July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Immediate versus Delayed Spectacle Treatment for Moderate Hyperopia in Children 3 to 5 Years of Age
Author Affiliations & Notes
  • Marjean T Kulp
    College of Optometry, Ohio State University, Columbus, Ohio, United States
  • Jonathan M Holmes
    Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Trevano W Dean
    Jaeb Center for Health Research, Tampa, Florida, United States
  • Donny W Suh
    University of Nebraska Medical Center, Omaha, Nebraska, United States
  • Raymond T Kraker
    Jaeb Center for Health Research, Tampa, Florida, United States
  • David Keith Wallace
    Department of Ophthalmology, Indiana University, Indianapolis, Indiana, United States
  • David B Petersen
    Rocky Mountain Eye Care Associates, Salt Lake City, Utah, United States
  • Susan A Cotter
    Southern California College of Optometry at Marshall B. Ketchum University, Fullerton, California, United States
  • Earl R Crouch
    Department of Ophthalmology, Virginia Pediatric Eye Center, Norfolk, Virginia, United States
  • Ingryd J Lorenzana
    Advanced Vision Center, Illinois, United States
  • Benjamin H Ticho
    The Eye Specialists Center, LLC, Chicago Ridge, Illinois, United States
  • Lisa C Verderber
    Pediatric Eye Associates, Wilmette, Illinois, United States
  • Katherine Weise
    University of Alabama Birmingham School of Optometry, Birmingham, Alabama, United States
  • Footnotes
    Commercial Relationships   Marjean Kulp, None; Jonathan Holmes, None; Trevano Dean, None; Donny Suh, None; Raymond Kraker, None; David Wallace, None; David Petersen, None; Susan Cotter, None; Earl Crouch, None; Ingryd Lorenzana, None; Benjamin Ticho, None; Lisa Verderber, None; Katherine Weise, None
  • Footnotes
    Support  NH Grants EY011751, EY023198, and EY018810
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3612. doi:
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      Marjean T Kulp, Jonathan M Holmes, Trevano W Dean, Donny W Suh, Raymond T Kraker, David Keith Wallace, David B Petersen, Susan A Cotter, Earl R Crouch, Ingryd J Lorenzana, Benjamin H Ticho, Lisa C Verderber, Katherine Weise; Immediate versus Delayed Spectacle Treatment for Moderate Hyperopia in Children 3 to 5 Years of Age. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3612.

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

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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.


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