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A longitudinal study of a population based sample of astigmatic children. I. Refraction and amblyopia
M Abrahamsson1, G Fabian, A K Andersson
1Department of Ophthalmology, University of Göteborg, Sweden.
Insights
Children with increasing astigmatism between ages 1 and 4 years face a higher risk of developing amblyopia (lazy eye). Most children saw their astigmatism decrease, but those with significant amblyopia often had stable or increasing astigmatism.
Area of Science:
- Ophthalmology
- Developmental Pediatrics
- Vision Science
Background:
- Amblyopia, or lazy eye, affects visual development and is often linked to refractive errors.
- Early detection and understanding of risk factors for amblyopia are crucial for timely intervention.
Purpose of the Study:
- To investigate the relationship between changes in astigmatism and the development of amblyopia in young children.
- To identify refractive and ocular predictors of amblyopia in a cohort of children from age 1 to 4 years.
Main Methods:
- Longitudinal study tracking refraction in 310 children aged 1 year with astigmatism (≥1.0 D).
- Children were monitored for 3 years, with assessments up to age 4.
- Refraction data and visual acuity (V.A.) were analyzed, comparing children who developed amblyopia with those who did not.
Main Results:
- Amblyopia was diagnosed in 7% (23 children) by age 4.
- Increasing astigmatism from age 1 to 4 was associated with a higher risk of developing amblyopia.
- Most children (280) showed decreased astigmatism; however, cases of marked or binocular amblyopia typically had unchanged or increasing astigmatism.
- Strabismus and oblique astigmatism were strongly linked to amblyopia development.
Conclusions:
- Failure of emmetropization (the eye's ability to achieve normal refractive state) may significantly impact visual development and contribute to amblyopia.
- Refractive changes over time, rather than a single measurement, are critical indicators for amblyopia risk.
- Early monitoring of astigmatism progression in children is essential for identifying those at risk for amblyopia.
Abstract:
The refraction changes in 310 children with astigmatism greater than or equal to 1.0 D in at least one eye at one year of age were followed during a period of 3 years. At the age 4 years amblyopia was found in 23 children (7%). The refraction data of these children were compared to the rest of the sample. We found that an increasing astigmatism during the test period was associated with an increased risk to develop amblyopia. The majority of children (n = 280) showed a decrease of their astigmatism, whereas all cases with a marked amblyopia (V.A. less than 0.5) or binocular amblyopia, except one, had an increasing or unchanged astigmatism during the age period 1 to 4 years. Strabismus and oblique astigmatism at any time during the test period was also strongly related to amblyopia. The incidence of strabismus (1%) was unexpectedly low. The study also showed that independent of age there was no simple relationship between amblyopia and refraction errors measured at a single test session. The main conclusion of this study is that failure of emmetropization may play an important role in visual development.