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Published on: June 20, 2020
A Randomized Clinical Trial of Immediate Versus Delayed Glasses for Moderate Hyperopia in Children 3 to 5 Years of
Jonathan M Holmes1, Marjean T Kulp2, Trevano W Dean3
1Mayo Clinic, Rochester, Minnesota, USA.
Insights
Early glasses for moderate hyperopia in young children showed no significant difference in visual acuity or binocularity outcomes compared to observation. Low failure rates suggest immediate prescription may not be necessary to prevent vision problems.
Area of Science:
- Ophthalmology
- Pediatric Optometry
Background:
- Moderate hyperopia in young children can impact visual development.
- Early intervention strategies for hyperopia include glasses prescription or observation.
Purpose of the Study:
- To compare visual acuity (VA) and binocularity outcomes in children with moderate hyperopia.
- To evaluate the effectiveness of immediate glasses prescription versus observation in preventing vision deterioration.
Main Methods:
- A prospective randomized clinical trial (RCT) involving 119 children aged 3-5 years with hyperopia (+3.00D to +6.00D).
- Children were randomly assigned to receive glasses or observation, with glasses prescribed later if vision deteriorated.
- Outcomes were assessed over 3 years, defining 'failure' as subnormal VA, stereoacuity, or manifest strabismus.
Main Results:
- Failure rates were low and similar between groups: 12% for glasses and 9% for observation.
- No significant difference was found in VA or binocularity outcomes between the two groups.
- Deterioration requiring glasses occurred in 29% of the glasses group and 27% of the observation group.
Conclusions:
- In moderately hyperopic children with normal initial VA and binocularity, failure rates were uncommon regardless of early glasses prescription.
- Due to insufficient enrollment and retention, the study could not definitively determine if immediate glasses reduce failure rates.
- Low failure rates suggest that immediate glasses prescription may not be essential for preventing VA or binocularity issues in this population.
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.
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