Astigmatism in children: changes in axis and amount from birth to six years
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Insights
Early childhood astigmatism is common, often resolving by age four. Most astigmatism in young children is against-the-rule, shifting to with-the-rule later, suggesting natural correction.
Area of Science:
- Ophthalmology
- Pediatric Optometry
- Developmental Biology
Background:
- Astigmatism is a common refractive error affecting visual development.
- Understanding the natural history of astigmatism in early childhood is crucial for early intervention.
- Previous studies have provided limited data on astigmatism progression in the first six years of life.
Purpose of the Study:
- To investigate the incidence and progression of astigmatism in children aged 0-6 years.
- To determine the prevalence of against-the-rule and with-the-rule astigmatism in different age groups.
- To explore the relationship between early astigmatism and its later resolution or persistence.
Main Methods:
- Conducted noncycloplegic refractions on a cohort of 1,000 children aged 0-6 years.
- Collected longitudinal data on astigmatism measurements over a four-year period.
- Categorized astigmatism as with-the-rule or against-the-rule based on refractive error orientation.
Main Results:
- A high incidence of astigmatism was observed, particularly within the first two years of life.
- Astigmatism predominantly presented as against-the-rule before 4.5 years of age, transitioning to with-the-rule thereafter.
- Children without initial astigmatism rarely developed it by age four; conversely, significant early astigmatism often resolved or reduced substantially by age four.
Conclusions:
- Astigmatism in early childhood exhibits a dynamic natural history with a tendency towards spontaneous correction.
- The age-related shift in astigmatism orientation provides insights into its underlying etiological factors.
- Findings support the hypothesis that early-onset astigmatism may be a transient phase in visual development for many children.
Abstract:
Noncycloplegic refractions of 1,000 children aged 0-6 years revealed a high incidence of astigmatism, especially in the first 2 years of life. Before age 41/2 years, most of the astigmatism was against-the-rule and after that age most was with-the-rule. Of 19 children who did not show astigmatism in the first year, only one acquired it by 4 years. Of 29 children who had large amounts of astigmatism in the first year, all showed elimination or a large reduction in the amount of the cylindrical error by 4 years. These results are relevant to the etiology of astigmatism.