The Epidemiology of Early Childhood Hyperopia

Hyperopia is present in a small proportion of children aged between 6 and 12 months, with ethnicity likely affecting prevalence, and higher prevalences in certain subgroups, especially those with a family history of hyperopia or accommodative esotropia. Around a fifth of children who are hyperopic in infancy go on to develop strabismus, while an unknown proportion develop bilateral ametropic amblyopia; persistent hyperopia appears to be a harbinger of future pathology. Early prophylactic spectacle correction of hyperopia has failed to prevent strabismus in three of four studies, but showed reduced incidence of strabismus in one study, and yielded improved visual acuity outcomes in two studies by one investigator. Currently our ability to detect or measure refractive error with automated instruments easily adaptable to a screening setting has outpaced our knowledge of how best to identify the subset of hyperopes who are really at risk, and how to manage isolated early hyperopia once it has been identified.