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Screening for refractive errors at age 1 year: a pilot study
Insights
Early vision screening in 1-year-old children using cycloplegic refraction is feasible. Specific refractive errors like hypermetropia at age 1 year strongly predict later squint and amblyopia development.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Vision Science
Background:
- Early detection of visual defects in infants is crucial for preventing long-term vision impairment.
- Cycloplegic refraction is a standard method for assessing refractive errors in children.
- Identifying risk factors for conditions like squint and amblyopia at an early age can guide timely interventions.
Purpose of the Study:
- To assess the feasibility and maternal acceptance of cycloplegic refraction for screening 1-year-old children.
- To determine the range of refractive errors in a sample of 1-year-old infants.
- To identify early refractive predictors for the development of squint and amblyopia.
Main Methods:
- Conducted cycloplegic refraction on 186 1-year-old children.
- Analyzed the distribution of refractive errors, including hypermetropia, astigmatism, and anisometropia.
- Statistically evaluated the association between refractive errors at age 1 year and the later diagnosis of squint and/or amblyopia.
Main Results:
- Cycloplegic refraction in 1-year-olds is technically possible and well-accepted by mothers.
- Bilateral hypermetropia, astigmatism, or anisometropia at age 1 year showed a significant association (P < 10⁻⁴) with later squint/amblyopia.
- +2.50 D or more of hypermetropia in any meridian at age 1 year was highly significantly associated (P = 5 x 10⁻⁸) with squint/amblyopia.
Conclusions:
- Cycloplegic refraction is a viable screening tool for visual defects in 1-year-old infants.
- Specific refractive error patterns at 1 year of age can predict the risk of developing squint and amblyopia.
- Further refinement of screening age and abnormality criteria may be necessary, with meridional hypermetropia being a key potential indicator.
Abstract:
Cycloplegic refraction of 1-year-old children is technically possible and is acceptable to mothers as a method for screening children for visual defects. The range of refractions found in a sample of 186 1-year-old children is reported. Prediction of which children are significantly at risk for squint and/or amblyopia is possible on the basis of refractions at age 1 year according to the criteria selected for an 'abnormal' refraction. Bilateral hypermetropia and/or astigmatism or anisometropia at age 1 year was significantly (P less than 1 in 10 000) associated with a child eventually being found to have squint or amblyopia. Both the age of screening and criteria of abnormality will probably need modification. +2.50 or more D hypermetropia in any one meridian of either eye at age 1 year was even more significantly (P = 0.000 000 05%) associated with squint and/or amblyopia. The possibility that meridional hypermetropia could be the basic defect in squint and amblyopia is discussed.