September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Vision In Preschoolers - Hyperopia In Preschoolers (VIP-HIP) Study: Associations between visual function and accommodative lag for emmetropic to moderately hyperopic children
Author Affiliations & Notes
  • T. Rowan Candy
    Indiana University, Bloomington, Indiana, United States
  • Elise B Ciner
    Salus University, Elkins Park, Pennsylvania, United States
  • Marjean T Kulp
    Ohio State University, Columbus, Ohio, United States
  • Maxwell Pistilli
    University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Maureen G Maguire
    University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Gui-Shuang Ying
    University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Graham E Quinn
    Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Bruce D Moore
    New England College of Optometry, Boston, Massachusetts, United States
  • Lynn Cyert
    Northeastern State University, Talequah, Oklahoma, United States
  • Footnotes
    Commercial Relationships   T. Rowan Candy, None; Elise Ciner, None; Marjean Kulp, None; Maxwell Pistilli, None; Maureen Maguire, None; Gui-Shuang Ying, None; Graham Quinn, None; Bruce Moore, None; Lynn Cyert, None
  • Footnotes
    Support  EY021141, EY014460
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1533. doi:
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      T. Rowan Candy, Elise B Ciner, Marjean T Kulp, Maxwell Pistilli, Maureen G Maguire, Gui-Shuang Ying, Graham E Quinn, Bruce D Moore, Lynn Cyert; Vision In Preschoolers - Hyperopia In Preschoolers (VIP-HIP) Study: Associations between visual function and accommodative lag for emmetropic to moderately hyperopic children. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1533.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : While infants are typically hyperopic at birth, emmetropization is largely complete by 3 years of age. The impact of persistent hyperopia on visual function in the absence of strabismus, amblyopia or anisometropia in preschool children is proposed to be related to accommodative performance. The purpose of this investigation was to assess clinical measures of accommodation in relation to other visual functions in uncorrected 4- and 5-year-olds with refractive error spanning emmetropia to moderate hyperopia.

Methods : 546 children evaluated for the VIP-HIP study with no amblyopia or strabismus and refractive error on cycloplegic refraction from >-1.0D in the most myopic meridian to ≤+6.0D in the most hyperopic meridian, with anisometropia and astigmatism <1D, were included. Accommodative lag was measured with a naturalistic cartoon target at 33cm using MEM retinoscopy and Grand Seiko autorefraction. Three additional near visual functions were also assessed: heterophoria by cover testing, binocular visual acuity (VA) by crowded HOTV testing, and stereoacuity by the Preschool Assessment of Stereopsis with a Smile (PASS) test.

Results : The upper 95% confidence limit for accommodative lag in the emmetropes (most hyperopic meridian ≤+1D) was 1.79D for the Grand Seiko and 2.01D for MEM along the vertical meridian. Using these thresholds as criteria for increased lag, and the same 95%CI approach for the other 3 visual functions, 17 (22%) of the increased MEM lag group (≥2.01D, n= 79) had 2 or more other abnormal functions and 16 (24%) of the increased Grand Seiko lag group (≥1.79D, n= 67) had 2 or more other abnormal functions. In comparison, 4.5% of each group who showed a typical lag had 2 or more other abnormal functions. Of note, 49% (GS) and 42% (MEM) of the children with increased lags had no other abnormal functions.

Conclusions : Accommodative lag was greater on average when measured with MEM as compared to Grand Seiko. A classification criterion based on the lag of emmetropic children selectively identifies children with other abnormal visual functions suggesting that accommodative lag may be an additional test by which to identify children at risk. One benefit of this test is that it does not require subjective responses from a child who is reluctant to perform VA or stereoacuity testing.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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