[Analysis of eyeball development in children between the fourth month and seventh year of life with regard to eyeball length, refraction value and fundus].

An ophthalmologic screening of three-month-old infants was conducted between 1990 and 1993 in the province of Szczecin. The screening was aimed at early detection and treatment of vision defects and diseases of the eye. Attention was also focused on the appearance of the eyeballs. Approximately 50% of children had a retina of more or less "reduced density". The fundus appeared much like in the case of near-sightedness, raising the question whether such eye would continue towards myopia or would this just be a morphological trait of immature retina which will disappear with growth and development of the eyeball. The children were selected among those reporting for ophthalmologic screening and were divided into four groups: I--children with retina of "reduced density" and near-sightedness in the family (at least one parent had myopia), 45 children--90 eyes; II--children with retina of reduced density, whose parents did not have myopia, 45 children--90 eyes; III--children without changes in the fundus and with near-sightedness in the family, 30 children--60 eyes; IV--children without changes in the fundus, whose parents did not have myopia, 30 children--60 eyes. An additional group consisted of children without family history of near-sightedness, in whom myopia was -5.0 D sph or more during skiascopy with cycloplegia when the child finished six months of life (10 children--20 eyes). The following was examined in all children after three months of life: pupillary reflexes, fixation, anterior segment of eyeball, eyeball length, fundus, intraocular pressure, and refraction. The examination was repeated when the children finished three years, and six years ten months of life. Skiascopy was performed with prior cycloplegia. Statistics were done using Mann-Whitney test for unpaired and Wilcoxon's test for paired results. The following conclusions were made: 1. Length of the eyeball was not related to the appearance of fundus or family history of myopia (Tab. 1). Growth of the eyeball could be divided into two periods. The first was fast, lasting until the end of the third year of life. The second was slow and by the end of the seventh year, growth was almost complete. In children with inborn near-sightedness, the eyeballs were already longer in the fourth month of life. 2. Average size of refraction after cycloplegia in six-month-old infants does not depend on the appearance of eye fundus or family history of near-sightedness. Between six months and three years of life, a limited increase in refraction took place, whereas between the fourth and seventh year of life a decrease was observed. This decrease was significantly greater in children with a family history of near-sightedness. In children with inborn near-sightedness, there was no increase in refraction and decrease proceeded at a faster pace. In six-month-old infants, reversed astigmatism predominated, but between the seventh month and fourth year of life it declined and between the fourth and seventh year its axis changed (Tab. 3 and 4). 3. "Reduced density" found in three-month-old infants is a morphological trait of the retina and does not predispose to near-sightedness. It occurs more often in children with blue or light gray color of the iris, i.e. with little pigment in the stroma (Tab. 6). In most cases, "reduced density" disappeared before the end of the third year of life (Tab. 5). In children with inborn near-sightedness it was not possible to assess on the grounds of the eye speculum whether the observed reduced density was caused by lack of pigment in the pigmented layer of the eyeball or by near-sightedness, or both.