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Refractive factors affecting the persistence of anisometropia in preschool-aged children
Ran Moshkovsky1,2, Itay Nitzan3,4, Michael Kinori2,5
1Department of Ophthalmology, Wolfson Medical Center, Holon, Israel.
Insights
Higher baseline anisometropia, hyperopia, myopia, and astigmatism in young children predict future anisometropia. The risk of persistent anisometropia increases with the severity of these refractive errors at presentation.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Science
Background:
- Pediatric vision screening identifies children with amblyopic anisometropia.
- Anisometropia, a significant refractive error, can impact visual development in children.
- Understanding risk factors for persistent anisometropia is crucial for timely intervention.
Purpose of the Study:
- To identify refractive factors associated with the persistence of anisometropia in preschool-aged children.
- To analyze the relationship between baseline refractive errors and the likelihood of anisometropia at follow-up.
Main Methods:
- A cohort analysis of 35,854 children aged 1-6 years evaluated between 2012-2022.
- Collection of refractive data at presentation and follow-up visits.
- Logistic regression models to assess associations between baseline refractive error and follow-up anisometropia.
Main Results:
- 6.6% of children presented with anisometropia.
- Higher baseline anisometropia (≥3.0 diopters) was linked to increased persistence, particularly when the more ametropic eye was hyperopic (73.5%) or myopic (62.5%).
- Increased odds ratios for follow-up anisometropia were observed with greater baseline anisometropia, hyperopia, myopia, and astigmatism.
Conclusions:
- Higher degrees of baseline anisometropia, hyperopia, myopia, and astigmatism are associated with a greater prevalence of future anisometropia in preschool-aged children.
- The persistence of anisometropia is influenced by the magnitude of initial refractive errors.
- Astigmatic hyperopia may play a significant role in anisometropia persistence.
Purpose:
Pediatric vision screening programs can detect children with amblyopic anisometropia. We aim to determine which refractive factors may be associated with the persistence of anisometropia in this population.
Methods:
A cohort analysis included all children aged one to six years, evaluated for refractive status between 2012 and 2022 at the Maccabi Healthcare Services. Refractive data were collected at presentation and at a subsequent follow-up visit. Logistic regression models were used to analyze relationships between baseline refractive error and anisometropia at follow-up.
Results:
Of 35,854 children evaluated, 6.6% (n = 2,358) had anisometropia at presentation. Those with a baseline anisometropia of ≥ 3.0 diopters exhibited a higher prevalence of anisometropia at the last follow-up compared to those with a baseline anisometropia of a lesser magnitude; when the more ametropic eye was hyperopic (73.5% vs. 41.4%, respectively, p < 0.001) or myopic (62.5% vs. 41.8%, respectively, p = 0.009). Adjusted odds ratios for anisometropia at follow-up increased with greater levels of baseline anisometropia with the more ametropic eye being hyperopic (OR = 3.75, 95% CI 2.57 - 5.48) or myopic (OR = 2.19, 95% CI 1.11 - 4.33). A higher degree of hyperopia, myopia and astigmatism at baseline demonstrated similar patterns.
Conclusion:
In anisometropic preschool-aged children, higher degrees of baseline anisometropia, hyperopia, myopia and astigmatism, are associated with a higher prevalence of future anisometropia. The likelihood for later anisometropia increases with greater levels of baseline anisometropia, hyperopia, myopia and astigmatism.
Key Messages:
What is known Higher refractive errors, lifestyle factors and educational levels have been considered as risk factors for anisometropia. Severe anisometropia at young age is more prone to persist. What is new In this cohort of 2,358 anisometropic preschool-aged children, the likelihood for anisometropia at the last follow-up has increased considerably when, at baseline, the more ametropic eye was hyperopic. It has also increased with astigmatic hyperopia, which possibly underscores the combined effect of astigmatism and hyperopia on anisometropia persistence. These findings were independent of socio-economic status, body mass index, and country of birth.
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