Visual outcome in high hypermetropia

We wished to determine whether final visual acuity is dependent on age at optical correction or presence of esotropia in children with bilateral high hypermetropia.

We reviewed the charts of all patients at Childrens Hospital Los Angeles Division of Ophthalmology with bilateral hypermetropia of greater than or equal to 5D who were able to provide objective visual acuity outcomes with Snellen letters or linear E.

One hundred thirteen patients met entry criteria. The age at first optical correction ranged from 8 months to 141 months (average 45 months). Initial visual acuity (before optical correction) was obtainable in 82 patients. Initial visual acuity ranged from 20/20 to 20/200, with 57% of patients having acuity better than or equal to 20/40. Final visual acuity (after optical correction) ranged from 20/20 to 20/70, with 109 patients (96%) having acuity better than or equal to 20/40 and 104 patients (92%) having acuity better than or equal to 20/30. There was no relationship between final visual acuity and age that spectacles were first worn. Ninety-five patients (84%) had esotropia with or without glasses, and six of these (6%) had final visual acuity less than 20/30. Of the 18 patients with orthotropia, three (16%) had final visual acuity less than 20/30. The prevalence of ametropic amblyopia in patients with esotropia and orthotropia was not significantly different (p = 0.18).

Visual acuity outcome in children with high hypermetropia is generally good regardless of age at initial optical correction or presence of strabismus. A significantly increased risk for ametropic amblyopia was not found in those patients with orthotropia.