Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania, USA.
The Ohio State University College of Optometry, Columbus, Ohio, USA.
Ophthalmic Physiol Opt. 2021 May;41(3):553-564. doi: 10.1111/opo.12810. Epub 2021 Mar 27.
To evaluate associations between visual function and the level of uncorrected hyperopia in 4- and 5-year-old children without strabismus or amblyopia.
Children with spherical equivalent (SE) cycloplegic refractive error of -0.75 to +6.00 on eligibility testing for the Vision in Preschoolers-Hyperopia in Preschoolers (VIP-HIP) study were included. Children were grouped as emmetropic (<1D SE myopia or hyperopia), low hyperopic (+1 to <+3D SE) or moderate hyperopic (+3 to +6D SE). Children with anisometropia or astigmatism (≥1D), amblyopia or strabismus were excluded. Visual functions assessed were monocular distance visual acuity (VA) and binocular near VA with crowded HOTV charts, accommodative lag using the Monocular Estimation Method and near stereoacuity by 'Preschool Assessment of Stereopsis with a Smile'. Visual functions were compared as continuous measures among refractive error groups.
554 children (mean age 58 months) were included in the analysis. Mean SE (SD) {N} for emmetropia, low and moderate hyperopia were +0.52D (0.49) {N = 270}, +2.18D (0.57) {N = 171} and +3.95D (0.78) {N = 113}, respectively. There was a consistent trend of poorer visual function with increasing hyperopia (p < 0.001). Although all children had age-normal distance VA, logMAR (Snellen) VA of 0.00 (6/6) or better was achieved (distance, near) among more emmetropic (52%, 26%) and low hyperopic (47%, 15%) children than moderate hyperopes (25%, 9%). Mean (SD) distance logMAR VA declined from emmetropic 0.05 (0.10), to low hyperopic 0.06 (0.10) to moderately hyperopic children 0.12 (0.11) (p < 0.001); A mild progressive decrease in near VA also was observed from the emmetropic 0.13 (0.11) to low hyperopic 0.15 (0.10) to moderate hyperopic 0.19 (0.11) groups, (p < 0.001). Accommodative responses showed an increased lag with increasing hyperopia (ρ = 0.50, p < 0.001). Median near stereoacuity for emmetropes, low and moderate hyperopes was 40, 60 and 120 sec arc, respectively. The percentage of these groups with no reduced near visual functions was 83%, 61%, and 34%, respectively.
Decreasing visual function was associated with increasing hyperopia in 4- and 5-year-olds without strabismus or amblyopia. As hyperopia with reduced visual function has been associated with early literacy deficits, near visual function should be evaluated in these children.
评估 4 至 5 岁无斜视或弱视儿童的未矫正远视程度与视觉功能之间的关系。
入选在学龄前儿童远视研究（VIP-HIP）中进行资格测试时，等效球镜（SE）散瞳屈光不正为-0.75 至+6.00 的儿童。儿童被分为正视眼（<1D 近视或远视）、低度远视（+1 至<+3D SE）或中度远视（+3 至+6D SE）。排除屈光不正或散光（≥1D）、弱视或斜视的儿童。评估的视觉功能包括单眼远距离视力（VA）和双眼近距离拥挤 HOTV 图表的 VA、使用单眼估计法评估调节滞后和使用“微笑的学龄前立体视评估”评估近立体视锐度。在屈光不正组之间，将视觉功能作为连续测量值进行比较。
共纳入 554 名儿童（平均年龄 58 个月）进行分析。正视眼、低度远视和中度远视的 SE（SD）{N}分别为+0.52D（0.49）{N=270}、+2.18D（0.57）{N=171}和+3.95D（0.78）{N=113}。随着远视程度的增加，视觉功能呈持续下降趋势（p<0.001）。尽管所有儿童的远距视力均正常，但正视眼（52%，26%）和低度远视眼（47%，15%）的儿童获得更好的视力（距离、近距），logMAR（Snellen）视力为 0.00（6/6）或更好，而中度远视眼（25%，9%）则较差。平均（SD）远距 logMAR VA 从正视眼 0.05（0.10）下降到低度远视眼 0.06（0.10），再到中度远视眼 0.12（0.11）（p<0.001）；近距 VA 也观察到轻度进行性下降，从正视眼的 0.13（0.11）到低度远视眼的 0.15（0.10），再到中度远视眼的 0.19（0.11）（p<0.001）。调节反应随远视程度的增加而表现出滞后增加（ρ=0.50，p<0.001）。正视眼、低度远视眼和中度远视眼的近距立体视锐度中位数分别为 40、60 和 120 秒弧。这些组中近距视觉功能正常的比例分别为 83%、61%和 34%。
4 至 5 岁无斜视或弱视儿童的视觉功能随远视程度的增加而下降。由于伴有视觉功能降低的远视与早期读写能力缺陷有关，因此应在这些儿童中评估近距视觉功能。
