Associations between anisometropia, amblyopia, and reduced stereoacuity in a school-aged population with a high prevalence of astigmatism

Abstract

Purpose: To describe the relation between magnitude of anisometropia and interocular acuity difference (IAD), stereoacuity (SA), and the presence of amblyopia in school-aged members of a Native American tribe with a high prevalence of astigmatism.

Methods: Refractive error (cycloplegic autorefraction confirmed by retinoscopy), best corrected monocular visual acuity (VA; Early Treatment Diabetic Retinopathy Study logMAR charts), and best corrected SA (Randot Preschool Stereoacuity Test) were measured in 4- to 13-year-old Tohono O'odham children (N = 972). Anisometropia was calculated in clinical notation (spherical equivalent and cylinder) and in two forms of vector notation that take into account interocular differences in both axis and cylinder magnitude.

Results: Astigmatism >or= 1.00 D was present in one or both eyes of 415 children (42.7%). Significant increases in IAD and presence of amblyopia (IAD >or= 2 logMAR lines) occurred, with >or=1 D of hyperopic anisometropia and >or=2 to 3 D of cylinder anisometropia. Significant decreases in SA occurred with >or=0.5 D of hyperopic, myopic, or cylinder anisometropia. Results for vector notation depended on the analysis used, but also showed disruption of SA at lower values of anisometropia than were associated with increases in IAD and presence of amblyopia.

Conclusions: Best corrected IAD and presence of amblyopia are related to amount and type of refractive error difference (hyperopic, myopic, or cylindrical) between eyes. Disruption of best corrected random dot SA occurs with smaller interocular differences than those producing an increase in IAD, suggesting that the development of SA is particularly dependent on similarity of the refractive error between eyes.

FIGURE 1

Mean IAD in the children with SHA (A), SMA (B), and CA (C), compared with mean IAD in children in the ISO group. The children in the ISO group had anisometropia <0.25 D SE and <0.25 D cylinder; children in the SHA and SMA groups had cylinder anisometropia <1.00 D, and children in the CA group had SE anisometropia <1.00 D. *Mean IAD in the subgroup was significantly different from that in the ISO group. Bars, 1 SEM.

FIGURE 2

Vector notation results for IAD. (A) Mean IAD in children with various amounts of difference between eyes in refractive error along the horizontal/vertical (J0) and/or the oblique (J45) meridians. (B) Mean IAD in children with various amounts of VDD,, between eyes. *The mean IAD in the subgroup was significantly different from that in the group with minimal difference between eyes (difference <0.25 D M and <0.125 D for J0 and J45; difference <0.35 VDD). Bars, 1 SEM.

FIGURE 3

The percentage of children with amblyopia (≥2 logMAR line difference in best corrected acuity between eyes) in the SHA (A), SMA (B), and CA (C) groups, compared with that in the ISO group. *The prevalence of amblyopia in the subgroup was significantly different from that in the ISO group.

FIGURE 4

Vector notation results for amblyopia. (A) The percentage of children with amblyopia by amount of difference between eyes in refractive error along the horizontal/vertical (J0) and/or the oblique (J45) meridians. (B) The percentage of children with amblyopia by amount of VDD,, between eyes. *The prevalence of amblyopia in the subgroup was significantly different from that in the group with minimal (<0.35 VDD) difference between eyes.

FIGURE 5

Mean SA in SHA (A), SMA (B), and CA (C) groups, compared with that in the ISO group. *The mean SA in the subgroup was significantly different from that in the ISO group. Bars, 1 SEM.

FIGURE 6

Vector notation results for SA. (A) The mean SA in the children with various amounts of difference between eyes in refractive error along the horizontal/vertical (J0) and/or the oblique (J45) meridians. (B) The mean SA in the children with various amounts of VDD,, between eyes. *The mean SA in the subgroup was significantly different from that in the group with minimal difference between eyes (difference <0.25 D SE and <0.125 D for J0 and J45, respectively; difference <0.35 VDD for VDD). Bars, 1 SEM.