Related Experiment Video
Updated: Aug 20, 2026
Subjective Refraction Test Using a Smartphone for Vision Screening
Published on: October 18, 2024
Non-cycloplegic refractive screening can identify infants whose visual outcome at 4 years is improved by spectacle
S Anker1, J Atkinson, O Braddick
1Visual Development Unit, University College, London, UK. s.anker@ucl.ac.uk
Insights
Untreated significant hyperopia in infants can lead to poor visual acuity and strabismus. Early spectacle correction improves visual outcomes, highlighting the importance of infant vision screening programs.
Area of Science:
- Ophthalmology
- Developmental Pediatrics
- Public Health
Background:
- Infant vision screening programs aim to detect refractive errors that may lead to amblyopia or strabismus.
- The Second Cambridge Population Infant Vision Screening Programme utilized videorefractor technology without cycloplegia.
Purpose of the Study:
- To evaluate the long-term visual acuity and strabismus outcomes in infants identified with refractive errors.
- To assess the impact of spectacle correction on visual development in hyperopic infants.
Main Methods:
- Infants identified with refractive errors at eight months were enrolled in a treatment trial with partial spectacle correction.
- Visual acuity and strabismus were monitored through long-term follow-up.
- Poor acuity was defined as best-corrected acuity of 6/12 or worse (crowded) or 6/9 or worse (single letters) at age 4 years.
Main Results:
- Untreated hyperopic infants had significantly poorer visual acuity outcomes compared to controls and those compliant with spectacle wear.
- Significantly hyperopic infants were more likely to develop strabismus by 5.5 years compared to emmetropic controls.
- Children not refractively corrected for hyperopia were four times more likely to have poor acuity at 5.5 years than those wearing correction.
Conclusions:
- Early detection and correction of significant hyperopia in infancy are crucial for optimal visual acuity development.
- While hyperopia increases strabismus risk, this study did not find a significant difference in strabismus incidence between corrected and uncorrected hyperopic infants.
- Findings support the efficacy of infant vision screening and timely intervention with spectacle correction.
Abstract:
The Second Cambridge Population Infant Vision Screening Programme using the VPR-1 videorefractor without cycloplegia was undertaken in order to identify those infants with refractive errors who were potentially amblyogenic or strabismogenic. Infants identified at eight months were entered into a control trial of treatment with partial spectacle correction and underwent a long-term follow-up that monitored a wide range of visual, visuoperceptual, visuocognitive, visuomotor, linguistic and social development. In the present paper, the authors report on the outcome measures of visual acuity and strabismus. Poor acuity was defined as a best-corrected acuity of 6/12 or worse on crowded letters or 6/9 or worse on single letters, at age 4 years. Acuity was measured in 79 infants who were significantly hyperopic and/or anisometropic at 11-12 months of age, 23 who showed hyperopia of +3D but less than +3.5D, 196 control subjects, 14 controls with refractive errors, and 126 others who showed an accommodative lag on screening but were not significantly hyperopic on first retinoscopy. There was a poorer acuity outcome in the untreated group of hyperopes compared to controls (p < 0.0001) and to the children who were compliant in spectacle wear (p < 0.001) or who were prescribed spectacles (p < 0.05). Children who were significantly hyperopic at eight months were also more likely to be strabismic by 5.5 years compared to the emmetropic control group (p < 0.001). However, the present study did not find a significant difference in the incidence of strabismus between corrected and uncorrected hyperopic infants. Children who were not refractively corrected for significant hyperopia were four times more likely to have poor acuity at 5.5 years than infants who wore their hyperopic correction, supporting the findings of the First Cambridge Population Infant Vision Screening Programme.
