Hyperopic Children Research Articles

Comparative analysis of biometry and anterior chamber metrics in the eyes of extreme hyperopic and emmetropic children

PurposeTo investigate the clinical and biometric features of pediatric eyes with extreme hyperopia and report baseline biometric values. MethodsIn this prospective case-control study, the biometric parameters of eyes in children with extreme hyperopia were compared to those of an emmetropic cohort of similar age. Comprehensive eye examinations were conducted for new patients. Anterior OCT (CASIA-2, Tomey) and ocular biometry imaging (IOL Master 700, Zeiss) were performed for all participants. ResultsA total of 19 children (mean age, 12.3 ± 2.3 years) with extreme hyperopia (+8.84 ± 0.77) were compared with 17 emmetropic (+0.53 ± 0.43) controls of similar age (mean age, 12.4 ± 2.2 years [P = 0.864]). Extreme hyperopic eyes exhibited significantly shorter axial length, normal spherical equivalent corneal keratometry, higher astigmatism, lower anterior chamber area and volume, and narrower iridotrabecular angle optical coherence tomography (OCT) parameters. Lens thickness and curvature were similar, with a slightly anterior and tilted position. ConclusionsIn our study cohort, extreme hyperopia was associated with shorter axial length, reduction in anterior chamber size, with well-formed, regular-sized lens positioned anteriorly, and a narrower iridotrabecular angle.

Comparison of cycloplegic refraction in children with different iris colour categories. A cross- sectional survey

Objective: To compare the cycloplegic refraction in children with different iris colour categories and age groups. Methods: The cross-sectional study was conducted from December 2022 to June 2023 at the Eye Clinic of Sehat Medical Complex, Hanjarwal, Lahore, and Khizar Eye Centre, Lahore, Pakistan, and comprised hyperopic children aged 5-12 years of either gender. Data regarding age, gender, iris colour, auto-refraction and retinoscopy before and after cycloplegic refraction was collected using a structured proforma. Data was analysed using SPSS 21. Results: Of the 139 subjects, 73(52.5%) were males and 60(47.5%) were females. There were 79(56.8%) subjects aged 5-8 years and 60(43.2%) aged 9-12 years. The iris colour distribution was 23(16.5%) light, 80(57.6%) medium and 36(25.9%) dark, with a mean visual acuity of 0.7±0.6. There was a significant difference in non-cycloplegic and cycloplegic refraction for different iris colours and age groups (p<0.05). Conclusion: Children with light iris colour accommodated more and needed a low concentration of cyclopentolate compared to those with medium and dark iris colours. More accommodation was noted among children aged 9-12 years. Key Words: Cycloplegic refraction, Cyclopentolate, Hyperopia, Iris, Ocular refraction, Retinoscopy.

Spectacle Lenses With Highly Aspherical Lenslets for Slowing Axial Elongation and Refractive Change in Low-Hyperopic Chinese Children: A Randomized Controlled Trial

Purpose: Spectacle lenses with highly aspherical lenslets (HAL) have been shown to effectively retard myopia progression in myopic children. This study aimed to investigate the impact of spectacle lenses with HAL on refractive and axial length (AL) changes in Chinese children with low amount of hyperopia. Design: Randomized controlled trial Methods: A total of 108 Chinese children aged 6.0 to 9.9 years and spherical equivalent refractive error (SERE) from 0.00 to +2.00 D were randomly allocated into two groups: the HAL group and the single vision spectacle lens (SVL) group. Cycloplegic refraction, AL, and uncorrected visual acuity (UCVA) was measured at baseline, three months, six months, and 12 months after lens dispensing. The duration of spectacle lens wear was monitored using a wearable device attached to the spectacle frame and by questionnaire logs provided by participants at each follow up visit. Results: The one-year SERE change was -0.19 [-0.32, 0.03] D and −0.23 [-0.36, 0.05] D in the SVL and HAL groups (P=0.883). The one-year AL elongation was 0.24 [0.18, 0.34] mm and 0.19 [0.12, 0.27] mm in the SVL and HAL groups (P=0.057). In the HAL group, changes in AL and SERE were significantly correlated to lens wearing time (P<0.001 and P=0.024, respectively). Participants in the HAL group who wore their lenses for more than 30 hours per week had significantly slower AL elongation (0.11 [0.05, 0.17] mm) compared to their SVL counterparts (0.27 [0.21, 0.33] mm) (P<0.001). Conclusion: Spectacle lenses with HAL significantly reduced AL elongation in low hyperopic children who wore lenses for over 30 hours per week. A dose-response relationship was evident with longer lens wearing time associated with less AL change.

Refractive and ocular biometric characteristics of non-myopic and pseudomyopic eyes in mild hyperopic Chinese children aged 3–12 years

PurposeTo investigate the refractive and ocular biometric characteristics of children with mild hyperopia and distinguish between non-myopic and pseudomyopic eyes before cycloplegia. MethodsThe eligible children underwent refractive error measurements using a NIDEK autorefractor before and after the administration of 0.5 % tropicamide. Ocular biometric parameters, including axial length (AL), anterior chamber depth (ACD), and lens thickness (LT), were measured using the IOLMaster 700 before cycloplegia. We performed comparative analyses between the non-myopic and pseudomyopic groups, categorized based on whether the spherical equivalent (SE) before cycloplegia exceeded −0.50 diopters (D). Univariable and multivariable regression analyses were performed to control for confounding factors. ResultsThe final analysis included 968 eyes. The participants with pseudomyopia were more likely to be boys (P = 0.029), younger (P = 0.004), less hyperopic (P < 0.001) after cycloplegia, and exhibit a higher delta SE (P < 0.001) compared to the non-myopic participants. Pseudomyopic eyes were associated with a shallower ACD (P = 0.004) and thicker LT (P < 0.001) than non-myopic eyes. After adjusting for sex, age, and SE, pseudomyopic eyes showed increased AL (P = 0.001) and LT (P < 0.001) and decreased ACD (P = 0.005) compared with non-myopic eyes before cycloplegia. ConclusionsAmong the children with mild hyperopia, pseudomyopia was more common in younger boys with a lower cycloplegic SE and higher delta SE. A thicker LT, shallower ACD, and increased AL may indicate the presence of pseudomyopia, which may provide insights into the rapid progression of myopia in children with pseudomyopia.

Ocular Biometric Components in Hyperopic Children and a Machine Learning-Based Model to Predict Axial Length.

The purpose of this study was to investigate the development of optical biometric components in children with hyperopia, and apply a machine-learning model to predict axial length. Children with hyperopia (+1 diopters [D] to +10 D) in 3 age groups: 3 to 5years (n=74), 6 to 8years (n=102), and 9 to 11years (n=36) were included. Axial length, anterior chamber depth, lens thickness, central corneal thickness, and corneal power were measured; all participants had cycloplegic refraction within 6 months. Spherical equivalent (SEQ) was calculated. A mixed-effects model was used to compare sex and age groups and adjust for interocular correlation. A classification and regression tree (CART) analysis was used to predict axial length and compared with the linear regression. Mean SEQ for all 3 age groups were similar but the 9 to 11year old group had 0.49D less hyperopia than the 3 to 5year old group (P < 0.001). With the exception of corneal thickness, all other ocular components had a significant sex difference (P < 0.05). The 3 to 5year group had significantly shorter axial length and anterior chamber depth and higher corneal power than older groups (P < 0.001). Using SEQ, age, and sex, axial length can be predicted with a CART model, resulting in lower mean absolute error of 0.60 than the linear regression model (0.76). Despite similar values of refractive errors, ocular biometric parameters changed with age in hyperopic children, whereby axial length growth is offset by reductions in corneal power. We provide references for optical components in children with hyperopia, and a machine-learning model for convenient axial length estimation based on SEQ, age, and sex.

Longitudinal Changes in Refractive Development in Highly Hyperopic Children: A 2.6-11.2 Year Follow-up of Preschoolers Diagnosed with High Hyperopia

Purpose This study aims to elucidate the longitudinal refractive and ocular biometric alterations in preschool children with high hyperopia who underwent early interventions. Methods We conducted a retrospective analysis of preschool children diagnosed with high hyperopia at Tianjin Medical University Eye Hospital between 2011 and 2023. Inclusion criteria required an initial examination with cycloplegic refraction, bilateral spherical equivalent power (SE) ≥ +5.00D with a difference <1.00D, a minimum two-year follow-up, and at least three ocular biometric measurements. The annual axial growth rate evaluated emmetropization in highly hyperopic children. We applied Restricted Cubic Spline (RCS) models to explore potential nonlinear relationships between age and spherical equivalent, axial length, corneal curvature, and axial length-to-corneal curvature ratio. Additionally, Mixed-effects models were employed to investigate factors associated with changes in refractive error and axial length. Results The study enrolled 60 eligible subjects, with a median initial diagnosis age of 3.5 years (IQR, 2.8-4.9 years) and a median last visit age of 9.3 years (IQR, 8.1-10.8 years). The average follow-up duration was 5.7 years. RCS analysis revealed notable nonlinear changes in spherical equivalent power, axial length, and axial length-to-corneal curvature ratio, although corneal curvature displayed no statistically significant nonlinear trend. Factors affecting SE changes included the presence of strabismus, the use of cycloplegia, baseline SE, and age. Conversely, changes in axial length solely correlated with baseline axial length and age. Conclusion Highly hyperopic preschool children undergoing early intervention display a marked emmetropization tendency, though most still remain moderately to highly hyperopic, with the progression of refractive changes showing non-uniform patterns with respect to age.

Study of myopia progression and risk factors in Hubei children aged 7–10 years using machine learning: a longitudinal cohort

BackgroundTo investigate the trend of refractive error among elementary school students in grades 1 to 3 in Hubei Province, analyze the relevant factors affecting myopia progression, and develop a model to predict myopia progression and the risk of developing high myopia in children.MethodsLongitudinal study. Using a cluster-stratified sampling method, elementary school students in grades 1 to 3 (15,512 in total) from 17 cities in Hubei Province were included as study subjects. Visual acuity, cycloplegic autorefraction, and height and weight measurements were performed for three consecutive years from 2019 to 2021. Basic information about the students, parental myopia and education level, and the students’ behavioral habits of using the eyes were collected through questionnaires.ResultsThe baseline refractive errors of children in grades 1 ~ 3 in Hubei Province in 2019 were 0.20 (0.11, 0.27)D, −0.14 (−0.21, 0.06)D, and − 0.29 (−0.37, −0.22)D, respectively, and the annual myopia progression was − 0.65 (−0.74, −0.63)D, −0.61 (−0.73, −0.59)D and − 0.59 (−0.64, −0.51)D, with the prevalence of myopia increasing from 17.56%, 20.9%, and 34.08% in 2019 to 24.16%, 32.24%, and 40.37% in 2021 (Χ2 = 63.29, P < 0.001). With growth, children’s refractive error moved toward myopia, and the quantity of myopic progression gradually diminished. (F = 291.04, P = 0.027). The myopia progression in boys was less than that in girls in the same grade (P < 0.001). The change in spherical equivalent refraction in myopic children was smaller than that in hyperopic and emmetropic children (F = 59.28, P < 0.001), in which the refractive change in mild myopia, moderate myopia, and high myopia children gradually increased (F = 73.12, P < 0.001). Large baseline refractive error, large body mass index, and high frequency of eating sweets were risk factors for myopia progression, while parental intervention and strong eye-care awareness were protective factors for delaying myopia progression. The nomogram graph predicted the probability of developing high myopia in children and found that baseline refraction had the greatest predictive value.ConclusionMyopia progression varies by age, sex, and myopia severity. Baseline refraction is the most important factor in predicting high myopia in childhood. we should focus on children with large baseline refraction or young age of onset of myopia in clinical myopia prevention and control.

Prevalence of anisometropia and its associated factors in school-age children

ABSTRACT Purpose To determine the prevalence of anisometropia and the associated demographic and biometric risk factors in children. Methods This cross-sectional study was conducted on the elementary school children of Shahroud, east of Iran, in 2015. All rural students were recruited, while multistage cluster sampling was used to select the students in urban areas. All children underwent optometric examinations including the measurement of uncorrected and corrected visual acuity, autorefraction, and subjective refraction with cycloplegia. Biometric components were measured using the Allegro Biograph. Myopia and hyperopia were defined as a spherical equivalent ≤−0.5 and ≥ +2.00 diopter, respectively. Students with a history of ocular trauma or lack of cycloplegic refraction at least in one eye were excluded from the study. Results Of 6624 selected children, 5620 participated in the study. After applying the exclusion criteria, the data of 5357 students (boys: 52.8%, n = 2834) were analyzed. The mean age of the subjects was 9.2 ± 1.7 years (range: 6–12 years). The prevalence of anisometropia ≥ 1 D was 1.1% (95% CI: 0.8 to 1.4) in all children, 1.0% (95% CI: 0.7–1.3) in boys, 1.3% (95% CI: 0.8–1.7) in girls, 1.1% (95% CI: 0.8–1.4) in urban children, and 1.4% (95% CI: 0.5–2.3) in rural children. The prevalence of anisometropia was 8.8% (95% CI: 5.3–12.2) in myopic and 5.7% (95% CI: 2.8–8.5) in hyperopic children. Axial length asymmetry (OR = 40.9; 95%CI: 10.2–164.1), myopia (OR = 17.9; 95% CI: 9.4–33.9), and hyperopia (OR = 10.1; 95% CI: (5.1–19.7) were associated with anisometropia in multiple logistic regression model. More anisometropia was associated with more severe amblyopia. The odds of amblyopia (OR = 82.3: 38.2-177-3) and strabismus (OR = 17.6: 5.5–56.4) were significantly higher in anisometropic children. The prevalence of amblyopia was 21.7% in children with myopic anisometropia ≥ 3D, 66.7% in children with hyperopic anisometropia ≥ 3D, and 100% in cases with antimetropia ≥ 3D. Conclusion The prevalence of anisometropia was low in Iranian school children. However, a high percentage of anisometropic students had amblyopia and strabismus. Axial length was the most important biometric component associated with anisometropia.

Management of Exotropia Associated with Hyperopia in Children

Management of Exotropia Associated with Hyperopia in Children

Effect of spectacle correction on hyperopic children.

Background: Hyperopia is a significant refractive error in children, often leading to vision impairment. This study aimed to investigate whether partial or full spectacle correction is benefit for hyperopia in preschool-aged children. Methods: A retrospective study was conducted on hyperopic children visited to teaching medical center outpatient clinic between October 2011 and October 2018, and were categorized into three groups: full correction, overcorrection, and undercorrection. The study was approved by the institutional ethical committee of Tri-Service General Hospital. Results: Following a minimum of one-year follow-up period, no statistically significant differences were observed in best-corrected visual acuity (BCVA) among children receiving full, over, or under spectacle correction. Notably, the overcorrection group exhibited a significant reduction in spherical equivalent (SE) compared to both the full and under correction groups, indicating a better SE with spectacle overcorrection. Conclusions: Spectacle overcorrection may offer potential benefits for enhancing SE in preschool children with hyperopia. Nevertheless, further investigation through randomized controlled trials is warranted to establish the validity of this approach and its impact on visual outcomes in this hyperopic pediatric population.

How Do Most Young Moderate Hyperopes Avoid Strabismus?

Uncorrected hyperopic children must overcome an apparent conflict between accommodation and vergence demands to focus and align their retinal images. This study tested hypotheses about simultaneous accommodation and vergence performance of young hyperopes to gain insight into ocular motor strategies used to maintain eye alignment. Simultaneous eccentric photorefraction and Purkinje image tracking were used to assess accommodative and vergence responses of 26 adult emmetropes (AE) and 94 children (0-13 years) viewing cartoons. Children were habitually uncorrected (CU) (spherical equivalent refractive error [SE] -0.5 to +4 D), corrected and aligned (CCA), or corrected with a history of refractive esotropia (CCS). Accommodative and vergence accuracy, dissociated heterophoria, and vergence/accommodation ratios in the absence of retinal disparity cues were measured for 33- and 80-cm viewing distances. In binocular viewing, median accommodative lags for 33 cm were 1.0 D (AE), 1.33 D (CU), 1.25 D (CCA), and 1.0 D (CCS). Median exophorias at 80 and 33 cm were 1.2 and 4.5 pd (AE), 0.8 and 2.5 pd (CU), and 0 and 1.2 pd (CCA), respectively. Without disparity cues, most response vergence/accommodation ratios were between 1 and 2 meter angle/D (∼5-10 pd/D) (69% of AE, 44% of CU, 60% of CCA, and 50% of CCS). Despite apparent conflict in motor coupling, uncorrected hyperopes were typically exophoric and achieved adultlike accuracy of both vergence and accommodation simultaneously, indicating ability to compensate for conflicting demands rather than bias to accurate vergence while tolerating inaccurate accommodation. Large lags and esophoria are therefore atypical. This analysis provides normative guidelines for clinicians and a deeper mechanistic understanding of how hyperopes avoid strabismus.

Changes in the Ocular Biometric Measurements of Korean Children with Myopia and Hyperopia

Purpose: To document changes in the optical coherence biometry data over 1 year of Korean children aged 6 to 9 years with myopia and hyperopia.Methods: We used fluorescein angiography to retrospectively study changes in refractive errors over 1 year in 60 children who visited our hospital between December 2019 and June 2022. The IOL master 700 platform was used to derive axial length, corneal curvature (the K value), central corneal thickness, anterior chamber depth, lens thickness, and the white-to-white size at 1-year intervals. The Mann-Whitney and Wilcoxon signed-ranked tests were used to compare the values. A p-value &lt; 0.05 was taken to indicate a significant difference.Results: The mean ages of hyperopic and myopic children were 6.27 ± 0.87 and 6.93 ± 0.87 years at initial presentation. Significant 1-year changes in axial length, anterior depth, and lens thickness were apparent. The mean corneal curvature, and central corneal and lens thicknesses were significantly higher in hyperopic than myopic children but the axial length and anterior chamber depth were significantly greater in myopic children. However, after 1 year, the lens thicknesses did not significantly differ between the two groups.Conclusions: Over 1 year of early life, changes in the mean corneal curvature and lens thickness were significant in hyperopic children and changes in the axial length and anterior depth were significant in myopic children. Thus, the eye growth pattern may differ between hyperopic and myopic children.

Trends in the prevalence of common ocular conditions and comparison of ophthalmic outpatient utilisation related to these conditions in children with and without various types of disabilities: analysis of nationwide population-based data from Taiwan, 2014–2019

ObjectiveThe study objectives were to investigate trends in the prevalence of common ocular conditions among children with and without disabilities; to compare the prevalence of these conditions in children with...

Correlation of the macular microvasculature to the axial length in pediatric patients with high axial refractive errors.

To compare the vascular density (VD) of the macular superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC), and the foveal avascular zone (FAZ) among high hyperopic, high myopic, and emmetropic children using optical coherence tomography angiography (OCTA). This was a cross sectional comparative study of otherwise healthy children with different refractive errors. Patients were recruited from Cairo University Children's Hospital. OCTA imaging was performed using the RTVue XR Avanti device with AngioVue software. Both the 3 × 3 and 6 × 6 mm macular scans were utilized. Automated measurements were obtained from the built-in machine software. Axial length (AL) measurements were done using Lenstar LS 900 optical biometer. Ninety eyes from 51 healthy children were included. Among high myopes, there was significant thinning of the parafovea (p < 0.001). SCP-VD was also lower in high myopes in all areas except the fovea (all p < 0.001). The DCP-VD was significantly lower in high myopes in the parafovea and perifovea. High hyperopes had lower subfoveal CC-VD. Despite high myopes showing a significantly lower OCTA signal strength, linear regression analysis revealed that AL was an independent and significant predictor for the FAZ-area, as well as parafoveal and perifoveal SCP and DCP-VD. High myopia results in a reduction of VD in both the SCP and DCP, which can be non-invasively detected and monitored using OCTA. While lower VD may, in part, be attributed to lower OCTA image quality, our findings demonstrate that AL independently and significantly predicts macular vascular parameters on OCTA in children.

An investigative study on the correlation between refractive status and ocular biometric parameters in 3-6-year-old children in Shunyi District, Beijing, China

Objective: To investigate the relationship between refractive status and ocular biometric parameters in preschool children in Shunyi District, Beijing. Methods: This cross-sectional study employed a random cluster sampling method to measure the ocular axial length (AL), corneal curvature(CR), anterior chamber depth, and horizontal corneal diameter (WTW) using an optical biometer in 3-6-year-old children from 11 kindergartens in Shunyi District, Beijing. The ratio of AL to corneal curvature radius (AL/CR) was calculated. Cycloplegic refraction was performed using 1% cyclopentolate, and the equivalent spherical diopter (SE) was calculated. Ocular biometric parameters were compared among different age groups and refractive statuses. Correlation and regression analyses were conducted between SE and ocular biometric parameters. Results: A total of 1, 142 children completed the examination, with a mean age of (4.52±0.87) years, including 119 three-year-olds, 487 four-year-olds, 362 five-year-olds, and 174 six-year-olds. Among them, 554 were boys and 588 were girls. The mean SE of the examined children was (1.19±0.81) D, AL was (22.27±0.67) mm, corneal curvature radius was (7.73±0.25) mm, and the anterior chamber depth was (3.33±0.67) mm. The mean SE for three-, four-, five-, and six-year-old children was 1.18, 1.19, 1.21, and 1.13 D, respectively. SE showed correlations with AL, AL/CR, and anterior chamber depth (r=-0.350, -0.542, -0.083; all P<0.05), but no correlation with WTW or corneal curvature radius (P>0.05). Among children with different refractive statuses, SE showed stronger correlations with AL and AL/CR in myopic, hyperopic, and highly hyperopic children compared to emmetropic children, and the correlation tended to be stronger with increasing age. The linear regression equations for SE and AL, AL/CR were SE=10.64-0.42·AL and SE=21.48-7.043·AL/CR, respectively. Conclusions: The refractive status of 3-6-year-old children in Shunyi District, Beijing, showed minimal changes. Myopic children had longer AL, deeper anterior chamber, and slightly steeper cornea.

Baseline Refractive Error, Habitual Accommodative Tone, and Its Association With Myopia in Children: The Lhasa Childhood Eye Study.

The purpose of this study was to describe the baseline refractive error, habitual accommodative tone (HAT) in Tibetan children and its longitudinal association with incident myopia and myopia progression. This was a prospective cohort study. From 7 elementary schools, 1440 children with mean age of 6.83 ± 0.46 years were included with full noncycloplegic and cycloplegic refraction data at baseline, 1-year and 2-year follow-up in the Lhasa Childhood Eye Study. Noncycloplegic and cycloplegic automated refraction were performed at baseline and annually over the next 2 years. HAT was measured as the difference in spherical equivalent (DSE) between noncycloplegic and cycloplegic refraction. The mean HAT decreased from a baseline value of 0.92 ± 0.82 diopters (D) to 0.55 ± 0.65 D, P < 0.0001 at 2 years. In multivariable logistic regression models, only baseline spherical equivalent (SE; P < 0.0001) was significantly (negatively) associated with 1- and 2-year incident myopia. Among 1386 children without myopia at baseline, 271 developed myopia over 2 years. For hyperopic children, baseline HAT was significantly associated with the incidence of myopia over 2 years (odds ratio [OR] = 0.43, P < 0.001), and the incidence of myopia was significantly lower with baseline HAT ≥0.5D, compared to children <0.5 D. For 54 (3.75%) children who were myopic at baseline, SE was significant positively associated with myopic progression in univariable (P = 0.03) and multivariable general mixed linear regression analysis (P = 0.03). Baseline SE was an independent influencing factor for the incidence of myopia and its progression. The incidence of myopia was significantly higher with lower baseline HAT among hyperopic children, indicating that lower HAT was potentially associated with myopic development.

The need for cycloplegic refraction in adolescents and young adults

Cycloplegic refraction is considered the gold standard method when examining children and for ensuring accurate refractive error assessment within epidemiological studies. Recent reports underline that cycloplegia is equally important for ensuring accurate refractive error assessment in Chinese adolescents and young adults (Sun et al., 2018). The aim of this study was to assess whether cycloplegia is of equal importance for refractive error assessment in Norwegian adolescents and young adults. Non-cycloplegic and cycloplegic autorefraction (Huvitz HRK-8000A), and cycloplegic ocular biometry (IOLMaster 700), were undertaken in 215 Norwegian adolescents (101 males) aged 16–17 years. Topical cyclopentolate hydrochloride 1% was used for cycloplegia. Two years later, autorefraction and ocular biometry were repeated in 93 of the participants (34 males), both non-cycloplegic and cycloplegic. Non-cycloplegic spherical equivalent refractive errors (SER = sphere + 1⁄2 cylinder) were more myopic (less hyperopic) than cycloplegic SER in 93.6% of the participants (overall mean ±SD difference in SER: -0.59 ±0.50 D, 95% limit of agreement: -1.58 – 0.39 D). Refractive error classification by non-cycloplegic SER underestimated the hyperopia frequency (10.4% vs. 41.4%; SER ≥ +0.75 D) and overestimated the myopia frequency (12.1% vs. 10.7%; SER ≤ -0.75 D), as compared with refractive error classification by cycloplegic SER. Mean crystalline lens thickness decreased and mean anterior chamber depth increased with cycloplegia, with the largest changes in the hyperopes compared with the emmetropes and myopes (p ≤ 0.04). The individual differences between non-cycloplegic and cycloplegic SER varied by more than ±0.25 D between first and second visit for 31% of the participants. Accurate baseline measurements — as well as follow-up measurements — are imperative for deciding when and what to prescribe for myopic and hyperopic children, adolescents, and young adults. The results here confirm that cycloplegia is necessary to ensure accurate measurement of refractive errors in Norwegian adolescents and young adults.

Prescribing patterns for paediatric hyperopia among paediatric eye care providers.

To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age-based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov-Smirnov cumulative distribution function test. Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age-normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5-2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. Prescribing patterns for paediatric hyperopia vary significantly among eye care providers.

Evaluation of a Pilot Protocol for Detecting Infant Hyperopia.

Highly hyperopic children are at greater risk for developing conditions such as strabismus, amblyopia, and early literacy and reading problems. High hyperopia is a common finding in infants in a pediatric medical practice, and early detection can be done effectively in that setting with tropicamide autorefraction. This study aimed to evaluate the effectiveness of a pilot screening program to detect high hyperopia in 2-month-old infants in a pediatric medical practice in Columbus, Ohio. Cycloplegic refractive error (1% tropicamide) was measured by retinoscopy and autorefraction with the Welch Allyn SureSight (Welch Allyn/Hillrom, Skaneateles Falls, NY) in 473 infants (55.4% female) who were undergoing their 2-month well-baby visit at their pediatrician's medical practice. Cycloplegic retinoscopy (1% cyclopentolate) was repeated at a subsequent visit in 35 infants with ≥+5.00 D hyperopia in the most hyperopic meridian during the screening. Twenty-eight infants (5.9%) had high hyperopia (spherical equivalent, ≥+5.00 D), and 61 (12.9%) had high hyperopia (≥+5.00 D in at least one meridian of at least one eye) by retinoscopy with 1% tropicamide. The mean ± standard deviation spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D (range, -3.25 to +7.00 D) and with SureSight was +2.29 ± 1.64 D (range, -2.90 to +7.53 D). Retinoscopy done using 1% cyclopentolate was 0.44 ± 0.54 D more hyperopic in spherical equivalent than with 1% tropicamide ( P < .001). High hyperopia was a common finding in 2-month-old infants in a pediatric medical setting that could be detected effectively by cycloplegic autorefraction using tropicamide. Greater cooperation between pediatric primary vision and medical care could lead to effective vision screenings designed to detect high hyperopia in infants.

Changes of Choroidal Thickness in Children after Short-Term Application of 1% Atropine Gel

Introduction: The aim of the study was to assess changes in choroidal thickness (ChT) after administration of 1% atropine for 1 week in myopic, emmetropic, and hyperopic children. Methods: A total of 235 children aged 4–8 years, which included 46 myopia, 34 emmetropia, and 155 hyperopia patients, were recruited and divided into three groups according to the spherical equivalent with the use of 1% atropine twice a day for 1 week. The ChT was measured at baseline and 1 week. Results: In the myopia and emmetropia groups, following administration of 1% atropine gel, the ChT thickened significantly under the fovea (i.e., from 278.29 ± 53.01 μm to 308.24 ± 57.3 μm, p < 0.05; from 336.10 ± 78.60 μm to 353.46 ± 70.22 μm, p < 0.05, respectively), and at all intervals from the fovea, while in the hyperopia group, there was no significant difference in the ChT except the nasal side (p < 0.05). Conclusion: Topical administration of 1% atropine gel for 1 week significantly increased the subfoveal and parafoveal ChT in children with myopia and emmetropia. Atropine did not increase the ChT in hyperopic children, except on the nasal side.