Prevalence, Characteristics, and Risk Factors of Moderate or High Hyperopia among Multiethnic Children 6 to 72 Months of Age: A Pooled Analysis of Individual Participant Data

Abstract

Purpose: To describe the prevalence, ocular characteristics, and associated risk factors of moderate to high hyperopia in early childhood.

Design: Pooled analysis of individual participant data from population-based studies.

Participants: Six- to 72-month-old multiethnic children who participated in 4 population-based studies of pediatric eye diseases.

Methods: The pooled studies conducted comparable parental interviews and ocular examinations including cycloplegic autorefraction. Presence of hyperopia was defined based on cycloplegic refractive error in the worse eye. Multivariate analyses were performed to evaluate the association of potential risk factors with hyperopia risk.

Main outcome measures: Prevalence and odds ratios of moderate to high hyperopia (≥4.0 diopters [D]).

Results: Cycloplegic refraction was completed in 15 051 children 6 to 72 months of age. Among these children, the overall prevalence of moderate to high hyperopia (≥4.0 D) in the worse eye was 3.2% (95% confidence interval, 2.9%-3.5%), accounting for 15.6% of all hyperopia (≥2.0 D). Among children with moderate to high hyperopia, both eyes were affected in 64.4%, 28.9% showed spherical anisometropia of 1.0 D or more, and 19.5% showed astigmatism of 1.5 D or more. Among 36- to 72-month-old children with moderate to high hyperopia, 17.6% wore glasses. Prevalence of moderate to high hyperopia was slightly less in 12- to 23-month-old children and was relatively stable in children 24 months of age and older. Non-Hispanic and Hispanic white race and ethnicity, family history of strabismus, maternal smoking during pregnancy, and being a participant in the United States studies were associated with a higher risk of moderate to high hyperopia (P < 0.05).

Conclusions: By assembling similarly designed studies, our consortium provided robust estimates of the prevalence of moderate to high hyperopia in the general population and showed that in 6- to 72-month-old children, moderate to high hyperopia is not uncommon and its prevalence does not decrease with age. Risk factors for moderate to high hyperopia differ from those for low to moderate hyperopia (2.0-<4.0 D) in preschool children, with family history of strabismus and maternal smoking during pregnancy more strongly associated with moderate to high hyperopia than low to moderate hyperopia.

Figure 1.. Quantile Regression Plots (a-f) Demonstrating the Estimated Effect of Age Across the Distribution of Refractive Errors (D) in Children 6 to 72 Months of Age.

The effect estimates were generated from multivariable quantile regression adjusted for other risk factors. The x-axis represents the quantile level (e.g., 0.1 = 10th percentile) of refractive error, and the y-axis represents the difference in corresponding refractive error between age groups (refractive error for older age group minus refractive error for younger age group). The shaded area represents 95 percent confidence intervals.