title: Longitudinal follow-up of hypermetropic children identified during preschool vision screening.
abstract: OBJECTIVE
  Early childhood hypermetropia is an important risk factor for the development of amblyopia and esotropia. Understanding the natural history of these complications aids in management decisions.
  
  
  METHODS
  A retrospective observational review was undertaken of 149 patients referred from a preschool photoscreening program who were determined to have hypermetropia of >or=+3.75 D spherical equivalent on criterion standard examination and were treated/followed by one group of academic pediatric ophthalmologists. The prevalence and incidence of accommodative esotropia and amblyopia were determined.
  
  
  RESULTS
  At presentation 19% of hypermetropic children had amblyopia, 32% had esotropia, and 13% had both. Follow-up data of 108 patients during a mean of 40 months showed that 20 (24%) of 83 initially nonamblyopic patients developed amblyopia and that 22 (33%) of 67 initially nonstrabismic patients developed accommodative esotropia. Of patients initially managed with observation, 38% (6 of 16) developed amblyopia, and 31% (5 of 16) developed accommodative esotropia as compared with 21% (14 of 67) and 33% (17 of 51), respectively, for those given full or partial refractive correction. For patients without amblyopia or strabismus at presentation, only 20% developed amblyopia and 35% esotropia. Strabismic patients responded well to treatment, with no cases developing partially accommodative strabismus requiring surgery during follow-up.
  
  
  CONCLUSIONS
  In this case series we found a high prevalence of amblyopia and strabismus. The results support the importance of early preschool vision screening and spectacle correction of moderate to high hypermetropia (>+3.50 D) to reduce the risk of amblyopia, although more research is needed.
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Colburn
authors.forename: David G
authors.initials: DG
authors.lastname: Morrison
authors.forename: Robert L
authors.initials: RL
authors.lastname: Estes
authors.forename: Chun
authors.initials: C
authors.lastname: Li
authors.forename: Pengcheng
authors.initials: P
authors.lastname: Lu
authors.forename: Sean P
authors.initials: SP
authors.lastname: Donahue
mesh_terms: D000550:Amblyopia / Q000453:epidemiology*; D015858:Anisometropia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000453:epidemiology*; D005139:Eyeglasses / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013285:Strabismus / Q000453:epidemiology; D015351:Vision Screening