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Emmetropization in highly hyperopic infants: A randomized clinical trial of partial refractive correction
Ann M Morrison1, Matthew L Robich, Lisa A Jordan
1The Ohio State University College of Optometry, Columbus, Ohio.
Insights
Early intervention for highly hyperopic infants using partial correction and visual exercises did not change average refractive error but influenced the rate of emmetropization. This suggests a potential benefit for higher levels of initial hyperopia.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Refractive Error Development
Background:
- Highly hyperopic infants face increased risks for conditions like strabismus and amblyopia.
- Early intervention may influence emmetropization, the natural process of refractive development in infants.
Purpose of the Study:
- To investigate if moderate spectacle correction and accommodative exercises enhance emmetropization in highly hyperopic infants.
- To compare refractive outcomes at 18 months in treated versus observation groups.
Main Methods:
- Randomized controlled trial involving 35 highly hyperopic 3-month-old infants.
- Intervention group received partial hyperopic correction (3.00 D cut) and visual exercises.
- Primary outcome: mean hyperopia at 18 months; secondary outcome: time to reach ≤+3.00 D using survival analysis.
Main Results:
- No significant difference in mean refractive error at 18 months between treated (+1.6 D) and observation (+1.2 D) groups.
- Treatment significantly affected the rate of emmetropization based on initial hyperopia (p=0.01).
- Treatment slowed emmetropization for lower initial hyperopia but potentially enhanced it for higher levels.
Conclusions:
- Partial correction and accommodative exercises did not alter average refractive error at 18 months in highly hyperopic infants.
- The intervention influenced the rate and time to achieve emmetropia (≤+3.00 D).
- Treatment may be beneficial for enhancing emmetropization in infants with higher degrees of initial hyperopia.
Significance:
Highly hyperopic infants are at greater risk for not undergoing emmetropization and later developing conditions such as strabismus, amblyopia, and early literacy and reading problems. An early intervention consisting of partial hyperopic correction and encouragement of accommodation may influence the rate of emmetropization in these high-risk infants.
Purpose:
This study aimed to determine if moderate spectacle partial correction (3.00 D cut from cycloplegic) and visual exercises to promote accommodation enhance emmetropization (reaching ≤+3.00 D) in highly hyperopic (≥+5.00 D to ≤+7.00 D) 3-month-old infants compared with no treatment (observation).
Methods:
Thirty-five highly hyperopic 3-month-old infants (57% female) were randomized to observation or treatment ( clinicaltrials.gov ; NCT03669146). Primary analysis compared the mean hyperopia at 18 months of age in treated versus untreated participants. Data were also modeled using proportional hazards survival analysis (time to reach ≤+3.00 D).
Results:
There was no significant difference in refractive error at 18 months of age between infants in the treated (+1.6 ± 0.6 D) and observation groups (+1.2 ± 0.7 D; p = 0.23) but treatment affected the rate of emmetropization depending on baseline hyperopia (p = 0.01). At 12 months of age, treated infants had similar refractive errors regardless of baseline hyperopia but untreated infants at 12 months underwent faster emmetropization if their baseline hyperopia was <+5.50 D and slower emmetropization if it was >+5.50 D.
Conclusions:
Partial hyperopic refractive correction with accommodative exercises in highly hyperopic infants did not affect average refractive error at 18 months. However, treatment affected the rate of emmetropization and how long it took to reach ≤+3.00 D. Treatment slowed the rate of emmetropization at lower levels of initial hyperopia but may enhance emmetropization at higher levels.
