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Atkinson has shown that early correction of hypermetropia reduces the incidence of esotropia. If esotropia is reduced by prescribing glasses early, the rate of esotropia-induced amblyopia can be similarly reduced; this would have important economic consequences. We have studied (1) how costs compare to benefits in early visual screening, (2) how videorefraction as used by Atkinson compares to retinoscopy, and (3) whether esotropia is more likely to occur in children who have increasing as opposed to decreasing hypermetropia. The costs of the study so far have been high. It was exceedingly difficult to get all infants invited, come to the clinic and examined. Videorefraction did not compare favourably with retinoscopy in terms of costs and precision, whereas the amount of skill and time needed was approximately equal. The third question, whether esotropia is more likely to occur in children who have increasing as opposed to decreasing hypermetropia, arose from the controversy whether, in the general population, refraction increases or decreases during the first years of life. We found that papers reporting a decrease of hypermetropia in early childhood were studies of large cross-sections of the general population, whereas papers that reported an initial increase originated from ophthalmological practices or strabismus departments. These conflicting results could be reconciled by assuming a population bias: if esotropia is more likely to occur in children with increasing hypermetropia, children with increasing hypermetropia will preferentially be seen by ophthalmologists. It seems natural that children with increasing hypermetropia are more likely to squint, because additional accommodation, needed to overcome increasing hypermetropia, will inevitably confer additional convergence. This relationship has meanwhile been confirmed by others.
Four siblings in a family of five were found to be affected with hypermetropia in differing degrees and with differing effects. These were unilateral hypermetropia, producing amblyopia; hypermetropia inducing an accommodative esotropia with minimal amblyopia and fully controlled with glasses; hypermetropia producing an accommodative esotropia with a high AC/A ratio, fully controlled with bifocals; and hypermetropia producing esotropia which was only partially corrected with glasses, therefore partially accommodative, with a residual squint which required surgery. This family of four nicely demonstrates all the permutations and combinations possible in accommodative-type esotropia and the pitfalls therein.
The need and accuracy of a hypermetropia test, recommended as a screening test in Swedish schools, was evaluated in a series of 118 8-year-old children not wearing glasses. The distant visual acuity was determined without correction and with plus spheres of two different strengths, +1.5 D and +2.0 D respectively. When compared to the objective refraction and with an arbitrary limit of hypermetropia of +2.5 diopters, it could be shown that neither of the hypermetropia tests fulfilled the criteria of an adequate screening test. Except for two children all hypermetropics beyond +3.0 were previously known. The reading skills of the children were estimated by their teachers. No correlation was found between the degree of hypermetropia and reading difficulties. The results indicate that the hypermetropia test could be omitted from the regular vision tests of schoolchildren, at least in areas covered with an efficient pre-school vision screening.
Two hundred and thirty-one patients, aged 6 to 18, with hypermetropia were examined. They were shared between two groups with respect to an accommodation state: group 1--patients with weak accommodation, group 2--patients with normal accommodation. The below ocular parameters were registered for groups 1 and 2, respectively: axial size--22.35 mm and 21.58 mm, corneal diameter--11.48 mm and 10.74 mm, scleral ring diameter in the projection of the scleral central portion--14.66 mm and 13.98 mm, ocular refracting power--59.79 d and 62.23 d, corneal refraction--41.85 d and 42.82 d, and lens refraction--22.05 d and 24.03 d. New clinical signs were specified for uncomplicated type of congenital hypermetropia. The parameters of patients with normal-accommodation hypermetropia are typical of axial hypermetropia in adults due to growth inhibition, while the parameters of patients with weakened accommodation are typical of optical hypermetropia as a variation of normal eye development.
Hypermetropia, like myopia, is a defect of axial refraction, most often due to reduction of the anteroposterior diameter of the eyeball. Hypermetropia is normal in the young child and usually diminishes with age. Moderate hypermetropia is generally well tolerated in young subjects. When severe or associated with functional changes, hypermetropia should be corrected by prescription lenses. Contrary to myopia, definitive treatment by surgery is not yet current practice in hypermetropia.
PURPOSE: An association between hypermetropia and hypertension was recently reported. We sought to verify this finding in the Blue Mountains Eye Study cohort (n = 3654; ages 49 to 97 years). DESIGN: Cohort study. METHODS: We defined hypermetropia as mean spheric equivalent refraction (SER) > 1.00 diopter, myopia as mean SER < -1.00 diopters, and emmetropia as mean SER < or = 1.00 diopters and > or = -1.00 diopters, inclusive. We used the 2003 World Health Organization/International Society of Hypertension guidelines to define severe hypertension as grade 2 or higher. RESULTS: Of 1290 people who were at risk of the development of hypertension, 378 people developed incident severe hypertension after five years. The multivariate-adjusted relative risk of incident hypertension in persons with hypermetropia compared with those with emmetropia was 1.06 (95% CI, 0.89 to 1.26); the relative risk in persons with myopia was 1.22 (95% CI, 0.96 to 1.56). CONCLUSION: Neither hypermetropia nor myopia was associated with incident hypertension in this older population.
BACKGROUND: Excimer laser treatment has been shown to be effective and safe in correcting anisometropia following penetrating keratoplasty (PKP). In this report we review our experience with excimer laser in situ keratomileusis (LASIK) to correct refractive myopia, hypermetropia and astigmatism in patients who had undergone PKP for keratoconus. METHODS: We reviewed the records of 22 patients (27 eyes) who had undergone LASIK to correct myopia, hypermetropia or astigmatism, in simple or combined forms, following corneal transplantation for keratoconus. LASIK was performed at a hospital in Curitiba, Brazil, between September 1998 and February 2000. The eyes were classified into two groups: those with a negative spherical equivalent and those with a positive spherical equivalent. LASIK was performed using the Moria LSK microkeratome and the Nidek EC-5000 excimer laser. RESULTS: The mean length of follow-up was 9.52 months for the 23 eyes with myopia and 5.75 months for the 4 eyes with hypermetropia. The mean refractive spherical equivalent in the myopic eyes was -5.27 (standard deviation [SD] 1.91) dioptres before LASIK and -0.45 D (SD 1.68 D) at the last follow-up visit. The corresponding values in the eyes with hypermetropia were +5.18 D (SD 1.46 D) and + 1.18 D (SD 0.94 D). The rate of regression of astigmatism in the myopic eyes was 76%. After surgery 18 (78%) of the myopic eyes and all the hypermetropic eyes had an uncorrected visual acuity of 20/40 or better. The best spectacle-corrected visual acuity was better than 20/25 in 22 (95.7%) of the myopic eyes and all the hypermetropic eyes. One eye lost 1 line of best spectacle-corrected Snellen visual acuity, and one eye lost 6 lines secondary to epithelial ingrowth. Wound dehiscence, intraoperative flap complications, graft rejection or other complications did not develop in this series. INTERPRETATION: In this series, LASIK proved to be relatively safe and effective in correcting refractive errors after PKP for keratoconus.
PURPOSE: To characterize the phenotype of two families with high hypermetropia from the Faroe Islands. METHODS: Ophthalmologic evaluation including ultrasound oculometry and anthropometric measurements. RESULTS: Of the 40 examined family members, 15 individuals (8 males, 7 females; ages: 6-77 years; mean: 36.5 years) had small deep-set eyes with high hypermetropia (median: + 16.5 D; range: + 7.75 to + 22), short axial eye length (< 21 mm), and a thickened eye wall. The median corrected visual acuity was 0.4 (0.2-0.9). Ocular complications included angle-closure glaucoma in six eyes, uveal effusion in three eyes, cataract in two eyes, and esotropia with amblyopia in three eyes. An emergency case of uveal effusion and retinal detachment after Yag iridotomy eventually responded to systemic corticosteroids and scleral resection surgery with a slow visual recovery. No associated ocular or systemic malformations were found in the series. In addition to the two examined families, six smaller Faroese families with high hypermetropia are briefly reported. CONCLUSIONS: The study highlights the signs and symptoms of a rare hereditary phenotype characterized by a short axial length mainly confined to the posterior segment of the eye, a shallow anterior chamber, and a thickened eye wall. The morphological characteristics predispose for sight-threatening complications such as angle-closure glaucoma, chorioretinal pathology including uveal effusion, and amblyopia. Regular ophthalmic follow-up is therefore of obvious importance in families known to have small eyes/high hypermetropia. An endemic high prevalence in the Faroe Islands suggests the presence of a founder effect, and further genetic research would probably indicate pseudodominant rather than dominant transmission
PURPOSE: To describe and analyze the oculometric features of small eyes with high hypermetropia in two Faroese families, with emphasis on refractive components. METHODS: Members of the two families (N=40; age, 1 to 77 years), including 15 cases of extreme hypermetropia (+7.5 to +19.25 D), had an ophthalmic evaluation including refractometry, keratometry, and axial ocular measurements using A-scan ultrasound. Eye-wall thickness was assessed using B-scan. Nonparametric statistics were used, mainly the Mann-Whitney U test. RESULTS: In the two families, there were six and nine probands, respectively, with hypermetropia more than +7 D and short eyes as defined by axial eye lengths <21 mm. The median corrected visual acuity was 0.4 (range, 0.2 to 0.9). Gross fundus abnormalities were not observed. All 15 had a short posterior segment with a thick eye wall and a relatively thick lens. Furthermore, steep and rather small corneas were present. In one of the families, 70% of the affected had a corneal curvature radius of < or =7.0 mm. Five probands from family 2 were labeled as possibly affected because of hypermetropia and borderline axial length findings (21 to 22 mm). The remaining 20 subjects had visual acuity and oculometric findings within physiologic limits. CONCLUSIONS: The axial measurement features in our series of highly hypermetropic eyes mainly presented as an extension downward from the hypermetropic bottom line of the normal distribution. The axial shortness of the eyes was primarily the result of a short posterior eye segment ("posterior microphthalmos"). A steep cornea was a feature in most small eyes in our series, particularly in one family branch.
A 32-year-old female with bilateral congenital stapes fixation accompanied by bilateral proximal symphalangism and bilateral hypermetropia is reported. This is the 19th case of congenital stapes fixation and symphalangism in Japan. Hypermetropia was speculated to be one of the cardinal symptoms of the disease based on the present case and cases previously reported. In this case hypermetropia was due to pure microphthalmos and this was the first report that revealed the cause of hypermetropia in the syndrome. Bilateral stapedotomy were carried out and her hearing loss was improved to the satisfactory level.
The valuation of 541 cases of convergent squint occuring together with a hypermetropia of more than +5 dpt showed that, the stronger the hypermetropia was, the higher was the proportion of primary microstrabismus to full-accommodative strabismus convergens. In patients who had hypermetropia of more than +8 D, the proportion of primary microstrabismus was 46%. Here the squint was always one-sided, so a high proportion of amblyopia could be expected. In 10% of the cases there was a spontaneous change from convergent to divergent squint - the angle reduction was up to 23 degrees, and could occur at any age. Factors, which seem to favour the appearence of a consecutive divergence, are: high hypermetropia of more than +8 D, increased ACA-ratio, onesided exclusion and vertical divergence. The measuring of the ACA ratio should be done at all orthoptic examinations.
Contradicting earlier doctrine, several studies have indicated that hypermetropia in childhood increases over the first seven years of life, and decreases thereafter. No clear consensus exists as to these characteristics in patients with accommodative esodeviation. In 68 subjects (136 eyes), the mean annual change in hypermetropia up to the seventh birthday was an increase of +0.19 +/- 0.36 D. Subjects whose accommodative deviation deteriorated showed changes similar in magnitude. The corresponding mean annual change in a previously reported age-matched series unselected for strabismus was +0.28 D. Hypermetropia in accommodative esodeviation showed a mean annual decrease between ages 7 and 13 years of -0.18 +/- 0.25 D. The corresponding finding in the general childhood population was -0.22 D. While clinically important individual departures from these results do occur, an accelerated rate of increase in hypermetropia is not characteristic of most cases of either controlled or of deteriorated accommodative esodeviation.
PURPOSE: To describe the first reported cases of uveal effusion syndrome following laser in situ keratomileusis (LASIK). DESIGN: Interventional case reports. METHODS: A 50-year-old woman developed bilateral submacular choroidal folds with subtle fluid elevation of the macula on the first day following uneventful LASIK for hypermetropia. A 48-year-old man developed right, prominent, 360-degree, peripheral choroidal effusions and submacular choroidal and retinal folds several months following LASIK for hypermetropia. RESULTS: Case 1 was treated with systemic diclofenac and case 2 with systemic prednisolone. Both cases showed gradual improvement in vision over several weeks, returning to best-corrected visual acuity of 6/6. CONCLUSIONS: Uveal effusion syndrome is a previously unreported complication that may occur following LASIK for hypermetropia.
PURPOSE: To explore the relationship between the refractive state of the eye and high blood pressure in a representative population. DESIGN: Case-control study. METHODS: Three hundred twenty-one patients with essential hypertension (mean age 53.9 +/- 15.5 years) and 188 age-matched and sex-matched healthy control subjects (mean age 50.9 +/- 7.3 years) from the same regional Health Maintenance Organization were consecutively included for the study (P > .05 for age and sex). The refractive state of the eyes was identified objectively by an autorefractometer and retinoscopic examination, recording the autorefractometer values. Spherical equivalents between -0.50 (included) and +0.50 (included) diopters were regarded as emmetropia. Values below or above this interval were regarded as either myopia or hypermetropia. Mean spherical equivalents of the groups were compared using independent samples t test; distributions of refraction were compared with chi(2) test. RESULTS: The mean spherical equivalent of the patients with essential hypertension was +0.88 +/- 1.34 diopters (range -3.75 to +6.38 diopters), whereas the mean spherical equivalent of the control subjects was -0.26 +/- 1.12 diopters (range -5.00 to +3.38 diopters) (P < .0001). Whereas 61.4% of hypertensive patients were hypermetropic, 18.1% of normotensive patients were hypermetropic (P < .0001). CONCLUSIONS: There is a strong association of essential arterial hypertension with hypermetropia, which has not been previously reported. Given the findings of this study, we recommend that patients who have hypermetropia and have had no recent systemic examination should at least have their blood pressure checked.
PURPOSE: To examine the relationship among hypermetropia, axial length, and hypertension in a Chinese population. DESIGN: Population-based cross-sectional study. METHODS: This study included 1213 Chinese individuals aged 40 to 81 years. Hypertension was defined as systolic blood pressure > or =140 mm Hg, diastolic blood pressure > or =90 mm Hg, or self-report history of antihypertension treatment. Refraction was determined with an autorefractor and refined subjectively. A-mode ultrasound scanning was used to measure axial length. RESULTS: The crude odds ratio of hypertension was 2.5 (95% CI, 1.4-4.6) for moderate hypermetropia (> or =+2.00 spheric equivalent diopters) vs high myopia (< or =-6.00 diopters), and 1.4 (95% CI, 0.9-2.1) for highest vs lowest axial length quintile. These associations were no longer significant after adjustment for age, gender, education, housing type, and income. CONCLUSIONS: These data provide no evidence that hypermetropia or shorter axial length is associated independently with hypertension in Chinese individuals.
INTRODUCTION: We wished to determine whether final visual acuity is dependent on age at optical correction or presence of esotropia in children with bilateral high hypermetropia. METHODS: We reviewed the charts of all patients at Childrens Hospital Los Angeles Division of Ophthalmology with bilateral hypermetropia of greater than or equal to 5D who were able to provide objective visual acuity outcomes with Snellen letters or linear E. RESULTS: One hundred thirteen patients met entry criteria. The age at first optical correction ranged from 8 months to 141 months (average 45 months). Initial visual acuity (before optical correction) was obtainable in 82 patients. Initial visual acuity ranged from 20/20 to 20/200, with 57% of patients having acuity better than or equal to 20/40. Final visual acuity (after optical correction) ranged from 20/20 to 20/70, with 109 patients (96%) having acuity better than or equal to 20/40 and 104 patients (92%) having acuity better than or equal to 20/30. There was no relationship between final visual acuity and age that spectacles were first worn. Ninety-five patients (84%) had esotropia with or without glasses, and six of these (6%) had final visual acuity less than 20/30. Of the 18 patients with orthotropia, three (16%) had final visual acuity less than 20/30. The prevalence of ametropic amblyopia in patients with esotropia and orthotropia was not significantly different (p = 0.18). CONCLUSION: Visual acuity outcome in children with high hypermetropia is generally good regardless of age at initial optical correction or presence of strabismus. A significantly increased risk for ametropic amblyopia was not found in those patients with orthotropia.
The author presents a detailed analysis of hypermetropia. He defines its three pathogenetically important forms:--facultative, relative and absolute, starting from the principles of Donders and based upon the dioptrics of Gullstrand. The author then deals with the pathological processes caused by hypermetropia, especially with the formation of strabismus. Finally he discusses the effects of the three forms of hypermetropia and of the associated other deficiencies of refraction.