Purpose

To investigate the association of hyperopia greater than +3.25 diopters (D) with amblyopia, strabismus, anisometropia, astigmatism, and reduced stereoacuity in preschoolers.

Methods

Three- to five-year-old Head Start preschoolers (N = 4040) underwent vision examination including monocular visual acuity (VA), cover testing, and cycloplegic refraction during the Vision in Preschoolers Study. Visual acuity was tested with habitual correction and was retested with full cycloplegic correction when VA was reduced below age norms in the presence of significant refractive error. Stereoacuity testing (Stereo Smile II) was performed on 2898 children during study years 2 and 3. Hyperopia was classified into three levels of severity (based on the most positive meridian on cycloplegic refraction): group 1: greater than or equal to +5.00 D, group 2: greater than +3.25 D to less than +5.00 D with interocular difference in spherical equivalent greater than or equal to 0.50 D, and group 3: greater than +3.25 D to less than +5.00 D with interocular difference in spherical equivalent less than 0.50 D. "Without" hyperopia was defined as refractive error of +3.25 D or less in the most positive meridian in both eyes. Standard definitions were applied for amblyopia, strabismus, anisometropia, and astigmatism.

Results

Relative to children without hyperopia, children with hyperopia greater than +3.25 D (n = 472, groups 1, 2, and 3) had a higher proportion of amblyopia (34.5 vs. 2.8%, p < 0.0001) and strabismus (17.0 vs. 2.2%, p < 0.0001). More severe levels of hyperopia were associated with higher proportions of amblyopia (51.5% in group 1 vs. 13.2% in group 3) and strabismus (32.9% in group 1 vs. 8.4% in group 3; trend p < 0.0001 for both). The presence of hyperopia greater than +3.25 D was also associated with a higher proportion of anisometropia (26.9 vs. 5.1%, p < 0.0001) and astigmatism (29.4 vs. 10.3%, p < 0.0001). Median stereoacuity of nonstrabismic, nonamblyopic children with hyperopia (n = 206) (120 arcsec) was worse than that of children without hyperopia (60 arcsec) (p < 0.0001), and more severe levels of hyperopia were associated with worse stereoacuity (480 arcsec for group 1 and 120 arcsec for groups 2 and 3, p < 0.0001).

Conclusions

The presence and magnitude of hyperopia among preschoolers were associated with higher proportions of amblyopia, strabismus, anisometropia, and astigmatism and with worse stereoacuity even among nonstrabismic, nonamblyopic children.

Purpose

To evaluate, by receiver operating characteristic (ROC) analysis, the ability of noncycloplegic retinoscopy (NCR), Retinomax Autorefractor (Retinomax), and SureSight Vision Screener (SureSight) to detect significant refractive errors (RE) among preschoolers.

Methods

Refraction results of eye care professionals using NCR, Retinomax, and SureSight (n = 2588) and of nurse and lay screeners using Retinomax and SureSight (n = 1452) were compared with masked cycloplegic retinoscopy results. Significant RE was defined as hyperopia greater than +3.25 diopters (D), myopia greater than 2.00 D, astigmatism greater than 1.50 D, and anisometropia greater than 1.00 D interocular difference in hyperopia, greater than 3.00 D interocular difference in myopia, or greater than 1.50 D interocular difference in astigmatism. The ability of each screening test to identify presence, type, and/or severity of significant RE was summarized by the area under the ROC curve (AUC) and calculated from weighted logistic regression models.

Results

For detection of each type of significant RE, AUC of each test was high; AUC was better for detecting the most severe levels of RE than for all REs considered important to detect (AUC 0.97-1.00 vs. 0.92-0.93). The area under the curve of each screening test was high for myopia (AUC 0.97-0.99). Noncycloplegic retinoscopy and Retinomax performed better than SureSight for hyperopia (AUC 0.92-0.99 and 0.90-0.98 vs. 0.85-0.94, P ≤ 0.02), Retinomax performed better than NCR for astigmatism greater than 1.50 D (AUC 0.95 vs. 0.90, P = 0.01), and SureSight performed better than Retinomax for anisometropia (AUC 0.85-1.00 vs. 0.76-0.96, P ≤ 0.07). Performance was similar for nurse and lay screeners in detecting any significant RE (AUC 0.92-1.00 vs. 0.92-0.99).

Conclusions

Each test had a very high discriminatory power for detecting children with any significant RE.

PURPOSE: To compare visual acuity (VA) and binocularity outcomes in moderately hyperopic children with normal VA and binocularity assigned to glasses versus observation. DESIGN: Prospective randomized clinical trial (RCT). METHODS: One hundred nineteen 3- to 5-year-old children with hyperopia between +3.00D and +6.00D spherical equivalent were randomly assigned to glasses versus observation (with glasses prescribed if deteriorated for subnormal distance VA or near stereoacuity, or manifest strabismus). Follow-up occurred every 6 months. At 3 years, the treatment strategy was classified as failed if any of the following were met, both with and without correction: subnormal distance VA or stereoacuity; manifest strabismus; or strabismus surgery during follow-up. RESULTS: Of 84 (71%) children who completed the primary outcome examination, failure occurred in five (12%; 95% confidence interval [CI]: 4%-26%) of 41 assigned to glasses and four (9%; 95% CI: 3%-22%) of 43 assigned to observation (difference = 3%; 95% CI: -12%-18%; P = .72). Deterioration prior to 3 years (requiring glasses per protocol) occurred in 29% (95% CI: 19%-43%) assigned to glasses and 27% (95% CI: 17%-42%) assigned to observation. CONCLUSIONS: In an RCT comparing glasses to observation for moderately hyperopic 3- to 5-year-old children with normal VA and binocularity, failure for VA or binocularity was not common. With insufficient enrollment and retention, our study was unable to determine whether immediate glasses prescription reduces failure rate, but low failure rates suggest that immediate glasses prescription for these children may not be needed to prevent failure for VA and/or binocularity.