Immediate Versus Delayed Spectacle Use in Toddlers With Moderate Hyperopia
Ophthalmology, June 2019
Although there is consensus that eyeglasses should be prescribed for children with moderate hyperopia and strabismus or amblyopia, optimal management of moderate hyperopia in the absence of the other conditions is unclear. Kulp et al. compared two strategies for young children with moderate hyperopia but no manifest strabismus: immediate use of eyeglasses versus observation only (unless circumstances warranted otherwise). Their findings were inconclusive but suggest that immediate spectacle use may confer a small or moderate benefit in some cases.
This randomized study included 130 toddlers (1- and 2-year-olds) with hyperopia ranging from +3.00 D to +6.00 D spherical equivalent (SE) in at least one eye, anisometropia ≤1.50 D SE, astigmatism ≤1.50 D based on cycloplegic refraction, and no evident strabismus. Patients were assigned randomly to receive eyeglasses (1.00 D less than the full cycloplegic hyperopia) or observation. Follow-up visits occurred every six months for three years.
During follow-up, children in the observation group were prescribed eyeglasses if they met prespecified deterioration criteria for distance visual acuity (VA) for age norm, if near stereoacuity fell below age norm, or if strabismus became evident. These criteria also were used to define failure in both study arms at the three-year mark.
All told, 106 children (82%) completed all three years of follow-up. There was no significant difference in failure rate between the two groups. Failure occurred in 21% of the spectacle group (11 of 53) and in 34% of the observation group (18 of 53; p = .14). In addition, 62% of the observation group and 34% of the spectacle group met the criteria for VA deterioration (e.g., requiring eyeglasses if not wearing them).
This study was limited by unsatisfactory enrollment, and the investigators acknowledged that larger studies are warranted to better estimate the effects of spectacle treatment in this age group and to determine the best approach for managing moderate hyperopia. However, it is clear from this study that whether or not spectacles are prescribed, VA deterioration is not uncommon, and young children with hyperopia should be monitored closely by eye care professionals.
The original article can be found here.