Long-term Changes in the Spherical Equivalent and Axial Length in Bilateral High-hyperopia Children

Sue Hey Chae; Sun A Kim

doi:10.3341/jkos.2018.59.4.369

Journal List > J Korean Ophthalmol Soc > v.59(4) > 1010888

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Chae and Kim: Long-term Changes in the Spherical Equivalent and Axial Length in Bilateral High-hyperopia Children

Original Article

J Korean Ophthalmol Soc 2018;59(4):369-375.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.369

Long-term Changes in the Spherical Equivalent and Axial Length in Bilateral High-hyperopia Children

Sue Hey Chae, MD, Sun A Kim, MD

Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Sun A Kim, MD Sungmo Eye Hospital, #409 Haeun-daero, Haeundae-gu, Busan 48064, Korea Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: sunei2@naver.com

Received 23 November 2017 Revised 4 January 2018 Accepted 2 April 2018

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 explore changes in the spherical equivalent refractive error and axial length of both eyes of children with high hyperopia over time.

Methods

Children with bilateral hyperopia ≥ 4.0 diopters (D) underwent visual acuity testing and comprehensive ophthalmic examinations. The mean age at the first visit was 6.5 years and spherical equivalent refractive error and axial length were measured at least three times over the following year. Axial length was measured using an intraocular lens Master instrument (Carl Zeiss Meditec, Jena, Germany).

Results

The mean annual increase in axial length was +0.21 mm and the mean annual reduction in spherical equivalent refractive error was −0.39 D. Between the ages of 3 and 5 years, the mean annual increase in axial length was +0.36 ± 0.26 mm. In patients aged ≥ 9 years old, the mean annual increase was 0.12 ± 0.09 mm (p = 0.00). The mean annual reduction in spherical equivalent refractive error was −0.53 ± 1.00 D between the ages of 3 and 5 years, but became −0.32 ± 0.54 D at age ≥ 9 years old. This difference was not significant (p = 0.11).

Conclusions

In children with bilateral hyperopia, the spherical equivalent refractive error decreased and the axial length increased with age. The rate of axial length growth was higher in younger children.

Keywords: Ambylopia, Axial length growth rate, Hyperopia, Intraocular lens (IOL) Master, Refractive error

REFERENCES

1). Goldschmidt E. Refraction in the newborn. Acta Ophtahlmol (Copenh). 1969; 47:570–8.

2). Edelman PM, Borchert MS. Visual outcome in high hypermetropia. J AAPOS. 1997; 1:147–50.

3). Ingram RM, Barr A. Changes in refraction between the ages of 1 and 3 1/2 years. Br J Ophthalmol. 1979; 63:339–42.

4). Raab EL. Hypermetropia in accommodative esodeviation. J Pediatr Ophthalmol Strabismus. 1984; 21:P64–8.

5). Lambert SR, Lynn MJ. Longitudinal changes in the spherical equivalent refractive error of children with accommodative esotropia. Br J Ophthalmol. 2006; 90:357–61.

6). Grisham JD, Simons HD. Refractive error and the reading process: a literature analysis. J Am Optom Assoc. 1986; 57:44–55.

7). Sorsby A, Leary GA, Richards MJ. Correlation ametropia and component ametropia. Vision Res. 1962; 2:309–13.

8). Saunders KJ, Woodhouse JM, Westall CA. Emmetropization in human infancy: rate of change is related to initial refractive error. Vision Res. 1995; 35:1325–8.

9). Gwiazda J, Thorn F, Bauer J, Held R. Emmetropization and the progression of manifest refraction in children followed from infancy to puberty. Clin Vision Sci. 1993; 8:337–44.

10). Koretz JF1, Rogot A, Kaufman PL. Physiological strategies for emmetropia. Trans Am Ophthalmol Soc. 1995; 93:105–18. discussion 118-22.

11). Flitcroft DI. Emmetropisation and the aetiology of refractive errors. Eye (Lond). 2014; 28:169–79.

12). Atkinson J, Braddick OJ, Durden K, et al. Screening for refractive errors in 6-9 month old infants by photorefraction. Br J Ophthalmol. 1984; 68:105–12.

13). Atkinson J, Braddick O, Robier B, et al. Two infant vision screening programs: prediction and prevention of strabismus and amblyopia from photo- and videorefractive screening. Eye (Lond). 1996; 10(Pt 2):189–98.

14). Klimek DL, Cruz OA, Scott WE, Davitt BV. Isoametropic amblyopia due to high hyperopia in children. J AAPOS. 2004; 8:310–3.

15). Chen W, Chen J, Zhang F, et al. Visual outcome in isoametropic amblyopic children with high hyperopia and the effect of therapy on retinal thickness. Am J Ophthalmol. 2013; 155:536–43.e1.

16). Na SJ, Choi NY, Park MR, Park SC. Long-term follow-up results of hyperopic refractive change. J Korean Ophthalmol Soc. 2005; 46:1704–10.

17). Lim HT, Cho SI, Lee SJ, Park SH. Long-term observations on the emmetropization of the high hyperopia. J Korean Ophthalmol Soc. 2002; 43:1230–7.

18). Noh JH, Kim SY. Comparison of clinical features in hypermetropic children according to refractive error. J Korean Ophthalmol Soc. 2015; 56:1416–23.

19). Paik HJ, Kang KH. The Refractive Errors and axial length in amblyopia. J Korean Ophthalmol Soc. 2002; 43:1040–5.

20). Atkinson J, Anker S, Bobier W, et al. Normal emmetropization in infants with spectacle correction for hyperopia. Invest Ophthalmol Vis Sci. 2000; 41:3726–31.

21). Yang HK, Choi JY, Kim DH, Hwang JM. Changes in refractive errors related to spectacle correction of hyperopia. PLoS One. 2014; 9:e110663. DOI: 10.1371/journal.pone.0110663. eCollection 2014.

Figure 1.

Number of axial length measurements participated longer than 2 years. Range from 3 to 9, there were 2 eyes measured 9 times of axial length.

Table 1.

The mean SE and AL changes during the period under observation

	1st visit	Last visit	Annual change	p-value*
SE (D)	+6.69 ± 2.5	+5.09 ± 3.0	−0.39 ± 0.28	<0.05
AL (mm)	+20.75 ± 1.36	+21.65 ± 1.74	+0.21 ± 0.15	<0.05
Age (years)	6.56 ± 1.55	10.97 ± 2.45

Values are presented as mean ± SD unless otherwise indicated.

SE = spherical equivalent; AL = axial length.

^* Student t-test. p-value < 0.05 was set as statistical significance.

Table 2.

Changes in keratometric values

	1st visit	Last visit	Annual change (D/year)	p-value*
K (D)	+42.83 ± 2.24	+42.79 ± 1.98	−0.04 ± 0.75	0.7

K = keratometry.

^* Student t-test.

Table 3.

The annual hyperopic change rates during follow up period after initial refraction according to the severity of hyperopia

	Number of eyes	Initial degree of hyperopia (D)	Annual change (D/year)
Group 1 (+4 ≤ and < +6D)	16	+5.60 ± 0.14	−0.43 ± 0.34
Group 2 (+6 ≤ and < +8D)	28	+7.11 ± 0.76	−0.31 ± 0.32
Group 3 (+8D ≤)	16	+ 11.04 ± 2.43	−0.43 ± 0.48
p-value*		0.00	0.279

Values are presented as mean ± SD unless otherwise indicated.

^* One way analysis of variance (ANOVA).

Table 4.

The annual axial length change rates during follow up period after initial measurement according to the severity of hyperopia

	Number of eyes	Initial measurement of axial length (mm)	Annual change (mm/year)
Group 1 (+4 < and < +6D)	17	+21.34 ± 0.65	+0.26 ± 0.12
Group 2 (+6 < and <+8D)	31	+21.18 ± 0.76	+0.18 ± 0.07
Group 3 (+8D <)	16	+19.48 ± 1.9	+0.24 ± 0.25
p-value*		0.00	0.11

Values are presented as mean ± SD unless otherwise indicated.

^* One way analysis of variance (ANOVA).

Table 5.

Comparison of SE and AL changes in different age interval

Age (years)	3~5 (n = 4)	5~7 (n = 24)	7~9 (n = 30)	9~ (n = 34)	p-value*
SE (D/year) annual change	−0.53 ± 1.00	−0.41 ± 0.57	−0.44 ± 0.47	−0.32 ± 0.54	0.11
AL (mm/year) annual change	+0.36 ± 0.26	+0.27± 0.17	+0.23 ± 0.18	+0.12 ± 0.09	0.00

Values are presented as mean ± SD unless otherwise indicated.

SE = spherical equivalent; AL = axial length.

^* Jonckheere-Terpstra test.

Table 6.

Comparison of SE in amblyopic eye and non-amblyopic eye

	Number of eyes	Initial degree of hyperopia (D)	Annual change (D/year)
Amblyopic eye	27	+7.71 ± 2.31	−0.08 ± 0.06
Non-Amblyopic eye	33	+5.85 ± 2.37	−0.35 ± 0.18
p-value		0.00	0.572

Values are presented as mean ± SD unless otherwise indicated.

SE = spherical equivalent.

^* Student t-test.

Table 7.

Comparison of AL in amblyopic eye and non-amblyopic eye

	Number of eyes	Initial degree of axial length (mm)	Annual change (mm/year)
Amblyopic eye	27	+20.54 ± 1.32	+0.22 ± 0.20
Non-Amblyopic eye	33	+20.93 ± 1.39	+0.19 ± 0.10
p-value*		0.000	0.801

Values are presented as mean ± SD unless otherwise indicated.

AL = axial length.

^* Student t-test.

Table 8.

Comparison of SE in eyes with undercorrection and full correction

	Number of eyes	Initial degree of hyperopia (D)	Estimates of annual change (D/year)
Undercorrection	28	+6.82 ± 2.13	−0.31 ± 0.27
Full correction	32	+6.58 ± 2.91	−0.40 ± 0.35
p-value*		0.224	0.744

Values are presented as mean ± SD unless otherwise indicated.

SE = spherical equivalent.

^* Student t-test.

Table 9.

Comparison of AL in eyes with undercorrection and full correction

	Number of eyes	Initial degree of Axial length (mm)	Estimates of annual change (mm/year)
Undercorrection	28	+20.49 ± 1.33	+0.17 ± 0.09
Full correction	32	+20.97 ± 1.41	+0.19 ± 0.49
p-value*		0.003	0.134

Values are presented as mean ± SD unless otherwise indicated.

AL = axial length.

^* Student t-test.

TOOLS

Similar articles