title: Uncorrected Hyperopia and Preschool Early Literacy: Results of the Vision in Preschoolers-Hyperopia in Preschoolers (VIP-HIP) Study.
abstract: OBJECTIVE
  To compare early literacy of 4- and 5-year-old uncorrected hyperopic children with that of emmetropic children.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Children attending preschool or kindergarten who had not previously worn refractive correction.
  
  
  METHODS
  Cycloplegic refraction was used to identify hyperopia (≥3.0 to ≤6.0 diopters [D] in most hyperopic meridian of at least 1 eye, astigmatism ≤1.5 D, anisometropia ≤1.0 D) or emmetropia (hyperopia ≤1.0 D; astigmatism, anisometropia, and myopia <1.0 D). Threshold visual acuity (VA) and cover testing ruled out amblyopia or strabismus. Accommodative response, binocular near VA, and near stereoacuity were measured.
  
  
  METHODS
  Trained examiners administered the Test of Preschool Early Literacy (TOPEL), composed of Print Knowledge, Definitional Vocabulary, and Phonological Awareness subtests.
  
  
  RESULTS
  A total of 492 children (244 hyperopes and 248 emmetropes) participated (mean age, 58 months; mean ± standard deviation of the most hyperopic meridian, +3.78±0.81 D in hyperopes and +0.51±0.48 D in emmetropes). After adjustment for age, race/ethnicity, and parent/caregiver's education, the mean difference between hyperopes and emmetropes was -4.3 (P = 0.01) for TOPEL overall, -2.4 (P = 0.007) for Print Knowledge, -1.6 (P = 0.07) for Definitional Vocabulary, and -0.3 (P = 0.39) for Phonological Awareness. Greater deficits in TOPEL scores were observed in hyperopic children with ≥4.0 D than in emmetropes (-6.8, P = 0.01 for total score; -4.0, P = 0.003 for Print Knowledge). The largest deficits in TOPEL scores were observed in hyperopic children with binocular near VA of 20/40 or worse (-8.5, P = 0.002 for total score; -4.5, P = 0.001 for Print Knowledge; -3.1, P = 0.04 for Definitional Vocabulary) or near stereoacuity of 240 seconds of arc or worse (-8.6, P < 0.001 for total score; -5.3, P < 0.001 for Print Knowledge) compared with emmetropic children.
  
  
  CONCLUSIONS
  Uncorrected hyperopia ≥4.0 D or hyperopia ≥3.0 to ≤6.0 D associated with reduced binocular near VA (20/40 or worse) or reduced near stereoacuity (240 seconds of arc or worse) in 4- and 5-year-old children enrolled in preschool or kindergarten is associated with significantly worse performance on a test of early literacy.
authors.affiliation: The Ohio State University, College of Optometry, Columbus, Ohio. Electronic address: Kulp.6@osu.edu.
authors.forename: Marjean Taylor
authors.initials: MT
authors.lastname: Kulp
authors.affiliation: Pennsylvania College of Optometry at Salus University, Elkins Park, Pennsylvania.
authors.forename: Elise
authors.initials: E
authors.lastname: Ciner
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Maureen
authors.initials: M
authors.lastname: Maguire
authors.affiliation: New England College of Optometry, Boston, Massachusetts.
authors.forename: Bruce
authors.initials: B
authors.lastname: Moore
authors.affiliation: American Institutes for Research, Washington, DC.
authors.forename: Jill
authors.initials: J
authors.lastname: Pentimonti
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Pistilli
authors.affiliation: Northeastern State University College of Optometry, Tahlequah, Oklahoma.
authors.forename: Lynn
authors.initials: L
authors.lastname: Cyert
authors.affiliation: Indiana University School of Optometry, Bloomington, Indiana.
authors.forename: T Rowan
authors.initials: TR
authors.lastname: Candy
authors.affiliation: Division of Ophthalmology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Graham
authors.initials: G
authors.lastname: Quinn
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004521:Educational Measurement / Q000379:methods; D004522:Educational Status; D058453:Emmetropia / Q000502:physiology; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D000067010:Literacy / Q000592:standards*; D008297:Male; D012029:Refraction, Ocular / Q000502:physiology; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology
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