Comparison of Clinical Features in Hypermetropic Children According to Refractive Error

Ju Hee Noh; So Young Kim

doi:10.3341/jkos.2015.56.9.1416

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Noh and Kim: Comparison of Clinical Features in Hypermetropic Children According to Refractive Error

Original Article

J Korean Ophthalmol Soc 2015;56(9):1416-1423.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.9.1416

Comparison of Clinical Features in Hypermetropic Children According to Refractive Error

Ju Hee Noh, M.D., So Young Kim, M.D., PhD

Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea

Address reprint requests to So Young Kim, MD, PhD Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, #44 Suncheonhyang 4-gil, Dongnam-gu, Cheonan 31151, Korea Tel: 82-41-570-2260, Fax: 82-41-570-2261 E-mail: ophdrkim@gmail.com

∗This work was supported by the Soonchunhyang University Research Fund.

Received 28 November 201427 May 2015 Accepted 21 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate risk factors of esotropia, anisometropia and amblyopia and compare the clinical features in hyper-metropic children according to the amount of hyperopia.

Methods

This study included 377 patients with cycloplegic refractive error of +1 D or greater at first visit. Patients were divided into 3 groups according to the refractive error. Odds ratios were calculated to evaluate the association of clinical risk factors with esotropia, anisometropi and amblyopia. Clinical features were compared between surgical and non-surgical groups.

Results

Hyperopia <+6 D showed greater odds of anisometropia. Hyperopia of ≥+6 D showed greater odds of bilateral am-blyopia to 14.796 and hyperopia of <+6 D increased odds of unilateral amblyopia. Moderate hyperopia (≥3 D to <6 D) increased the odds ratio for development of esotropia to 1.862. Patients with anisometropia ≥2 D had a 5.386 times increased odds of eso-tropia and those younger than 2 years had a 5.578 times increased odds of esotropia. Surgical groups showed lower amount of hyperopia than non-surgical groups. Hyperopia <+3 D had higher prevalence of esotropic surgery (50.72%).

Conclusions

Moderate hyperopia and anisometroia ≥2 D increased the risk for development of esotropia. Greater prevalence of bilateral amblyopia and lower prevalence of esotrpia was found predominantly in groups with higher amount of hyperopia. We recommend optical correction at an early age with higher hyperopia and surgical treatment should be considered for esotropic children with lower hyperopia.

Keywords: Amblyopia, Anisometropia, Esotropia, Hyperopia, Risk factor

References

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Table 1.

Clinical characteristics of the subjects according to the amount of hyperopia

	Hyperopia			p-value^∗
	≥1 D to <3 D (n = 156)	≥3 D to <6 D (n = 169)	≥6 D (n = 52)	p-value^∗
Age at first visit (years)	3.96 ± 2.15	4.03 ± 2.17	3.73 ± 2.21	0.866
Final BCVA	0.87 ± 0.16	0.83 ± 0.20	0.84 ± 0.20	0.294
Initial SE (D)	1.95 ± 0.50	4.16 ± 0.78	7.30 ± 0.99	<0.001
Final SE (D)	0.84 ± 1.14	2.82 ± 1.48	5.45 ± 1.97	<0.001
Anisometropia > 1 D (n, %)	39/156 (25.0)	45/169 (26.63)	6/52 (11.54)	0.069
Anisometropia > 2 D (n, %)	25/156 (16.03)	25/169 (14.79)	1/52 (1.92)	0.001
Unilateral amblyopia (n, %)	45/156 (28.85)	47/169 (27.81)	6/52 (11.54)	0.019
Bilateral ambylopia (n, %)	8/156 (5.13)	14/169 (8.28)	20/52 (38.46)	<0.001
Acc esotropia (n, %)	33/156 (21.15)	78/169 (46.15)	9/52 (17.31)	0.015
Surgery of ET (n, %)	35/69 (50.72)	20/89 (22.47)	2/21 (9.52)	0.001

Values are presented as mean ± SD unless otherwise indicated. D = diopter; BCVA = best-corrected visual acuity; SE = spherical equivalent; Acc = accommodative; ET = esotropia.

^∗ One way analysis of variance (ANOVA).

Table 2.

Clinical characteristics in children of the same age^∗ according to the amount of hyperopia

	Hyperopia
	≥1 D to <3 D (n = 14)	≥3 D to <6 D (n = 13)	≥6 D (n = 8)	p-value^†
Spherical equivalent (D)
Initial	2.28 ± 0.39	4.00 ± 0.72	6.56 ± 1.12	<0.001
Final^‡	1.24 ± 0.91	2.42 ± 1.07	4.63 ± 1.71	<0.001
Anisometropia (D)
Initial	0.43 ± 0.65	0.50 ± 0.76	0.15 ± 0.38	0.145
Final^‡	0.73 ± 0.79	0.75 ± 0.89	0.58 ± 0.52	0.546
Unilateral amblyopia (n, %)
Initial	1/14 (7.14)	1/13 (7.69)	0/8 (0.0)	0.533
Final^‡	2/14 (14.29)	2/13 (15.38)	2/8 (25.0)	0.502
Bilateral amblyopia (n, %)
Initial	1/14 (7.14)	1/13 (7.69)	3/8 (37.5)	0.387
Final^‡	0/14 (0.0)	0/13 (0.0)	2/8 (25.0)	0.144
Accommodative ET (n, %)
Initial	3/14 (21.43)	8/13 (61.54)	4/8 (50.0)	0.212
Final^‡	2/14 (14.29)	8/13 (61.54)	4/8 (50.0)	0.065
Hyperopic reduction rate (D/year)	0.25 ± 0.19	0.30 ± 0.18	0.39 ± 0.36	0.435

Values are presented as mean ± SD unless otherwise indicated. D = diopter; ET = esotropia.

^∗ 3 years old;

^† Kruskal-Wallis test;

^‡ 5 years follow-up.

Table 3.

Hyperopia and risk of anisometropia

	Risk of anisometropia (≥1 D)			Risk of anisometropia (≥2 D)
	OR	95% CI	p-value^∗	OR	95% CI	p-value^∗
Hyperopia
≥1 D to <3 D	1.769	0.785-3.987	0.114	1.232	1.137-1.335	<0.001
≥3 D to <6 D	1.855	0.829-4.154	0.089	1.217	1.128-1.312	<0.001
≥6 D	0.741	0.240-2.286	0.407	1.024	0.978-1.072	0.467

D = diopter; OR = odds ratio; CI = confidential interval.

^∗ Chi-square test.

Table 4.

Hyperopia and risk of amblyopia

	Risk of unilateral amblyopia			Risk of bilateral amblyopia
	OR	95% CI	p-value^∗	OR	95% CI	p-value^∗
Hyperopia
≥1 D to <3 D	2.854	1.239-6.572	0.008	1.480	0.303-7.224	0.474
≥3 D to <6 D	2.992	1.186-7.548	0.011	2.511	0.550-11.467	0.179
≥6 D	1.356	0.418-4.393	0.416	14.796	3.173-68.999	<0.001

D = diopter; OR = odds ratio; CI = confidential interval.

^∗ Chi-square test.

Table 5.

Risk factors for childhood esotropia

Risk factors	Risk of esotropia
Risk factors	OR	95% CI	p-value
Hyperopia
≥1 D to <3 D	1.263	0.657-2.431	0.483^∗
≥3 D to <6 D	1.862	1.169-3.579	0.044^∗
≥6 D	1.067	0.469-2.428	0.877^∗
Anisometropia
≥1 D	1.090	0.609-1.964	0.699^∗
≥2 D	5.386	2.046-14.179	0.001^†
≥2 D with hyperopia (<3 D)	8.039	2.637-24.508	<0.001^∗
≥2 D with hyperopia (≥3 D)	3.231	1.276-8.182	0.009^∗
Age at initial visit
<2 years	5.578	3.208-9.669	<0.001^†

D = diopter; OR = odds ratio; CI = confidential interval.

^∗ Chi-square test;

^† Logistic regression analysis.

Table 6.

Comparison between surgery and non-surgery groups

	Non-surgery group (n = 132)	Surgery group (n = 69)	p-value^∗
Age at first visit (years)	3.49 ± 2.01	3.04 ± 2.69	0.191
Spherical equivalent (D)	3.75 ± 1.87	2.39 ± 1.63	<0.001
Anisometropia (D)	0.58 ± 0.66	0.59 ± 0.87	0.912
Anisometropia >1 D (n, %)	26/129 (20.16)	13/69 (18.84)	0.997
Unilateral amblyopia (n, %)	35/132 (26.52)	17/69 (24.64)	0.473
Bilateral ambylopia (n, %)	3/132 (2.27)	0/69 (0.0)	0.083
Glasses wearing (n, %)	114/129 (88.37)	50/69 (72.46)	0.014
Angle of deviation (PD)
Without correction	22.00 ± 12.44	31.15 ± 14.04	0.001
With correction	2.98 ± 5.10	24.77 ± 14.70	<0.001

Values are presented as mean ± SD unless otherwise indicated. D = diopter; PD = prism diopter.

^∗ Independent t-test.

Table 7.

Comparison of clinical characteristics in esotropic groups

	Acc (n = 102)	Partial Acc (n = 18)	Non-Acc (n = 48)	Infantile (n = 31)	p-value^∗
Age at first visit (years)	3.81 ± 2.29	3.78 ± 1.87	3.44 ± 2.24	1.32 ± 1.17	<0.001
Final BCVA	0.84 ± 0.19	0.88 ± 0.17	0.83 ± 0.20	0.83 ± 0.13	0.833
Initial SE (D)	4.09 ± 1.79	3.19 ± 1.57	2.26 ± 1.66	2.27 ± 1.54	<0.001
Final SE (D)	3.09 ± 1.90	2.04 ± 1.71	0.64 ± 1.31	1.27 ± 1.55	<0.001
Anisometropia (D)	0.59 ± 0.69	0.51 ± 0.66	0.72 ± 0.97	0.41 ± 0.41	0.321
Unilateral amblyopia (n, %)	36/102 (35.29)	8/18 (44.44)	5/48 (10.42)	6/31 (19.35)	0.003
Bilateral ambylopia (n, %)	3/102 (2.94)	0/18	0/48	0/31	0.413
Associated strabismus (n, %)	10/102 (9.80)	3/18 (16.67)	13/48 (27.08)	7/31 (22.58)	0.036
Angle of deviation
Without correction	21.70 ± 8.90	34.50 ± 13.03	26.80 ± 18.63	31.36 ± 9.24	0.013
With correction	1.63 ± 3.19	19.50 ± 9.97	24.00 ± 17.22	25.00 ± 0.00	<0.001
Surgery of ET (n, %)	10^†/102 (9.80)	11/18 (61.11)	23/48 (47.92)	25/31 (80.65)	<0.001
Success rate of surgery (n, %)	10/10 (100)	8/11 (72.73)	16/23 (69.57)	12/25 (48.0)	0.015

Values are presented as mean ± SD unless otherwise indicated. Acc = accommodative esotropia; BCVA = best-corrected visual acuity; SE = spherical equivalent; D = diopter; ET = esotropia.

^∗ One way analysis of variance (ANOVA);

^† Non-refractive accommodative esotropia.

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