1. Nov 12, 2018

Should You Prescribe Glasses to Very Young Children with Hyperopia?

Trial compares immediate treatment with glasses vs observation

It is not yet clear if prescribing glasses in very young children with moderate to high hyperopia offers clinical benefit, noted Donny W. Suh, MD, chief of pediatric ophthalmology and strabismus at Children's Hospital and Medical Center in Omaha, NE, during the American Academy of Ophthalmology’s 2018 annual meeting in Chicago. 

Between 4% and 14% of children have moderate to high hyperopia, and many of them are at significant risk for strabismus and amblyopia. There is controversy over when to prescribe glasses for such patients. “Do you treat them immediately with glasses, or do you observe until you see signs of decompensation, and then prescribe glasses,” asked Dr. Suh. He and his colleagues conducted a randomized trial to determine if delaying treatment in 1- and 2-year-olds would create permanent damage.

Participants (n=106) were <3 years of age with moderate hyperopia (+3D to +6D) in either eye. Their astigmatism and anisometropia were each <1.5D, and none had strabismus. They were randomized to receive either glasses immediately or observation. Investigators followed them every 6 months for up to 36 months, looking for any signs of harm or permanent damage. 

Dr. Suh explained the importance of distinguishing between failure and deterioration. Deterioration was declared if during the trial investigators saw measurable heterotropia; visual acuity below age-normal values; significant intraocular differences; stereoacuity below age-normal ranges; and/or marked parental concern. 

When deterioration criteria were met, participants received cycloplegic refraction; new glasses; and were released to best care (patching, atropine, and/or surgery). Investigators continued to follow them. 

Failure was determined at the end of the study, and defined as doing harm to visual acuity, stereoacuity, or alignment. Failure was declared if investigators saw measurable heterotropia; visual acuity below age-normal values; stereoacuity below age-normal ranges; and/or strabismus surgery. 

One-third of those in the observation group failed, vs 21% in the contingent treated with glasses. Meanwhile, 42% in the observations group experienced deterioration during the observation period, vs. one-third in the glasses contingent.  Both differences were not statistically significant. 

On average, there was very little change in hyperopia in either group over the 3-year study period. Overall, it improved by just 0.16D. 

Dr. Suh noted that the results show a small to moderate benefit of treating immediately with glasses, but the findings were not definitive enough to make a firm recommendation at this point.

Suh D. Hyperopia Treatment Study 1. Talk presented at: AAO 2018 annual meeting; October, 26-30, 2018; Chicago.