Emmetropization, visual acuity, and strabismus outcomes among hyperopic infants followed with partial hyperopic corrections given in accordance with dynamic retinoscopy.

Object: To record emmetropization, visual acuity, and strabismus outcomes among hyperopic infants followed with partial hyperopic corrections given in accordance with dynamic retinoscopy (DR).

Methods: Infants (3.5-12 months of age) with ≥5 D hyperopia were followed without glasses or partial hyperopic corrections prescribed according to their near dynamic accommodative abilities determined by DR responses at the initial visit and follow-ups. Refraction and binocular accommodative ability assessments were made at 3-month intervals up to the age of 1 and at 6-month intervals afterwards for a mean 35.4±2.1 months; main outcome measures being the development of esotropia, emmetropization rate, and visual acuity level after emmetropization period.

Results: Among 211, 146 were normal accommodators initially (Group 1). These infants were followed without treatment and none presented with strabismus. Sixty-five infants were hypo-accommodators (Group 2) and received minimum DR-based corrections. Of the 65 infants 31 (48%) developed strabismus (Group 2B). The remaining 34 constituted Group 2A. Each of the three groups showed an overall reduction of hyperopia by 0.37±0.25 days per year, 0.50±0.28 days per year, and 0.60±0.20 days per year, respectively. Visual acuity assessments among Groups 1 and 2A revealed normal values (0.2-0.0 LogMAR); among Group 2B 19% were within normal range.

Conclusions: Binocular accommodative behavior at the initial visit seems to be one of the indicators for pointing out infants at risk of developing strabismus and amblyopia. Prescription of DR-based corrections to hyperopic orthotropic infants does not impede emmetropization and result in normal visual acuities after emmetropization period.