No judgment on glasses for farsighted children – Tips & Results

Early use of prescription glasses in young children with hyperopia showed no significant visual benefit after 3 years of follow-up in a randomized study.

Children assigned glasses had a failure rate of 21% versus 34% for children observed during the follow-up period, which did not reach statistical significance in the 130-patient study.

Still, nearly twice as many patients assigned to observation met criteria for vision deterioration, reported Marjean T. Kulp, OD, of Ohio State University College of Optometry in Columbus, and co-authors ophthalmology.

“Our estimates of failure at 3 years with 6 months of follow-up are inconclusive and consistent with small to moderate or no benefit of promptly prescribing glasses compared to careful observation, using the glasses only when deteriorating,” they concluded the authors .

“A larger study would be needed to provide a more accurate estimate of the treatment effect and whether one treatment strategy is better than the other,” they added. “Regardless of the initial treatment approach, the moderate to high rate of deterioration and subsequent moderate rate of failure at 3 years indicate that ophthalmologists need to closely monitor children aged 1 to 2 years with moderate hyperopia.”

The study addressed a common and confusing problem that pediatric ophthalmologists encounter in clinical practice, said David Epley, MD, who practices at EvergreenHealth in Kirkland, Washington.

“We see these kids all the time,” said Epley, a clinical spokesman for the American Academy of Ophthalmology. “You have this moderate degree of hyperopia or farsightedness and no other signs or problems. What are we going to do with these children? Is it better to give them glasses or is it better to watch them? There are camps on both sides that are fiercely debating this issue.”

The randomized study was designed with the aim of answering the question once and for all. “Unfortunately, the results show that there are still some questions. There is no stronger or better way to treat these children.”

A strong consensus has emerged on the need for optical correction in children with moderate hyperopia and associated strabismus or amblyopia. In contrast, the need for vision correction in children with moderate hyperopia without strabismus or amblyopia is less clear, the authors noted in their introduction.

The rationale for proactive vision correction in a child with asymptomatic hyperopia is to promote normal visual acuity and reading function and potentially prevent esotropia, amblyopia, or asthenopia, they continued. Some pediatric eye care professionals see no harm in postponing symptom-free use of glasses, including some advocates who have raised concerns about possible negative effects of optical correction on emmetropization.

In support of a contrary view, some evidence has shown that partial correction of farsightedness does not impede emmetropization, which is usually complete by the end of a child’s first year of life.

To add high-level prospective data to the discussion, Kulp and colleagues conducted a randomized, multicenter clinical trial to compare early use of corrective glasses with observation in young children with moderate hyperopia and no strabismus or amblyopia. Eligibility criteria included age 1 to < 3 years and moderate hyperopia (+3 to +6 dioptres spherical equivalent). [D SE]), astigmatism ≤ 1.5 D in each eye and SE anisometropia ≤ 1.5 D by cycloplegic refraction and no apparent strabismus in distance or near.

Children assigned to observation were given glasses if they met predetermined criteria for deterioration or TV acuity, stereo acuity nearly below normal for age, or squinting. The primary endpoint was the failure rate in each group at 3 years of follow-up with 6-month assessments. The main secondary endpoint was visual deterioration at the 36-month assessment.

Failure was defined as development of overt strabismus, strabismus surgery prior to the 36-month follow-up visit, VA below normal for age in each eye, ≥2 or ≥3 logMAR lines (minimum angle of resolution) of interocular difference (depending on baseline). visual acuity) or stereo acuity close below the normal age. The definition of deterioration included the same parameters minus strabismus surgery with the addition of non-protocol treatment in the absence of deterioration.

Of 130 children who participated in the study, 106 completed the 3-year follow-up. The authors reported that 11 of 53 patients assigned glasses met criteria for failure, as did 18 of 53 in the observation group (P=0.14). Analysis of deterioration included all 130 patients and showed that 20 (34%) assigned glasses had deterioration compared to 36 (62%) in the observation groups.

“The big takeaway for me is that a fairly high percentage of these kids get strabismus or amblyopia over time, so when you identify these kids it’s really important that you continue to follow them closely because quite a number of them are developing end of needing treatment,” Epley said MedPage today.

  • Charles Bankhead is senior editor for oncology and also covers urology, dermatology and ophthalmology. He joined MedPage Today in 2007. follow


The study was supported by the National Eye Institute.

The authors stated that they had no relevant financial disclosures.

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