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  • Pediatric Ophth/Strabismus

    Review of: Glasses versus observation for moderate bilateral astigmatism in 1- to <7-year-olds

    Wang J, Hodge D, Mohney B. American Journal of Ophthalmology, February 2022

    Investigators compared improvements in visual outcomes between glasses treatment and no treatment in children with moderate bilateral astigmatism and normal vision at diagnosis.

    Study design

    This was a retrospective case series of patients aged 1 to <7 years treated at a single US academic institution between 2005 and 2016. Of the 85 patients with moderate bilateral astigmatism (defined as +1.25 to +3.25 D), 58 were given glasses (median age at diagnosis 4.3 years; mean cylinder of 1.73 D) and 27 were observed for the duration of the study (median age at diagnosis 3.4 years; mean cylinder of 2.00 D). The decision for treatment with glasses or observation was made by the treating clinician. The primary outcome measure was the development of amblyopia and strabismus within the follow-up period (≥18 months to a minimum age of 4 years and a maximum age of <10 years at the last exam).


    Important and relevant findings include no significant difference in the risk of developing amblyopia or strabismus between the glasses and observation groups. Furthermore, a subgroup analysis of amblyopia development by 4 years of follow-up did not show a benefit for treatment with glasses for children who were younger at the time of astigmatism diagnosis and for those children who had higher levels of astigmatism.


    This study is retrospective and included a small sample size with an age range of only 1 to 6 years. There was also a lack of data regarding the compliance of the treatment group (in wearing the glasses (i.e., number of hours/day). Racial and ethnic diversity were not fully reported; demographic information was provided for only White race and Hispanic/Latino ethnicity.

    Clinical significance

    This retrospective study has valuable clinical significance. Children with normal vision and moderate bilateral astigmatism may not need treatment with glasses because they are not at significant risk of developing amblyopia or strabismus. A larger, prospective, randomized clinical trial is needed in the future to confirm these findings.