Hyperopia

Question 1

infants full term average

Answer 1

+2.00D with SD of 2D

significant decrease until 9 months (emmetropization)

will continue slowly until 18 months

Question 2

high hyperopia risks

Answer 2

strabismus (ESO) and bilateral amblyopia

Strab: child will try to make it clear so shuts off one eye and sacrifices binocularity

bilateral amblyopia: unclear in both eyes but still has binocularity

Question 3

Ingram J Ophthalmology 1990

Answer 3

9% of ages 6+ months had more than 4D of hyperopia and 20% of vision defects
(strab + bilateral amblyopia)
glasses earlier did not matter in this study

Question 4

Atkinson + Braddick 1996

Answer 4

Infants with more than 3.5D of hyperopia: 13x more risk of developing strabismus by age 4 and 6x more prone to amblyopia

Question 5

Hyperopia in Preschool

Answer 5

Hispanic > White > AA > AP

Question 6

VIP (3 - 5 year olds)

Answer 6

11% had more than +3.25D

34% had amblyopia and 17% had strabismus

Question 7

VIP Uncorrected H and Preschool Early Literacy 2016

Answer 7

Preschoolers with +3-6D and 20/40 or worse at near and used TOPEL for literacy test for 4-5 year olds

Question 8

Rosner JAOA 1997 School Age

Answer 8

782 children with diverse backgrounds Grades 1-5

Significantly lower test scores with more than +1.25D RE

Question 9

Vanrijn et al OVS 2014

Answer 9

65 hyperopes Ages 9-10 with at least 0.75D in 1 eye

full correction improved 1 min reading score by 13%

*low amounts of hyperopia corrected can improve reading

Question 10

hyperopia and literacy

Answer 10

1/6 children who are not reading proficiently by 3rd grade will drop out of HS or not finish in time

23% of low below basic readers drop out

Question 11

AAO, OMD

Answer 11

does not look at stereo, strabismus, esotropia

Children less than 3 years old: Rx +4.50D RE

Children 4+ years old: Rx as necessary to improve acuity

MD believe that children have enough accommodation

Question 12

AOA, OD

Answer 12

Infants: 3.50D
Young Child: 2.50D
Adolescent: 1.50D

Question 13

Hyperopia Correction for Infants, Toddlers

Answer 13

ET: push for plus

Infant: Average Rx +2D

• emmetropize by 9 months
• bring back to monitor

1 year old+: consider if more than 3.50D and can cut cycloplegic 1-2D OU

Question 14

Hyperopia Correction Preschool

Answer 14

ET: push plus

Ages 4+: Rx if more than 2.5D and may rx lower amounts if there are symptoms OR can cut cycloplegic by 1-2D OU

Question 15

Hyperopia Correction School-Aged

Answer 15

Rx if more than 1.50D without symptoms and lower if there are symptoms

Question 16

symptoms of hyperopia

Answer 16

blurry vision (+0.50D), headaches when reading, blurry when reading, below grade level reading, tired when reading or avoids reading

esophoria distance or near and a reduced stereopsis

accommodation insufficiency, high lag, variable reflex