Children with high hyperopia at increased risk of amblyopia; screening urged

Hyperopic correction should be prescribed for children with hyperopia of 4.5 D or greater, even if no strabismus is detected, to reduce their risk of developing isoametropic amblyopia, a study suggests. The study authors suggested that screening programs be put in place to identify these children at an early age.

Deborah L. Klimek, MD, and colleagues at St. Louis University in Missouri retrospectively reviewed the charts of 418 healthy children who had at least +4.5 D spherical equivalent and who did not have anisometropia greater than 1.5 D. Those who had bilateral amblyopia were further analyzed.

Of 418 children identified with the hyperopia criteria, 36 had bilateral amblyopia. According to the researchers, that correlated to an estimated prevalence of 8.6% of isoametropic amblyopia in children with at least 4.5 D of hyperopia in one or both eyes. Those with bilateral amblyopia tended to present at a later age (just over 5 years old) than the overall group of hyperopes, who presented at about 3.5 years of age.

Children with bilateral amblyopia had a lower prevalence of strabismus (64%) than the overall population of children with high hyperopia (81%). The group with bilateral amblyopia responded well to treatment with glasses, and patching was the treatment option in 13 cases. Surgical intervention for residual strabismus was necessary in very few cases (5.5%).

The study is published in the August issue of Journal of the AAPOS.