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Cycloplegic refractions of infants and young children: the axis of astigmatism
Insights
Astigmatism in children often presents as against-the-rule in infants but typically resolves by school age. This study tracked astigmatism changes in young children, finding most cases decreased over time.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Refractive Errors
Background:
- Astigmatism is a common refractive error affecting visual acuity.
- Understanding the prevalence and progression of astigmatism in children is crucial for early intervention.
Purpose of the Study:
- To investigate the prevalence and types of astigmatism in children aged 0-9.5 years.
- To determine the natural progression of astigmatism from infancy to school age.
Main Methods:
- Retrospective review of cycloplegic refractions from 281 children (0-9.5 years) with astigmatism (≥1 diopter).
- Analysis of astigmatism types (with-the-rule vs. against-the-rule) based on age groups.
- Follow-up refractions for 11 astigmatic infants to assess changes over time.
Main Results:
- Against-the-rule astigmatism was more prevalent in younger children (<3.5 years), while with-the-rule astigmatism dominated in older children (>5.5 years).
- Of 11 infants with astigmatism, 8 showed a significant decrease (≥0.75 D) by ages 5-11 years.
- Three children maintained their initial astigmatism magnitude and axis.
Conclusions:
- Infants and toddlers exhibit a high prevalence of against-the-rule astigmatism.
- This type of astigmatism often resolves naturally as children approach school age.
- Astigmatism in early childhood demonstrates a dynamic progression, with most cases showing improvement.
Abstract:
Review of the cycloplegic refractions of all children who were first examined at Children's Hospital Medical Center in Boston between 1968 and 1978 revealed that 281 children between the ages of 0 and 9.5 years had astigmatism of 1 diopter (D) or greater but no other ophthalmological or neurological problems. In the 85 children under 3.5 years of age, against-the-rule astigmatism was 2.5 times more common than with-the-rule astigmatism, whereas in the 103 children over 5.5 years of age, with-the-rule astigmatism was three times as common as against-the-rule astigmatism. Eleven children who had been astigmatic as infants were recalled; follow-up refraction at ages 5-11 years revealed that all but three had at least a 0.75 D decrease in astigmatism. The remaining three had astigmatism equal in magnitude and axis to the astigmatism they had as infants. Thus, there is a high prevalence of against-the-rule astigmatism in infants and toddlers, which disappears by the time the children reach school age.