Stereopsis Assessment in a Pediatric Population and Its Association With Refractive Error: A Cross-Sectional Study

Stereopsis is the perception of depth arising from binocular vision and is essential for fine motor skills and overall visual function in children. It has been observed that refractive errors diminish binocular function by causing visual blur and impairing fusion, which results in poor stereopsis. Poor stereoacuity can lead to inferior quality of vision and substandard work performance, especially where good eye-hand coordination and visual motor skills are required.

The purpose of this study is to assess the level of stereoacuity among children with refractive errors and to determine the prevalence and pattern of subnormal stereopsis in the pediatric population.

This cross-sectional study was conducted at a tertiary care center in Central India from October 2023 to September 2024 after Institutional Ethics Committee approval. A total of 120 children aged 5-17 years with previously diagnosed refractive errors and a history of spectacle use for at least one month were included. Children with strabismus, amblyopia, ocular pathology, or poor cooperation were excluded. All participants underwent detailed ophthalmic evaluation, including visual acuity assessment, slit-lamp examination, fundus evaluation, and refraction (dry and cycloplegic), followed by subjective correction. Stereoacuity was assessed using the Randot stereotest and categorized as normal (10-60 arc seconds), subnormal (61-120 arc seconds), moderate (121-240 arc seconds), and poor (≥241 arc seconds). Anisometropia was defined as an interocular difference of ≥ 1 D spherical or ≥ 1.5 D cylindrical power. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 17.0; SPSS Inc., Chicago, IL), and associations were tested using the chi-square test, with p < 0.05 considered significant.

The study included 120 children with a mean age of 11 ± 2.64 years, comprising 65 (54.17%) males and 55 (45.83%) females. The mean stereoacuity was 54.01 ± 32.19 arc seconds. Anisometropia was present in 19 (15.83%) patients. Normal stereopsis was observed in 96.82% of myopic patients, 93.48% of astigmatic patients, and 72.73% of hyperopic patients. Moderate-to-poor stereopsis was predominantly seen in hyperopic individuals (27.27%), whereas only 3.18% of myopes demonstrated subnormal stereopsis, with none showing moderate or severe impairment. Hypermetropic children had significantly poorer stereopsis compared to myopes. Anisometropia was associated with reduced stereopsis. Isometropic individuals demonstrated better stereoacuity (48 ± 28.18 arc seconds) compared to anisometropic individuals (60 ± 36.89 arc seconds) (t = 2.31, p = 0.02), indicating a significant impact of on binocular function.

Hypermetropia is associated with poorer stereoacuity compared to myopia, and anisometropia negatively affects stereopsis when compared to isometropia. These findings highlight the importance of early detection and appropriate correction of refractive errors in children to prevent impairment of binocular vision. Routine screening of stereopsis should be incorporated into pediatric ophthalmic evaluation to ensure optimal visual development.