Age affects childhood hyperopia
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Children with accommodative esotropia experienced shifts in their degrees of hyperopia as they aged, according to a study.
Lucas Bonafede, MD, department of ophthalmology at The Children’s Hospital of Philadelphia, and colleagues discovered a trend indicating that hyperopia increases or stabilizes in children as they reach the age of 7 years, followed by a small decrease between 7 and 12 years of age. This pattern occurred regardless of baseline refractive error.
“The established concept of emmetropization in babies has been expanded over the years to infer that hyperopic children become less hyperopic with age,” Bonafede and colleagues wrote. “This has also resulted in the conventionally held belief that children with accommodative esotropia become less hyperopic with age and can ‘outgrow’ their refractive correction.”
In this 12-year retrospective cohort study, researchers followed 405 children with fully or partially accommodative esotropia with at least two cycloplegic refractions. Participants’ mean age upon first examination was 3.2 years, and 12.1 years at final examination. Follow-ups continued for an average of 9 years.
Partially accommodative esotropia accounted for 32.3% of participants and fully accommodative for 67.7%. The researchers found no significant difference in refractive change between those with full or partial accommodative esotropia.
Bonafede and colleagues observed an increase of hyperopia of 0.06 D per year (95% CI, 0.03 D to 0.09 D) in all participants between 3 and 7 years old. However, between ages 7 to 15 years, participants experienced an annual decrease of 0.18 D per year (95% CI, 0.19 D to 0.16 D).
The results inform parents of children with esotropia to anticipate variations throughout the children’s youth and early adolescence.
“Over ages 7 to 12, parents might expect on average a decrease in hyperopia of only about 1 D, so the change is typically not large enough to allow their children to discontinue spectacle use,” the researchers wrote. “As a result, we can more confidently advise our patients on the likelihood of needing long-term refractive correction.”
Perspective
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Clarke D. Newman, OD, FAAO, FBCLA, FSLS, FNAP
Several aspects of the article by Bonafede and colleagues are worthy of note.
While this retrospective cohort study has some limitations compared with prospective, randomized clinical trials, one can still obtain valuable information from this paper. The study comprised a large number of children (N = 405), and the time interval of review (between 3 and 9 years) was long. Also, the authors looked at — for seemingly the first time — the difference in hyperopic reduction between fully and partially accommodative esotropia.
The take-home message of this study is that a reduction of hyperopic magnitude can be expected over time in children with both full and partial accommodative esotropia, and that the difference in magnitude was greater in those children with greater amounts of hyperopia. However, neither group had a significant enough reduction to warrant the claim that children will grow out of their accommodative esotropia and that glasses will no longer be needed.
This information allows us to educate the parents of children with accommodative esotropia properly about the likely need for long-term refractive correction.
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