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1. Korean J Ophthalmol. 2007 Sep;21(3):159-62. Links
Reduction of deviation angle during occlusion therapy: in partially
accommodative esotropia with moderate amblyopia.
Chun BY, Kwon SJ, Chae SH, Kwon JY.
Department of Ophthalmology, Kyungpook National University, School of
Medicine, Daegu, Korea.
PURPOSE: To evaluate changes in ocular alignment in partially
accommodative esotropic children age ranged from 3 to 8 years
during occlusion therapy for amblyopia. METHODS: Angle
measurements of twenty-two partially accommodative esotropic
patients with moderate amblyopia were evaluated before and at
2 years after occlusion therapy. RESULTS: Mean deviation angle
with glasses at the start of occlusion treatment was
19.45plusmn;5.97 PD and decreased to 12.14plusmn;12.96 PD
at 2 years after occlusion therapy (p<0.01). After occlusion
therapy, 9 (41%) cases were indications of surgery for residual
deviation but if we had planned surgery before occlusion
treatment, 18 (82%) of patients would have had surgery. There
was a statistical relationship between increase of visual acuity
ratio and decrease of deviation angle (r=-0.479, p=0.024).
CONCLUSIONS: There was a significant reduction of deviation
angle of partially accommodative esotropic patients at 2 years
after occlusion therapy. Our results suggest that occlusion
therapy has an influence on ocular alignment in partially
accommodative esotropic patients with amblyopia.
PMID: 17804922 [PubMed - in process]
2. 1: Ophthalmology. 2007 Jul 28; [Epub ahead of print]
Links
Prevalence of Hyperopia and Associations with Eye Findings in 6and 12-Year-Olds.
Ip JM, Robaei D, Kifley A, Wang JJ, Rose KA, Mitchell P.
Department of Ophthalmology (Centre for Vision Research, Westmead
Hospital), Westmead Millennium Institute, University of Sydney, and Vision
Cooperative Research Centre, Sydney, Australia.
PURPOSE: To describe the prevalence of hyperopia and
associated factors in a representative sample of Australian
schoolchildren 6 and 12 years old. DESIGN: Population-based
cross-sectional study. PARTICIPANTS: Schoolchildren ages 6 (n =
1765) and 12 (n = 2353) from 55 randomly selected schools
across Sydney. METHODS: Detailed eye examinations included
cycloplegic autorefraction, ocular biometry, cover testing, and
dilated fundus examination. Information on birth and medical
history were obtained from a parent questionnaire. MAIN
OUTCOME MEASURES: Moderate hyperopia defined as spherical
equivalent (SE) refraction of >/=+2.00 diopters (D), and eye
conditions including amblyopia, strabismus, astigmatism, and
anisometropia. RESULTS: Prevalences of moderate hyperopia
among children ages 6 and 12 were 13.2% and 5.0%,
respectively; it was more frequent in children of Caucasian
ethnicity (15.7% and 6.8%, respectively) than in children of
other ethnic groups. Compared with children without significant
ametropia (-0.49 </= SE refraction </= +1.99 D), the
prevalence of eye conditions including amblyopia, strabismus,
abnormal convergence, and reduced stereoacuity was
significantly greater in children with moderate hyperopia (all Ps <
0.01). Maternal smoking was significantly associated with
moderate hyperopia among 6-year-olds (P = 0.03), but this
association was borderline among 12-year-olds (P = 0.055).
Early gestational age (<37 weeks) and low birth weight (<2500
g) were not statistically significant predictors of moderate
hyperopia in childhood. CONCLUSIONS: Moderate hyperopia was
strongly associated with many common eye conditions,
particularly amblyopia and strabismus, in older children. Birth
parameters did not predict moderate hyperopia.
PMID: 17664011 [PubMed - as supplied by publisher]
3. J Fr Ophtalmol. 2007 Mar;30(3):255-9. Links
[Management of hyperopia in children]
[Article in French]
Jeddi Blouza A, Loukil I, Mhenni A, Khayati L, Mallouche N,
Zouari B.
Service d'Ophtalmologie, Hôpital La Rabta, Tunis, Tunisie.
PURPOSE: To study the prevalence of hyperopia in school-aged
children and to analyze the factors that increase the risk of
squint or amblyopia in a retrospective study. METHODS: Three
hundred eyes of 150 children with hyperopia who did not have
anisometropia > or =1.5 D were selected. Complete
ophthalmological examination was performed for all children.
Hyperopia was defined when spherical equivalent was +0.5 D or
greater. Amblyopia was screened and treated by patching
therapy and then penalisation. Complete spectacle correction was
achieved in children with high hyperopia (+3.5 D or greater) or in
presence of squint or amblyopia. A statistical analysis compared
the results using the Mann-Whitney test and the chi square test.
RESULTS: The mean age was 9.5+/-2.7 years. Girls were
statistically more represented than boys. The mean sphere
measured overall was +2 D (+/-1.65). Severe hyperopia was
detected in 19% of the children; it was latent in 35% of children.
Strabismus was detected in 7% and was accommodative in 25%.
Esotropia was the most prevalent deviation (72.8%). The
prevalence of amblyopia was 12%. The mean sphere measured
in amblyopic children was 5.66 D (+/-1.64 D). Initial depth of
amblyopia was mild to moderate and 98% of the children
achieved iso-acuity after patching therapy. The correlation
between severe hyperopia, amblyopia, and squint was
statistically significant. Indeed, the risk ratios of squint and
amblyopia, 5.2 and 3.70, respectively, were significantly high in
children with severe hypermetropia. Complete spectacle
correction improved final visual acuity and reduced the angle
deviation in accommodative esotropia. CONCLUSION: Children
with hyperopia of +3.5 D or greater have an increased risk of
amblyopia and squint that threatens their visual function.
Hyperopic correction should be prescribed even if no strabismus
or amblyopia is detected in order to prevent this risk. Screening
programs should also be promoted to detect these children at an
early age.
4. Survey of German Clinical Prescribing Philosophies for Hyperopia.
REITER, CONSTANTIN BS; LEISING, DANIEL PhD; MADSEN, ELLIS M. MS,
OD, FAAO
[Article] Optometry & Vision Science. 84(2):131-136, February 2007.
(Format: HTML, PDF)
Purpose. We surveyed a group of German ophthalmologists to evaluate their
prescribing philosophies for hyperopic refractive error in symptom-free children
and to compare them with the two groups of U.S. pediatric ophthalmologists and
U.S. pediatric optometrists as surveyed by Lyons et al.
Methods. Practitioners were selected from a list of ophthalmologists on the
Internet. They were either in general practice in three cities in northern Bavaria or
affiliated with large ophthalmology teaching hospitals in Wuerzburg and
Erlangen. The survey questions of Lyons et al. were translated into German and
mailed to 103 ophthalmologists. The data received from the German
ophthalmologists were compared with those of the U.S. optometrists and
ophthalmologists.
Results. A total of 45 surveys (44%) were returned to us and analyzed. In cases
of asymptomatic bilateral hyperopia, German ophthalmologists did not prescribe
significantly differently from U.S. optometrists at all patient age groups (p >=
0.05), but they did differ significantly from U.S. ophthalmologists (p < 0.001).
Prescribing fractional amounts of hyperopia or astigmatism was not a popular
rule of thumb among the German ophthalmologists, and there was no statistical
difference between the German and U.S. practitioners. German ophthalmologists
would prescribe for anisometropia for all patient age groups in the same way as
both U.S. optometrists and U.S. ophthalmologists.
Conclusion. The prescribing philosophies of German ophthalmologists for
pediatric patients did not differ from those of U.S. ophthalmologists and U.S.
optometrists when prescribing for anisometropia; they did differ from those of
U.S. ophthalmologists but not of those of the U.S. optometrists when prescribing
for asymptomatic bilateral hyperopia
5. 1: Optom Vis Sci. 2007 Feb;84(2):115-23. Links
The epidemiology of early childhood hyperopia.
Tarczy-Hornoch K.
Department of Ophthalmology, University of Southern California/Childrens
Hospital Los Angeles, Los Angeles, California, USA.
[email protected]
Hyperopia is present in a small proportion of children aged
between 6 and 12 months, with ethnicity likely affecting
prevalence, and higher prevalences in certain subgroups,
especially those with a family history of hyperopia or
accommodative esotropia. Around a fifth of children who are
hyperopic in infancy go on to develop strabismus, while an
unknown proportion develop bilateral ametropic amblyopia;
persistent hyperopia appears to be a harbinger of future
pathology. Early prophylactic spectacle correction of hyperopia
has failed to prevent strabismus in three of four studies, but
showed reduced incidence of strabismus in one study, and
yielded improved visual acuity outcomes in two studies by one
investigator. Currently our ability to detect or measure refractive
error with automated instruments easily adaptable to a screening
setting has outpaced our knowledge of how best to identify the
subset of hyperopes who are really at risk, and how to manage
isolated early hyperopia once it has been identified
6.
1: Optom Vis Sci. 2007 Feb;84(2):103-9.
Related Articles, Links
Management of childhood hyperopia: a pediatric
optometrist's perspective.
Cotter SA.
Southern California College of Optometry, Fullerton, California,
USA. [email protected]
PURPOSE: To provide an optometric perspective on the
management of hyperopia in children without strabismus or
amblyopia. METHODS: Factors that have potentially shaped
optometry's viewpoint and influenced its prescribing philosophy
for childhood hyperopia, such as optometry school and residency
training, professional association clinical guidelines, conferences
and continuing education courses, textbooks, scientific studies,
opinions of professional leaders, and clinical experiences are
discussed. RESULTS: Variations in prescribing patterns for
childhood hyperopia occur within optometry and within
ophthalmology. There are also differences in prescribing
philosophies between the two professions. These differences are
probably due to a greater level of concern, more so among
optometrists, about associated vision functions such as
accommodation, vergence, and stereopsis, as well as concerns
about the potential impact of uncorrected hyperopia on reading and
school performance. CONCLUSIONS: If indications for
prescribing spectacles for children with hyperopia are to be
validated, randomized controlled trials need to be performed.
Publication Types:
• Review
PMID: 17299339 [PubMed - indexed for MEDLINE]
2: Optom Vis Sci. 2007 Feb;84(2):97-102.
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To emmetropize or not to emmetropize? The question
for hyperopic development.
Mutti DO.
The Ohio State University College of Optometry, Columbus, Ohio,
USA.
Emmetropization appears to be a rapid process, occurring in the
first year of life. Failure to emmetropize leaves about 2 to 8% of
children with potentially clinically significant hyperopia after
infancy. Uncorrected hyperopia in childhood has a negative impact
on distance acuity and the accuracy of the accommodative
response for some unknown number of children. The clinical "gray
zone" for these problems as judged by distance refractive error
alone might begin somewhere around +2.00 to +3.00 D. Use of a
refractive correction seems to improve distance acuity and the
accuracy of accommodation. Clinicians' reluctance to prescribe
hyperopic corrections to children to improve visual performance
might be unwarranted. If emmetropization is largely complete, if
defocus has only a minor effect on the development of refractive
error in infancy or childhood, and if the hyperopic eye is already
growing longer but not moving toward emmetropia, then there may
be little reason to either wait or be concerned about interfering
with emmetropization that may never happen. The immediate
visual benefit may outweigh these concerns.
Publication Types:
• Research Support, N.I.H., Extramural
• Research Support, Non-U.S. Gov't
• Review
PMID: 17299338 [PubMed - indexed for MEDLINE]
3: Optom Vis Sci. 2007 Feb;84(2):84-96.
Related Articles, Links
Infant hyperopia: detection, distribution, changes and
correlates-outcomes from the cambridge infant
screening programs.
Atkinson J, Braddick O, Nardini M, Anker S.
Visual Development Unit, University College London, London,
United Kingdom. [email protected]
PURPOSE: To report on two population screening programs
designed to detect significant refractive errors in 8308 8- to 9month-old infants, examine the sequelae of infant hyperopia, and
test whether early partial spectacle correction improved visual
outcome (strabismus and acuity). The second program also
examined whether infant hyperopia was associated with
developmental differences across various domains such as
language, cognition, attention, and visuomotor competences up to
age 7 years. Linked programs in six European countries assessed
costs of infant refractive screening. METHOD: In the first
program, screening included an orthoptic examination and
isotropic photorefraction, with cycloplegia. In the second program
we carried out the same screening procedure without cycloplegia.
Hyperopic infants (> or = +4 D) were followed up alongside an
emmetropic control group, with visual and developmental
measures up to age 7 years, and entered a controlled trial of partial
spectacle correction. RESULTS: The second program showed that
accommodative lag during photorefraction with a target at 75 cm
(focus > or = +1.5 D) was a marker for significant hyperopia. In
each program, prevalence of significant hyperopia at 9 to 11
months was around 5%; manifest strabismus was 0.3% at 9 months
and 1.5 to 2.0% by school age. Infant hyperopia was associated
with increased strabismus and poor acuity at 4 years. Spectacle
wear by infant hyperopes produced better visual outcome than in
uncorrected infants, although an improvement in strabismus was
found in the first program only. The corrections did not affect
emmetropization to 3.5 years; however, both corrected and
uncorrected groups remained more hyperopic than controls in the
preschool years. The hyperopic group showed poorer overall
performance than controls between 1 and 7 years on
visuoperceptual, cognitive, motor, and attention tests, but showed
no consistent differences in early language or phonological
awareness. Relative cost estimates suggest that refractive screening
programs can detect visual problems in infancy at lower overall
cost than surveillance in primary care. CONCLUSIONS:
Photo/videorefraction can successfully screen infants for refractive
errors, with visual outcomes improved through early refractive
correction. Infant hyperopia is associated with mild delays across
many aspects of visuocognitive and visuomotor development.
These studies raise the possibility that infant refractive screening
can identify not only visual problems, but also potential
developmental and learning difficulties.
Publication Types:
• Research Support, Non-U.S. Gov't
• Review
PMID: 17299337 [PubMed - indexed for MEDLINE]
4: Optom Vis Sci. 2007 Feb;84(2):80.
Related Articles, Links
Infant and child hyperopia.
Mutti DO, Candy R, Cotter SA, Haegerström-Portnoy G.
Publication Types:
• Editorial
PMID: 17299334 [PubMed - indexed for MEDLINE]
5: Eye. 2007 Feb 2; [Epub ahead of print]
Related Articles, Links
Ethnic differences in refraction and ocular biometry in
a population-based sample of 11-15-year-old Australian
children.
Ip JM, Huynh SC, Robaei D, Kifley A, Rose KA, Morgan IG,
Wang JJ, Mitchell P.
1Department of Ophthalmology and the Westmead Millennium
Institute, Centre for Vision Research, University of Sydney,
Sydney, Australia.
PurposeTo examine the prevalence of refractive error and
distribution of ocular biometric parameters among major ethnic
groups in a population-based sample of 11-15-year-old Australian
children.MethodsThe Sydney Myopia Study examined 2353
students (75.3% response) from a random cluster-sample of 21
secondary schools across Sydney. Examinations included
cycloplegic autorefraction, and measures of corneal radius of
curvature, anterior chamber depth, and axial
length.ResultsParticipants mean age was 12.7 years (range 11.114.4); 49.4% were female. Overall, 60.0% of children had
European Caucasian ethnicity, 15.0% East Asian, 7.1% Middle
Eastern, and 5.5% South Asian. The most frequent refractive error
was mild hyperopia (59.4%, 95% confidence interval (CI), 53.265.6), defined as spherical equivalent (SE) +0.50 to +1.99 D.
Myopia (SE-0.50 D or less) was found in 11.9%, 95% (CI 6.617.2), and moderate hyperopia (SE>/=+2.00 D) in 3.5%, 95% (CI
2.8-4.1). Myopia prevalence was lower among European
Caucasian children (4.6%, 95% CI 3.1-6.1) and Middle Eastern
children (6.1%, 95% CI 1.3-11.0) than among East Asian (39.5%,
95%, CI 25.6-53.5) and South Asian (31.5%, 95%, CI 21.6-41.4)
children. European Caucasian children had the most hyperopic
mean SE (+0.82 D) and shortest mean axial length (23.23 mm).
East Asian children had the most myopic mean SE (-0.69 D) and
greatest mean axial length (23.86 mm).ConclusionThe overall
myopia prevalence in this sample was lower than in recent similaraged European Caucasian population samples. East Asian children
in our sample had both a higher prevalence of myopia and longer
mean axial length.Eye advance online publication, 2 February
2007; doi:10.1038/sj.eye.6702701.
PMID: 17277756 [PubMed - as supplied by publisher]
1: J Zhejiang Univ Sci B. 2006 Nov;7(11):884-6. Links
Spectacle correction of heterophoria in hyperopic amblyopic
children.
Liu X, Li YM, Li Y.
Ophthalmic Center, the First Affiliated Hospital, School of Medicine, Zhejiang
University, Hangzhou 310003, China.
OBJECTIVE: To test the effects of corrective spectacles in
hyperopic amblyopic children with heterophoria. METHODS:
Visual acuity, refraction and the amount of heterophoria on near
(33 cm) fixation were measured before and after 3 weeks of
spectacle-wearing in 30 hyperopic amblyopic children with
heterophoria. The control group consisted of 20 emmetropic
children age-matched to the patients. RESULTS: Uncorrected
eyes displayed hyperopic amblyopia accompanied by
heterophoria. Corrective spectacles not only attenuated the
hyperopia and amblyopia, but also changed the heterophoria to
orthophoria. The amount of heterophoria before wearing
spectacles was significantly different from that in emmetropic
children; but after correction with spectacles, it was the same as
that in the emmetropic controls. CONCLUSION: Correction with
spectacles is effective for the treatment of heterophoria in
hyperopic children with amblyopia.
1: Ophthalmology. 2007 Feb;114(2):374-82. Epub 2006 Nov
21. Links
Refractive error and visual impairment in school children in rural
southern China.
He M, Huang W, Zheng Y, Huang L, Ellwein LB.
Key Laboratory of Ophthalmology and Zhongshan Ophthalmic Center, Sun
Yat-Sen University, Guangzhou, China.
PURPOSE: To assess the prevalence of refractive error and visual
impairment in school children in a rural area of southern China.
DESIGN: Prospective cross-sectional survey. PARTICIPANTS: Two
thousand four hundred children from junior high schools in
Yangxi County. METHODS: Random selection of classes from the
3 junior high school grade levels was used to identify the study
sample. Children from 36 classes in 13 schools were examined in
April 2005. The examination included visual acuity (VA) testing;
ocular motility evaluation; cycloplegic autorefraction; and
examination of the external eye, anterior segment, media, and
fundus. MAIN OUTCOME MEASURES: Distance VA and cycloplegic
refraction. RESULTS: Among 2515 enumerated children, 2454
(97.6%) were examined. The study population consisted of the
2400 children between 13 and 17 years old. Prevalences of
uncorrected, presenting, and best-corrected VA < or = 20/40 in
the better eye were 27.0%, 16.6%, and 0.46%, respectively.
Sixty percent of those who could achieve acuity > or =20/32 in
at least one eye with best correction were without the necessary
spectacles. Refractive error was the cause in 97.1% of eyes with
reduced vision; amblyopia, 0.81%; other causes, 0.67%; and
unexplained causes, 1.4%. Myopia (spherical equivalent, -0.50
diopters [D] or more in either eye) affected 36.8% of 13-yearolds, increasing to 53.9% of 17-year-olds. Myopia was associated
with higher grade level, female gender, schooling in the county
urban center, and higher parental education. Hyperopia (+2.00 D
or more) affected approximately 1.0% in all age groups.
Astigmatism (> or =0.75 D) was present in 25.3% of all children.
CONCLUSIONS: Reduced vision because of uncorrected myopia is
a public health problem among school-age children in rural
China. Effective VA screening strategies are needed to eliminate
this easily treated cause of visual impairment