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Longitudinal follow-up of hypermetropic children identified during preschool vision screening
Jeffrey D Colburn1, David G Morrison, Robert L Estes
1Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Insights
Early childhood hypermetropia significantly increases the risk of amblyopia and esotropia. Early screening and spectacle correction for high hypermetropia can reduce these risks.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Vision Science
Background:
- Early childhood hypermetropia is a known risk factor for amblyopia and esotropia.
- Understanding the natural history of these conditions is crucial for effective management strategies.
Purpose of the Study:
- To determine the prevalence and incidence of amblyopia and accommodative esotropia in children with moderate to high hypermetropia.
- To evaluate the impact of early vision screening and refractive correction on the development of these visual impairments.
Main Methods:
- Retrospective observational review of 149 children with hypermetropia (>+3.75 D SE) identified through preschool photoscreening.
- Analysis of prevalence and incidence of amblyopia and esotropia over a mean follow-up of 40 months.
Main Results:
- At presentation, 19% had amblyopia, 32% had esotropia, and 13% had both.
- During follow-up, 24% of initially non-amblyopic children developed amblyopia, and 33% of non-strabismic children developed accommodative esotropia.
- Early spectacle correction showed a trend towards reduced development of amblyopia compared to observation, though not statistically significant in this series.
Conclusions:
- A high prevalence of amblyopia and strabismus was observed in this cohort of hypermetropic children.
- Results underscore the importance of early preschool vision screening.
- Prompt spectacle correction for moderate to high hypermetropia may mitigate the risk of amblyopia and esotropia development.
Purpose:
Early childhood hypermetropia is an important risk factor for the development of amblyopia and esotropia. Understanding the natural history of these complications aids in management decisions.
Methods:
A retrospective observational review was undertaken of 149 patients referred from a preschool photoscreening program who were determined to have hypermetropia of >or=+3.75 D spherical equivalent on criterion standard examination and were treated/followed by one group of academic pediatric ophthalmologists. The prevalence and incidence of accommodative esotropia and amblyopia were determined.
Results:
At presentation 19% of hypermetropic children had amblyopia, 32% had esotropia, and 13% had both. Follow-up data of 108 patients during a mean of 40 months showed that 20 (24%) of 83 initially nonamblyopic patients developed amblyopia and that 22 (33%) of 67 initially nonstrabismic patients developed accommodative esotropia. Of patients initially managed with observation, 38% (6 of 16) developed amblyopia, and 31% (5 of 16) developed accommodative esotropia as compared with 21% (14 of 67) and 33% (17 of 51), respectively, for those given full or partial refractive correction. For patients without amblyopia or strabismus at presentation, only 20% developed amblyopia and 35% esotropia. Strabismic patients responded well to treatment, with no cases developing partially accommodative strabismus requiring surgery during follow-up.
Conclusions:
In this case series we found a high prevalence of amblyopia and strabismus. The results support the importance of early preschool vision screening and spectacle correction of moderate to high hypermetropia (>+3.50 D) to reduce the risk of amblyopia, although more research is needed.
