The appropriate correction of childhood hyperopia is more complex than that of myopia for 2 reasons. First, children who are significantly hyperopic (>5.00 D) are more visually impaired than are their myopic counterparts, who can at least see clearly at near. Second, childhood hyperopia is more frequently associated with strabismus and abnormalities of the accommodative convergence/accommodation (AC/A) ratio (see BCSC Section 6, Pediatric Ophthalmology and Strabismus). The following are general guidelines for correcting childhood hyperopia:
Unless there is esodeviation or evidence of reduced vision, it is not necessary to correct low hyperopia. Most children have very high amplitude of accommodation. As with myopia, significant astigmatic errors should be fully corrected.
When hyperopia and esotropia coexist, initial management includes full correction of the cycloplegic refractive error. Reductions in the amount of correction may be appropriate later, depending on the amount of esotropia and level of stereopsis with the full cycloplegic correction in place.
In a school-aged child, the full refractive correction may cause blurring of distance vision because of the inability to relax accommodation fully. Reducing the amount of correction is sometimes necessary for the child to accept the glasses. A short course of cycloplegia may help a child accept the hyperopic correction.
Excerpted from BCSC 2020-2021 series : Section 3 - Clinical Optics. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.