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Randomized Controlled Trial
. 2025 May 1;102(5):310-319.
doi: 10.1097/OPX.0000000000002254. Epub 2025 Apr 10.

Emmetropization in highly hyperopic infants: A randomized clinical trial of partial refractive correction

Ann M Morrison  1 , Matthew L Robich, Lisa A Jordan, Loraine T Sinnott, Donald O Mutti
Affiliations
Randomized Controlled Trial

Emmetropization in highly hyperopic infants: A randomized clinical trial of partial refractive correction

Ann M Morrison et al. Optom Vis Sci. .

Abstract

Significance: Highly hyperopic infants are at greater risk for not undergoing emmetropization and later developing conditions such as strabismus, amblyopia, and early literacy and reading problems. An early intervention consisting of partial hyperopic correction and encouragement of accommodation may influence the rate of emmetropization in these high-risk infants.

Purpose: This study aimed to determine if moderate spectacle partial correction (3.00 D cut from cycloplegic) and visual exercises to promote accommodation enhance emmetropization (reaching ≤+3.00 D) in highly hyperopic (≥+5.00 D to ≤+7.00 D) 3-month-old infants compared with no treatment (observation).

Methods: Thirty-five highly hyperopic 3-month-old infants (57% female) were randomized to observation or treatment ( clinicaltrials.gov ; NCT03669146). Primary analysis compared the mean hyperopia at 18 months of age in treated versus untreated participants. Data were also modeled using proportional hazards survival analysis (time to reach ≤+3.00 D).

Results: There was no significant difference in refractive error at 18 months of age between infants in the treated (+1.6 ± 0.6 D) and observation groups (+1.2 ± 0.7 D; p = 0.23) but treatment affected the rate of emmetropization depending on baseline hyperopia (p = 0.01). At 12 months of age, treated infants had similar refractive errors regardless of baseline hyperopia but untreated infants at 12 months underwent faster emmetropization if their baseline hyperopia was <+5.50 D and slower emmetropization if it was >+5.50 D.

Conclusions: Partial hyperopic refractive correction with accommodative exercises in highly hyperopic infants did not affect average refractive error at 18 months. However, treatment affected the rate of emmetropization and how long it took to reach ≤+3.00 D. Treatment slowed the rate of emmetropization at lower levels of initial hyperopia but may enhance emmetropization at higher levels.

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Conflict of interest statement

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

References

    1. Mayer DL, Hansen RM, Moore BD, et al. Cycloplegic refractions in healthy children aged 1 through 48 months. Arch Ophthalmol 2001;119:1625–1628.
    1. Mutti DO, Mitchell GL, Jones LA, et al. Axial growth and changes in lenticular and corneal power during emmetropization in infants. Invest Ophthalmol Vis Sci 2005;46:3074–3080.
    1. Mutti DO, Sinnott LT, Lynn Mitchell G, et al. Ocular component development during infancy and early childhood. Optom Vis Sci 2018;95:976–985.
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    1. Luyckx J. Measurement of the optical components of the newborn eye by ultrasonic ultrasound. Arch Ophthalmol (Paris) 1966;26:159–170.

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