Immediate versus Delayed Spectacle Treatment for Moderate Hyperopia in Children 3 to 5 Years of Age

Abstract

Purpose : To determine if it is beneficial to prescribe glasses immediately for moderate hyperopia to prevent strabismus and amblyopia among children 3 to 5 years of age, without manifest strabismus and with age-normal visual acuity (VA) and stereoacuity.

Methods : In a prospective randomized clinical trial, 119 children (3 to <6 years of age with hyperopia between +3.00 diopters (D) and +6.00D spherical equivalent (SE) in at least one eye) were randomly assigned to glasses (full cycloplegic -1D) versus observation and were seen every 6 months for 3 years. Glasses were prescribed at follow-up visits to those assigned observation if they met pre-specified deterioration criteria of distance VA or near stereoacuity falling below age norms, or developed manifest strabismus. At the 3-year primary outcome examination, the randomized treatment strategy was classified as “failed” if one or more of the following criteria were met, both with and without correction in trial frames, when tested by masked examiner and confirmed by retest: distance VA or stereoacuity below age norm; or manifest strabismus; or strabismus surgery during follow-up.

Results : Of the 84 (71%) participants completing the 3-year primary outcome examination, failure occurred in 5 (12%; 95% CI=4% to 26%) of 41 in the glasses group and 4 (9%; 95% CI=3% to 22%) of 43 in the observation group (difference=3%; 95% CI = -12% to 18%; p=0.72). Twenty-seven percent (95% CI=18% to 41%) in the observation group and 26% (95% CI=16% to 40%) in the glasses group met deterioration criteria (requiring glasses per protocol).

Conclusions : Our study was inconclusive regarding whether or not immediate prescription of glasses reduces failure for VA or binocularity in hyperopic children (+3.00 to +6.00D) ages 3 to 5 years, with age-normal VA, age-normal stereoacuity, and no manifest strabismus. Nevertheless, after 3 years of 6 monthly follow-up, failure was not common whether or not glasses are prescribed upon presentation. Our study results suggest that the immediate prescription of glasses for these children may not be necessary to prevent failure, as defined. Semi-annual monitoring of VA and binocularity may be warranted in such children.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.