Children with moderate hyperopia may not immediately require glasses

This study assessed immediate versus delayed prescription of glasses for managing moderate hyperopia in young children.

Study design

This was a prospective randomized clinical trial that involved 130 children aged 1 to 2 years. Each had hyperopia between +3 D and +6 D spherical equivalent (SE) in at least 1 eye, anisometropia (≤1.5 D SE) and astigmatism (≤1.5 D) based on cycloplegic refraction and no manifest strabismus. Patients were randomized to receive an immediate prescription of glasses or were observed and only received a prescription when they deteriorated. The primary outcome was failure at 3 years, defined as decline in visual acuity, stereoacuity or ocular alignment.

Outcomes

At the 3-year primary outcome visit, failure was observed in 21% of the glasses group and 34% of the observation group, but the difference was not statistically significant (P=0.14). These children experienced a small to moderate benefit, if any, with immediate prescription of glasses compared with careful observation.

Limitations

This study had a slow enrollment and was closed before reaching the desired sample size. Investigators did not perform dynamic retinoscopy to assess accommodation.

Clinical significance

Children between 1 and 2 years old who have hyperopia (3 to 6 D) and lack esotropia can be closely monitored. Glasses should be considered if there are any changes in visual acuity, stereoacuity or ocular alignment.