifocal optical correction (р < 0.01). Despite refractive changes during the school years, regular courses of functional treatment and accommodation training led to a slight improvement in visual acuity in PAON patients (by an average of 0.05 ± 0.01 (p = 0.001) in myopes and 0.06 ± 0.01 (р < 0.001) in hypermetropes) and a significant increase in visual acuity in children with normal fundus ametropia (by an average of 0.14 ± 0.02 (р < 0.001) in myopes and 0.18 ± 0.02 (р < 0.001) in hypermetropes).Conclusion. The ten-year observation demonstrates a myopization trend in all groups of schoolchildren, which holds particular relevance for those with PAON due to their inherently lower visual acuity. An optimal optical correction strategy, employing modern myopia control measures in tandem with regular functional treatment and accommodation training, is essential for a health-preserving educational approach in schoolchildren with PAON.

Гиперметропия у детей и ее клинические особенности

Purpose. Assessment of the functional state of children with hypermetropia and its performance in the visual system. Material and methods. 212 (424 eyes) somatically healthy children aged 3 to 18 years with hypermetropic refraction from 1.5±0.6 to 7.5±0.7 D were examined. They underwent standard ophthalmological examination, including visometry, refractometry, biometry and keratometry. The statistics of the material were processed according to the MS Excel 2010 program. Results. Structure of hypermetropic children for various periods of life is described in detail – congenital (against the background of normal physiology), acquired and concomitant (in various variants). In addition, the axial length of their eyes was determined in the range from 21.0 to 23.85 mm, that is, in a short range. It is also clarified that hypermetropic children can not only determine the «regular» eye accommodation tension, but also timely detect and treat functional disorders – asthenopia and/or habitually excessive accommodation voltage (described by Somov E.E. in 2012). It is also confirmed that hypermetropia is naturally accompanied by friendly strabismus (at least 90%). However, this diagnosis reveals various forms of pathology of the visual organ – deviation of the eye, ametropia, amblyopia and dysbinocularity. It can be represented by the syndrome of friendly strabismus (SFS, Somov E.E.). Two clinical forms of hypermetropia have also been identified – ordinary and complicated. The first does not require treatment, apart from optical vision correction, and the second is described in different publications, due to accommodation disorders, friendly strabismus and amblyopia. Conclusion. Hypermetropia in children is represented by a complex anatomical and clinical structure with a short axial length of the eye, weak optics, functional disorders of accommodation (asthenopia and/or habitually excessive accommodation voltage). Moreover, it naturally occurs with the syndrome of friendly strabismus. Finally, due to anatomical features, hypermetropes are able to use only «simple» vision correction: traditional glasses (~75%), contact lenses (~25%) and still rare Perifocal-H lenses. In general, these ametropes require a lot of attention, especially in conducting new research. Key words: clinical refraction of the eye, anterior-posterior eye size, keratorefractometry, accommodation, commutant esotropia, vision correction in hypermetropia

A variation of foveal morphology in a group of children with hypermetropia.

During routine eye examinations, we noticed widened and flattened foveal pits with loss of normal V-shaped foveal profile and a pseudohole-like appearance in some otherwise healthy hypermetropic children. Our purpose was to describe clinical significance and multimodal imaging features of this incidental finding. Prospectively, 25 eyes of 13 hypermetropic children with these foveal changes and 36 eyes of 19 hypermetropic children with normal foveal appearance were enrolled. The macular thickness measurements and foveal parameters including pit diameter, depth, base, and area obtained by optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany), macular superficial and deep vessel density (VD) and foveal avascular zone values obtained by optical coherence tomography angiography (Avanti RTVue‑XR; Optovue, Fremont, CA, USA) were noted. The correlations of these parameters with visual function were evaluated. In the study group, significantly widened and flattened pit contours with decreased central foveal thickness (p = 0.01), and increased distance between foveal edges (p < 0.001) were observed. While the whole image superficial macular VD was similar between the groups (p = 0.74), a significant decrease in deep macular VD was observed in the study group (p = 0.01). None of these changes were correlated with visual acuity. Wider and flattened foveal pits described here represent a newly defined variation in healthy hypermetropic children. Although a correlation with visual acuity was not evident, these changes in foveal profile are shown to be related with macular microvascular changes in deep capillary plexus. Awareness of these morphologic changes will help clinicians in the differential diagnosis of macular pseudohole.

A Cross-sectional Observational Study to Assess the Influence of 1% Cyclopentolate and 1% Tropicamide on Intraocular Pressure in Children Undergoing Cycloplegic Refraction at a Tertiary Care Hospital in Southern India

Introduction: Cycloplegic refraction is necessary in children due to their high amplitude of accommodation. A combination of Tropicamide and Cyclopentolate is commonly used as cycloplegics in children. These medications can cause a substantial elevation in Intraocular Pressure (IOP) in a few susceptible children. Therefore, the present study was conducted to investigate the changes in IOP when 1% Cyclopentolate and 1% Tropicamide were used for cycloplegic refraction in children. Aim: To assess the influence of 1% Cyclopentolate eyedrops and 1% Tropicamide eyedrops on IOP in children undergoing cycloplegic refraction and to compare the changes in IOP between the hypermetropic and myopic groups before and after cycloplegia. Materials and Methods: This cross-sectional hospital-based study was conducted in the Outpatient Department (OPD) of Ophthalmology at KLE’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, in Northern Karnataka, India over a duration of six months. The study included 55 children in the age group of 5-15 years who met the inclusion criteria. All children underwent visual acuity assessment and a detailed examination of the anterior and posterior segments of the eye. Refraction was expressed in terms of Spherical Equivalence (SE), calculated as sphere plus half of the cylinder. Based on the SE calculated after refraction, children were diagnosed as having either myopia or hypermetropia as types of refractive error. Data were analysed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Statistics (Version 25.0, Chicago, IL, USA). Categorical variables were represented as frequency and percentages, while continuous variables were represented as Mean±Standard Deviation (SD). A p-value ≤0.05 was considered statistically significant. Results: Out of the 55 children included in the study, 25 children were hypermetropic, and 30 children were myopic based on the calculated SE. Among the total of 55 children, 34 were girls, and 21 were boys. The mean age of the 55 children was 10.98±2.4 years. The mean age of the myopic group was 11.97±2.21 years, while the hypermetropic group had a mean age of 9.74±3.29 years. The mean precycloplegic IOP was 14.21±2.76 mmHg, and the mean postcycloplegic IOP was 15.19±3.25 mmHg. The change in IOP was statistically significant (p≤0.0001). In the hypermetropic group of 25 children, the mean precycloplegic IOP was 13.74±2.55 mmHg, while the mean postcycloplegic IOP was 15.10±3.65 mmHg. There was a significant difference in IOP (p=0.0242). In the myopic group of 30, the mean precycloplegic IOP was 14.47±2.86 mmHg, while the postcycloplegic IOP was 15.08±2.86 mmHg. There was no statistically significant change in IOP in the myopic group (p=0.0669). After cycloplegic mydriasis, 2 eyes (3.7%) experienced an increase in IOP greater than 7 mmHg. Conclusion: Cycloplegic mydriasis using 1% Cyclopentolate and 0.8% Tropicamide caused a significant increase in IOP in a few children, with a higher increase observed in hypermetropic children compared to myopic children. Therefore, ophthalmologists should exercise caution and monitor IOP changes in children undergoing cycloplegic refraction to manage any transient rise in IOP and prevent damage to the optic nerve.

Eye colour and skin pigmentation as significant factors for refractive outcome and residual accommodation in hypermetropic children: a randomized clinical trial using cyclopentolate 1% and tropicamide 1.

PurposeTo compare the refractive outcome and residual accommodation with respect to various degrees of iris and skin pigmentation in hypermetropic children using 2 drops of cyclopentolate 1% (C + C) or 1 drop of cyclopentolate 1% and 1 drop of tropicamide 1% (C + T).MethodsTwo hundred fifty‐one hypermetropic children were classified according to iris and skin pigmentation (light, medium, dark) and received randomized and double‐blind C + C or C + T. Refractive error (spherical equivalent, SEQ) was determined using the Retinomax‐K + 3. In 204 subjects, residual accommodation (RA) was determined using the PlusoptiX PowerRefractor.ResultsA linear mixed model with a light‐irided and light skin‐pigmented reference group receiving C + T (mean SEQ +3.10 ± 1.87D) indicated significant less hypermetropia in subjects with a dark iris having a medium‐ and dark‐pigmented skin in C + T, −1.02 ± 0.29 (−1.59/−0.45) and −1.53 ± 0.30 (−2.10/−0.95); and in subjects having a light‐, medium‐ and dark‐pigmented skin in C + C, −0.74 ± 0.34 (−1.41/−0.06), −1.26 ± 0.30 (−1.85/−0.66) and −1.84 ± 0.30 (−2.42/−1.26). Similar findings were present for RA. Our model with a light‐irided and light skin‐pigmented reference group receiving C + T (mean RA +0.84 ± 0.61D) indicated significantly higher RA in dark‐irided subjects with medium‐ and dark‐pigmented skin in C + T, +1.05 ± 0.19 (+0.67/+1.43) and +1.35 ± 0.20 (+0.9/+1.74), and in C + C, +1.13 ± 0.21 (+0.71/+1.55) and +1.90 ± 0.19 (+1.51/+2.28).ConclusionsWe found solid evidence that skin pigmentation rather than iris pigmentation is the decisive factor for effectiveness of cycloplegics. Awareness of the limitations of cycloplegic regimens in dark‐irided/pigmented children is needed. Our study showed that cyclopentolate 1% combined with tropicamide 1% provides more accurate refractive outcomes both statistically and clinically integrating the factor skin pigmentation for dark‐irided subjects.

Multimodal imaging in non-syndromic microphthalmia: a case series

Microphthalmia is a rare congenital or developmental anomaly in which the globe is abnormally small. Between one-third and one-half of affected individuals have microphthalmia as part of a syndrome that affects other organs and tissues in the body. These forms are described as syndromic. When microphthalmia occurs by itself, it is described as nonsyndromic or isolated. We aimed to describe the clinical and paraclinical features of nonsyndromic microphthalmia through three cases. The first patient was an 8-year-old female child who presented with bilateral refractive accommodative esotropia due to hypermetropia. She was diagnosed with bilateral posterior microphthalmia qualified as non-syndromic and simple. Eyeglasses prescription has been upgraded and a 6-month clinical monitoring has been undertaken. The second case was about a 16-year-old female patient who had a bilateral amblyopia due to a non-syndromic microphthalmia. She presented with unilateral high intra-ocular pressure. Anterior Segment OCT showed unilateral narrow angle with iridotrabecular contact in the right eye. Microphtalmia has been qualified as complex in the right eye and simple in the left eye. The patient has been put under IOP-lowering topical medication for the OD and peripheral YAG laser iridotomy has been performed. IOP reduction was noticed within five days. The third case was a 7-year-old male child with bilateral non-syndromic complex nanophthalmia. Ophthalmic examination revealed bilateral microcornea and OCT of the macula showed bilateral retinal folds with apical surface corrugations. Optical correction and active surveillance were adopted. Non-syndromic microphthalmia is a rare and potentially blinding disease. We highlighted the interest of ocular ultrasound, especially in young hypermetropic children completed by an examination in OCT. Non-invasive, objective and repeatable, OCT seems to be of great interest in both the diagnosis and the monitoring of microphthalmia.

A randomized clinical trial using atropine, cyclopentolate, and tropicamide to compare refractive outcome in hypermetropic children with a dark iris; skin pigmentation and crying as significant factors for hypermetropic outcome

ABSTRACTPurpose: To evaluate the refractive outcome and influencing factors following atropine 0.5% eye-drops applied twice daily during 2 ½ days at home and two drops of cyclopentolate 1% (C+C) and one drop of cyclopentolate 1% and one drop of tropicamide 1% (C+T) applied in an outpatient clinic, in hypermetropic children with a dark iris.Methods: Double-blind randomized study including 67 3–6-year-old children receiving C+C in one eye and C+T in the other eye. Two weeks later followed by atropine 0.5% in both eyes. Primary outcome measures were: spherical equivalent (SEQ) following C+C, C+T and atropine, and secondarily SEQ with respect to sex, ethnicity, skin pigmentation (light, medium, dark) and crying. Data on atropine are divided in those with C+C (CC) or C+T (CT) as a first intervention.Results: Mean SEQ±SD for C+C, C+T, atropine-(CC) and atropine-(CT) was +1.74 ± 1.35, +1.77 ± 1.34, +2.15 ± 1.43 and +2.10 ± 1.38 diopter (D). Atropine 0.5% revealed significantly more hypermetropia than C+C and C+T; +0.41 ± 0.43, 95%CI +0.31 to +0.52D and +0.33 ± 0.39, 95%CI +0.24 to +0.34D. No significant difference was present between C+C and C+T; −0.03 ± 0.56, 95%CI −0.16 to +0.11D. Ethnicity and skin-color were strongly associated (r = 0.84, p < .001). Sex was not affecting outcomes (p = .101). Ethnicity was borderline significant (p = .049). Skin-color was a highly significant factor (p = .002). A statistical model combining intervention and skin-color, with light-pigmented subjects receiving atropine-(CC) as reference group (mean SEQ +2.61 ± 1.46D), indicated borderline significantly less hypermetropia in atropine-(CC)-dark: mean decrease (95%CI): −0.81 (−1.66 to +0.05)D and atropine-(CT)-dark −0.87 (−1.70 to −0.03)D, furthermore significantly less hypermetropia in C+C-dark: −1.15 (−1.97 to −0.32)D; C+T-dark: −1.21 (−2.03 to −0.39)D, C+C-medium: −1.02 (−1.81 to −0.24)D and C+T-medium: −0.86 (−1.64 to −0.08)D. Adding crying to the model significantly less hypermetropia was found for subjects crying in all interventions; −0.53 (−0.98 to −0.09)D. Within the interventions, with light-pigmented non-crying subjects as reference group (mean SEQ in atropine, C+C, respectively, C+T: +2.62 ± 1.41, +2.33 ± 1.20 and +2.32 ± 1.20D), showed significantly less hypermetropia in dark-pigmented crying subjects in each individual intervention: atropine −1.10 (−2.01 to −0.19), C+C −1.28 (−2.14 to −0.42) and C+T −1.34 (−2.20 to −0.48)D. For medium pigmented crying subjects this was present in atropine: −0.82 (−1.61 to −0.03)D and C+C: −0.86 (−1.68 to −0.04)D, but not in C+T: −0.58 (−1.25 to +0.09)D.Conclusions: Atropine 0.5% revealed a slight significantly higher hypermetropia. A dark-pigmented skin, especially when crying upon application, resulted in lower hypermetropia in all interventions. C+T provided clinically better results in medium pigmented crying subjects compared to C+C, and equal results compared to atropine 0.5%.

Comparison of Clinical Features in Hypermetropic Children According to Refractive Error

Comparison of Clinical Features in Hypermetropic Children According to Refractive Error

Association of birth parameters with refractive status in a sample of caucasian children aged 4-17 years.

Purpose. To investigate the association of birth parameters with refractive status in different age groups of Caucasian children. Materials and Methods. This cross-sectional study included 564 eyes of 282 children aged 4 to 17 years. All children underwent complete ophthalmologic examination. The children were divided into three groups according to their refractive status (emmetropia,myopia, and hyperopia), ages (4–7, 8-9, 10–12, and 13–17), and appropriateness for gestational age, respectively. Results. The mean age of the children was 9.2 ± 2.8 (age range 4–17 years). The mean spheric equivalent was +0.3 ± 1.7 (range: (−10.0)–(+10.0) diopters). The mean birth weight and gestational age were 2681.1 ± 930.8 grams (750–5000 grams) and 37.2 ± 3.7 weeks (25–42 weeks). According to multinominal logistic regression analysis, children with myopia were more likely to have higher birth weights than emmetropic children (OR: 1.0, 95% CI: 1.000–1.001, and P = 0.028). The hypermetropes were found to be significantly small for gestational age between 13 and 17 years of age. Conclusion. Birth weight and appropriateness for gestational age as birth parameters may have an impact on development of all types of refractive errors. The hypermetropic children tended to be small for gestational age.

Psychophysiology of refractive accommodative esotropia.

Purpose. To investigate the psychophysiologic aspects of refractive accommodative esotropia (RAE). Methods. I prospectively recruited patients aged 3–6 years with more than 3.0 diopters of hyperopia who presented at Kim's Eye Hospital from January 2011 to March 2013. I compared Korean Child Behavior Checklist (K-CBCL) which consists of internalizing factors (social withdrawal, somatic complaints, anxiety, and depression) and externalizing factors (social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior) between RAE group and control group. Results. Two out of three internalizing indexes were significantly different between groups (somatic complaints: RAE children 50.1 ± 4.6 and controls 46.6 ± 5.8, P = 0.026; depression/anxiety: RAE children 48.8 ± 7.9 and controls 43.9 ± 6.8, P = 0.024). Although there was no significant difference, RAE children scored slightly higher on the externalizing behavior index. In the RAE group, the far angle of esodeviation showed a moderate correlation with withdrawn behaviors. Conclusion. Hypermetropic children with high scores on the somatic complaint and depression/anxiety subscales of the CBCL could be at high risk for developing RAE. Psychosocial problems might be related to the pathogenesis of refractive accommodative esotropia.

Hypo-accommodation responses in hypermetropic infants and children

AimsAccommodation to overcome hypermetropia is implicated in emmetropisation. This study recorded accommodation responses in a wide range of emmetropising infants and older children with clinically significant hypermetropia to assess common...

Longitudinal follow-up of hypermetropic children identified during preschool vision screening

Early childhood hypermetropia is an important risk factor for the development of amblyopia and esotropia. Understanding the natural history of these complications aids in management decisions. A retrospective observational review was undertaken of 149 patients referred from a preschool photoscreening program who were determined to have hypermetropia of >or=+3.75 D spherical equivalent on criterion standard examination and were treated/followed by one group of academic pediatric ophthalmologists. The prevalence and incidence of accommodative esotropia and amblyopia were determined. At presentation 19% of hypermetropic children had amblyopia, 32% had esotropia, and 13% had both. Follow-up data of 108 patients during a mean of 40 months showed that 20 (24%) of 83 initially nonamblyopic patients developed amblyopia and that 22 (33%) of 67 initially nonstrabismic patients developed accommodative esotropia. Of patients initially managed with observation, 38% (6 of 16) developed amblyopia, and 31% (5 of 16) developed accommodative esotropia as compared with 21% (14 of 67) and 33% (17 of 51), respectively, for those given full or partial refractive correction. For patients without amblyopia or strabismus at presentation, only 20% developed amblyopia and 35% esotropia. Strabismic patients responded well to treatment, with no cases developing partially accommodative strabismus requiring surgery during follow-up. In this case series we found a high prevalence of amblyopia and strabismus. The results support the importance of early preschool vision screening and spectacle correction of moderate to high hypermetropia (>+3.50 D) to reduce the risk of amblyopia, although more research is needed.

Refractive Error among Strabismic Children in Ilorin, Nigeria

Objectives: This study was conducted to determine the pattern of refractive errors among a group of strabismic children. Methods: A cross sectional survey was carried out among primary school children in Ilorin South Local Government area of Kwara State, Nigeria to isolate those with manifest strabismus. These children with manifest strabismus then underwent a full ocular examination followed by an objective refraction using a Topcon 8000R autorefractometer without cycloplegia and then a subjective refraction. Results: Of the 7288 children screened, there were 32 cases of strabismus (22 esotropia and 10 exotropia) consisting of 19 males and 13 females (M: F = 1.5:1). Hypermetropia was the commonest refractive error among the children (50%) followed by astigmatism (30%) and myopia (20%). There was more astigmatism among esotropic children (66.7%) compared to exotropic children (33.3%). Majority of the hypermetropia (85%) was associated with esotropia while most of the myopia (62.5%) was associated with exotropia. The prevalence of significant refractive error was found to be 34.4% (95% CI, 34.2 – 34.6). A great proportion of the refractive errors are in the mild and moderate category. It was only among hypermetropic children that refractive errors greater than ±5.0DS/Cyl in any meridian was found. Conclusion: There is a high prevalence of significant refractive error in the study population. Hypermetropia is the dominant refractive error seen in this study and most of it is found among the esotropic children. There was more myopia among exotropic children compared to esotropic ones but the difference is not statistically significant.Keywords: Refractive Error, Strabismus, Children, Ilorin

011: Longitudinal follow-up of hypermetropic children identified during preschool vision screening

011: Longitudinal follow-up of hypermetropic children identified during preschool vision screening

Long-term changes in the cylinder power of hypermetropic children with and without accommodative esotropia

Introduction: Lambert and Lynn suggested that cylinder power increases in children with accommodative esotropia treated with spectacles. We analyzed the changes in cylinder power of spectacle-wearing hypermetropic children with and without esotropia. Methods: Refractive errors were followed in 108 children with hypermetropia with and without esotropia for a mean of 3.9 years. Cycloplegic refractions were performed by retinoscopy. The refractive data were analyzed for the entire group and according to age of spectacle prescription, and ocular alignment. Results: The mean cylinder power increased on average by 0.16 D. In the youngest age group (0 < 2 years) the mean increase was 0.3 D; in the second group (2 < 4 years) the mean increase was 0.2 D, and in the third group (>4 years) the mean increase was 0.08 D. There was a tendency toward a larger average increase in astigmatism in the accommodative esotropes. Discussion: Similar to the results reported by others, we found a slight increase in cylinder power, which was more substantial among patients under the age of two. Nevertheless, this change, although statistically significant, is probably of no clinical importance. Conclusions: In children wearing spectacles for hypermetropia with and without esotropia, astigmatism increases minimally. Cylinder power changes were more common in the accommodative esotrope group.

The long-term outcome of the refractive error in hypermetropic children

Introduction: There is scant information on the long-term natural course of the refractive error in children with high hypermetropia and mild hypermetropia. We investigated the long-term relationship in changes in the refraction, with other variables, in high as compared with mild hypermetropia. Methods: Ninety high hypermetropic and 54 mild hypermetropic children were included in this retrospective study. Boys represented 51% (73 of 144) of the subjects. Inclusion criteria were as follows: follow-up of at least 4 years; initial refractive error of at least +5.00 D in the high hypermetropic group; and +3.00 D or less in the mild hypermetropic group. Children with anisohypermetropia were excluded. The MIXED model was used for statistical analysis. Four variables were studied: age, gender, level of hypermetropia, and presence or absence of strabismus. Eight subgroups emerged. Results: The mean follow-up was 8 years (range, 5 to 11.5). In five of eight subgroups the variables had a statistically significant impact on the long-term outcome of hypermetropia (p < 0.001). Discussion: The change in the refractive error in eyes with high hypermetropia was found to be insignificant. Children with mild hypermetropia, a clinically significant reduction in refractive error over time, was observed. Conclusion: Our data provide the physician and patient’s families with information on the outcome of hypermetopia in children.

Accommodative Convergence in Hypermetropia

We compared the clinical characteristics of esotropic, hypermetropic children whose strabismus was fully corrected with spectacles (refractive accommodative esotropia) with those who remained orthotropic (that is, had no manifest strabismus on the cover test) in the presence of uncorrected hypermetropia. In addition to a standard ophthalmologic and orthoptic examination, we determined the stimulus accommodative convergence/accommodation (AC/A) ratio by using the gradient method over a range of 6 diopters, the near point of accommodation, and random dot stereopsis. Hypermetropic patients without esotropia or significant esophoria were found to have a low AC/A ratio in contrast to those patients with refractive accommodative esotropia. This finding explains why esodeviations may be absent in some hypermetropic patients with uncorrected vision. We found a high prevalence of abnormally low near points of accommodation and defective or absent stereopsis in both groups of patients.

Abstract of Clinical Lecture on the Use of Glasses in Hypermetropic Children

Abstract of Clinical Lecture on the Use of Glasses in Hypermetropic Children