Refractive Error Correction with Self-Adjustable Spectacles in Young Children

Abstract

Purpose : Self-adjustable spectacles have been studied in children ≥12 years old and offer the potential to deliver refractive care where conventional service is unavailable. We performed a prospective study to identify the lower age limit of children who could accurately self-refract using Adspecs by comparing visual and refractive outcomes of self-refraction (SR) to conventional refraction methods.

Methods : We recruited children 5-11 years old presenting to an academic pediatric eye clinic for a comprehensive, dilated exam, whose preferred language was English, who could follow instructions, and had an uncorrected visual acuity (UCVA) ≤20/40 in at least one eye. We excluded children if they had systemic or ocular conditions impairing their ability to achieve best corrected visual acuity (BCVA) of ≥20/25 in at least one eye. Children were taught and performed SR using Adspecs, then underwent a comprehensive eye exam. Their visual acuity (VA) was measured using SR, non-cycloplegic autorefraction (NCAR), and cycloplegic subjective refraction (CSR). Spherical equivalent (SE) refractive error and BCVA for each method were compared in aggregate and by age for the study eye (i.e. better-seeing eye except when UCVA >20/40 in better-seeing eye, the worse-seeing eye was used). Logistic regression was used to determine factors associated with failure to achieve BCVA of ≥20/25 by SR.

Results : Among 112 participants (52 [46%] boys) aged 5-11 years (mean ± standard deviation (sd)= 9.0 ± 1.6 years), 37 (33%) wore spectacles. Among better-seeing eyes, the percent with VA >20/40 was 31.3% with UCVA, 95.5% with NCAR, 97.3% with SR, and 93.8% with CSR (no difference between NCAR, SR, and SCR, all p≥0.2). The mean SE ± sd was -2.00 ± 1.52D for SR and -1.67 ± 1.49D for CSR (P= 0.003). Participants in all age groups achieved mean BCVA by SR ≥20/25 except those aged 5-6 years (n=7), who achieved mean BCVA 20/30. Within each age group, there was no difference in mean BCVA between SR and CSR (all p≥0.4). Those failing to achieve BCVA ≥20/25 by SR were more likely to have more astigmatism (odds ratio (OR)=10.6; p<0.001) and be younger (increasing age OR=0.7; p=0.02).

Conclusions : While children 5-11 years old were able to improve their VA with SR using Adspecs at a rate similar to CSR, younger children and those with more astigmatism tended to achieve worse corrected vision with SR. Children tended to over-minus with SR relative to CSR.

This is a 2020 ARVO Annual Meeting abstract.