Related Experiment Video
Updated: Aug 6, 2025
Author Spotlight: An Automated Method for Assessing Visual Acuity in Infants and Toddlers Using an Eye-Tracking System
Published on: March 17, 2023
Evaluation of a Pilot Protocol for Detecting Infant Hyperopia
Ann M Morrison, Donald O Mutti1
1The Ohio State University College of Optometry, Columbus, Ohio.
Insights
High hyperopia, a risk for vision problems, is common in infants. Tropicamide autorefraction effectively detects this condition during 2-month well-baby visits, enabling early intervention.
Area of Science:
- Pediatric ophthalmology
- Vision screening
- Infant eye care
Background:
- High hyperopia in children increases risks for strabismus, amblyopia, and literacy issues.
- Early detection of high hyperopia is crucial for timely intervention.
- Pediatric medical practices are ideal settings for infant vision screening.
Purpose of the Study:
- To evaluate a pilot screening program for high hyperopia in 2-month-old infants.
- To assess the effectiveness of tropicamide autorefraction in a pediatric setting.
Main Methods:
- A pilot screening program was conducted in a pediatric medical practice.
- Cycloplegic refractive error was measured using retinoscopy and autorefraction (Welch Allyn SureSight) with tropicamide in 473 infants.
- Repeat cycloplegic retinoscopy with cyclopentolate was performed on infants with high hyperopia.
Main Results:
- 5.9% of infants had high hyperopia (≥+5.00 D spherical equivalent) by retinoscopy.
- 12.9% had high hyperopia (≥+5.00 D in at least one meridian) by retinoscopy with tropicamide.
- Cycloplegic retinoscopy with cyclopentolate showed a statistically significant difference compared to tropicamide.
Conclusions:
- High hyperopia is common in 2-month-old infants and detectable via cycloplegic autorefraction with tropicamide.
- Enhanced collaboration between pediatric primary vision and medical care can improve infant vision screening.
- Early detection through effective screening programs is vital for preventing vision impairments.
Significance:
Highly hyperopic children are at greater risk for developing conditions such as strabismus, amblyopia, and early literacy and reading problems. High hyperopia is a common finding in infants in a pediatric medical practice, and early detection can be done effectively in that setting with tropicamide autorefraction.
Purpose:
This study aimed to evaluate the effectiveness of a pilot screening program to detect high hyperopia in 2-month-old infants in a pediatric medical practice in Columbus, Ohio.
Methods:
Cycloplegic refractive error (1% tropicamide) was measured by retinoscopy and autorefraction with the Welch Allyn SureSight (Welch Allyn/Hillrom, Skaneateles Falls, NY) in 473 infants (55.4% female) who were undergoing their 2-month well-baby visit at their pediatrician's medical practice. Cycloplegic retinoscopy (1% cyclopentolate) was repeated at a subsequent visit in 35 infants with ≥+5.00 D hyperopia in the most hyperopic meridian during the screening.
Results:
Twenty-eight infants (5.9%) had high hyperopia (spherical equivalent, ≥+5.00 D), and 61 (12.9%) had high hyperopia (≥+5.00 D in at least one meridian of at least one eye) by retinoscopy with 1% tropicamide. The mean ± standard deviation spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D (range, -3.25 to +7.00 D) and with SureSight was +2.29 ± 1.64 D (range, -2.90 to +7.53 D). Retinoscopy done using 1% cyclopentolate was 0.44 ± 0.54 D more hyperopic in spherical equivalent than with 1% tropicamide ( P < .001).
Conclusions:
High hyperopia was a common finding in 2-month-old infants in a pediatric medical setting that could be detected effectively by cycloplegic autorefraction using tropicamide. Greater cooperation between pediatric primary vision and medical care could lead to effective vision screenings designed to detect high hyperopia in infants.
