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Longitudinal Changes in Refractive Development in Highly Hyperopic Children: A 2.6-11.2 Year Follow-up of
Ling Sun1, Xiaoli Qi1, Linlin Song1
1Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
Insights
Early intervention for high hyperopia in preschoolers shows emmetropization, but most remain hyperopic. Refractive changes progress non-uniformly with age, highlighting the need for ongoing monitoring.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Refractive Error Research
Background:
- High hyperopia in preschool children presents significant visual challenges.
- Early intervention strategies are crucial for managing refractive development.
- Longitudinal data on ocular changes in this population are limited.
Purpose of the Study:
- To analyze longitudinal changes in refractive error and ocular biometrics.
- To investigate emmetropization trends in preschool children with high hyperopia.
- To identify factors influencing refractive and biometric alterations after early intervention.
Main Methods:
- Retrospective analysis of 60 preschool children with high hyperopia (SE ≥ +5.00D).
- Minimum two-year follow-up with at least three ocular biometric measurements.
- Restricted Cubic Spline and Mixed-effects models used to assess age-related changes and influencing factors.
Main Results:
- Significant nonlinear changes observed in spherical equivalent, axial length, and axial length-to-corneal curvature ratio.
- Corneal curvature showed no significant nonlinear trend.
- Strabismus, cycloplegia, baseline SE, and age influenced SE changes; baseline axial length and age affected axial length changes.
Conclusions:
- Preschool children with high hyperopia exhibit emmetropization tendencies with early intervention.
- Despite interventions, a majority remain moderately to highly hyperopic.
- Refractive progression patterns are non-uniform across different ages.
Purpose:
This study aims to elucidate the longitudinal refractive and ocular biometric alterations in preschool children with high hyperopia who underwent early interventions.
Methods:
We conducted a retrospective analysis of preschool children diagnosed with high hyperopia at Tianjin Medical University Eye Hospital between 2011 and 2023. Inclusion criteria required an initial examination with cycloplegic refraction, bilateral spherical equivalent power (SE) ≥ +5.00D with a difference <1.00D, a minimum two-year follow-up, and at least three ocular biometric measurements. The annual axial growth rate evaluated emmetropization in highly hyperopic children. We applied Restricted Cubic Spline (RCS) models to explore potential nonlinear relationships between age and spherical equivalent, axial length, corneal curvature, and axial length-to-corneal curvature ratio. Additionally, Mixed-effects models were employed to investigate factors associated with changes in refractive error and axial length.
Results:
The study enrolled 60 eligible subjects, with a median initial diagnosis age of 3.5 years (IQR, 2.8-4.9 years) and a median last visit age of 9.3 years (IQR, 8.1-10.8 years). The average follow-up duration was 5.7 years. RCS analysis revealed notable nonlinear changes in spherical equivalent power, axial length, and axial length-to-corneal curvature ratio, although corneal curvature displayed no statistically significant nonlinear trend. Factors affecting SE changes included the presence of strabismus, the use of cycloplegia, baseline SE, and age. Conversely, changes in axial length solely correlated with baseline axial length and age.
Conclusion:
Highly hyperopic preschool children undergoing early intervention display a marked emmetropization tendency, though most still remain moderately to highly hyperopic, with the progression of refractive changes showing non-uniform patterns with respect to age.
