Refractive changes in children with moderate to high astigmatism at a tertiary pediatric academic center

There is a lack of knowledge on myopic progression in patients with moderate to high astigmatism, which has been compounded by their exclusion from myopia control studies. This study found increased myopia that was linearly associated with age, emphasizing the importance of understanding myopia control treatments in this population.

Moderate to high amounts of astigmatism cause visual blur and may affect myopic progression. However, there is little information as to the effect of cylinder on change in myopia, and the vast majority of myopia control studies have excluded children with significant astigmatism. The purpose of this study was to assess myopic and cylinder changes in children with moderate to high astigmatism.

Retrospective review of children (2 to 15 years) who presented with astigmatism (>2.00D) and myopic spherical equivalent refraction (SER) to a tertiary care pediatric hospital. Best corrected visual acuity and cycloplegic refraction changes over at least 2 years of follow-up were analyzed. Patients with confounding ocular disease, history of myopia control, or Trisomy 21 were excluded.

Two hundred twenty-seven patients presented at 6.6 years (IQR 5.2, 9.1) with a median 0.00D (IQR -2.00, 0.50) sphere, -3.00D (IQR -4.25, -2.50) cylinder, and -1.75 (IQR -3.75, -0.99) SER. Twenty-four percent of patients had amblyopia and 46% had strabismus. At final exam (4.9 [IQR 3.0, 6.7] years), patients were more myopic and had greater cylinder (p<0.001). Hispanic patients were disproportionately represented (64%) but had no difference in refractive parameters versus non-Hispanic patients. Initial age was linearly associated with sphere and SER, and the rate of change in sphere and SER over 2 to 3 years of follow-up. Initial J 0 was linearly associated with myopic and cylindrical progression.

Children with moderate to high levels of astigmatism showed myopic and cylindrical progression at follow-up. Amblyopia and strabismus were common in our cohort, but neither amblyopia nor strabismus affected the rates of myopic or cylindrical progression. Patients with moderate astigmatism (-2.00 to -3.00D) had more myopic and cylindrical progression compared with those with higher levels of astigmatism.