Best treatment unclear for young children with moderate hyperopia
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It remains unclear whether children 1 to 2 years old with moderate hyperopia definitively benefit from hyperopic correction.
“For children aged 1 to 2 years with uncorrected moderate hyperopia (+3.00 D to +6.00 D spherical equivalent), estimates of failure for manifest strabismus, reduced distance [visual acuity] and reduced stereoacuity after 3 years of 6-month follow-up visits are inconclusive and consistent with a small to moderate benefit or no benefit (reduced failure rate) of immediate glasses compared with careful observation (glasses only if deteriorated),” researchers wrote in Ophthalmology.
In a randomized clinical trial, the authors compared distance visual acuity, stereoacuity and ocular alignment in 130 participants 1 to 2 years old with moderate hyperopia who were managed prophylactically with glasses (n = 65) or with observation (n = 65) during a 3-year period. Investigators did not include patients with manifest strabismus or prior optical correction for hyperopia.
Follow-up visits were scheduled every 6 months, with the primary outcome examination at 3-years. Failure at the 3-year examination both with and without the appropriate hyperopic correction in trial frames served as the primary outcome.
Researchers defined failure as visual acuity or stereoacuity below age norms or the development of manifest strabismus. They recorded failure if one or more criteria were met both with and without correction and confirmed in a masked retest.
The primary examination was completed by 53 participants (82%) in the glasses group and 53 participants (82%) in the observation group.
Investigators observed failure in 21% of the glasses group and 34% of the observation group. The results were insignificant, with the researchers concluding that the benefit to either treatment remained unclear.
Data showed that 34% of participants deteriorated with glasses, and 62% deteriorated with observation. Investigators expected a higher proportion of deterioration with observation.
Although failure at 3 years was more likely in participants who deteriorated during the 3 years of follow-up, at least half the participants who deteriorated before 3 years were not classified as failure at the end of follow-up (50% observation, 63% glasses).
“Regardless of initial treatment approach, the moderate to high proportion of deterioration and subsequent moderate proportion of failure at 3 years indicate the need for eye care professionals to closely follow children aged 1 to 2 years with moderate hyperopia,” the researchers wrote. – Kaitlin McGee
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Reena Patel, OD, FAAO
To prescribe or not to prescribe hyperopic correction for our young patients? This study looked into answering this age-old question. The results of the study, although inconclusive, still provide optometrists with helpful information that can be applied to clinical practice. The findings teach us that it is appropriate to prescribe glasses early on for children 1 year and 2 years old with moderate uncorrected hyperopia without strabismus, but it is also reasonable to hold off on immediately prescribing glasses for these individuals. However, if a decrease in vision, stereoacuity or ocular misalignment occurs, then glasses should be prescribed right away. Regardless of the management plan, these children should all be monitored very closely. While it is important to take clinical findings into account when deciding whether or not glasses are indicated, I believe nonclinical factors, such as parental concern and the child’s overall development, should also play a big part in the decision-making process.
Recruitment for this study was very slow, and enrollment had to be closed before the planned sample size was reached. Due to the smaller sample size of subjects completing the study, the overall conclusions are not definitive. Regardless, one of the main takeaway points from this study is the importance of frequent follow-ups for these cases.
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