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Purpose: To survey paediatric eye care providers to identify current patterns of prescribing for hyperopia. Methods: Paediatric eye care providers were invited, via email, to participate in a survey to evaluate current age‐based refractive error prescribing practices. Questions were designed to determine which factors may influence the survey participant's prescribing pattern (e.g., patient's age, magnitude of hyperopia, patient's symptoms, heterophoria and stereopsis) and if the providers were to prescribe, how much hyperopic correction would they prescribe (e.g., full or partial prescription). The response distributions by profession (optometry and ophthalmology) were compared using the Kolmogorov–Smirnov cumulative distribution function test. Results: Responses were submitted by 738 participants regarding how they prescribe for their hyperopic patients. Most providers within each profession considered similar clinical factors when prescribing. The percentages of optometrists and ophthalmologists who reported considering the factor often differed significantly. Factors considered similarly by both optometrists and ophthalmologists were the presence of symptoms (98.0%, p = 0.14), presence of astigmatism and/or anisometropia (97.5%, p = 0.06) and the possibility of teasing (8.3%, p = 0.49). A wide range of prescribing was observed within each profession, with some providers reporting that they would prescribe for low levels of hyperopia while others reported that they would never prescribe. When prescribing for bilateral hyperopia in children with age‐normal visual acuity and no manifest deviation or symptoms, the threshold for prescribing decreased with age for both professions, with ophthalmologists typically prescribing 1.5–2 D less than optometrists. The threshold for prescribing also decreased for both optometrists and ophthalmologists when children had associated clinical factors (e.g., esophoria or reduced near visual function). Optometrists and ophthalmologists most commonly prescribed based on cycloplegic refraction, although optometrists most commonly prescribed based on both the manifest and cycloplegic refraction for children ≥7 years. Conclusion: Prescribing patterns for paediatric hyperopia vary significantly among eye care providers. [ABSTRACT FROM AUTHOR]

Purpose: To compare the discrimination performance of 6‐year‐old children for optotypes from six paediatric visual acuity tests and to fit Luce's Biased Choice Model to the data to estimate the relative similarities and bias for each optotype. Methods: Full data sets were collected from 20 typically developing 6‐year‐olds who had passed a vision screening. They were presented with single optotypes labelled 6/12 at a distance of 9 m and were asked to identify the optotype using a matching task containing all optotypes from the relevant test. The data were combined to form a confusion matrix for each test and a biased choice model was fitted to the data. Results: Median correct performance varied from 40% to 100% across optotypes, with the HOTV test having the highest values. Estimates of the similarity of each pair of optotypes indicated equal values for all pairs in the Landolt C, HOTV, Lea numbers and Tumbling E tests. The values differed for the picture tests, that is Lea Symbols and Allen figures. The estimates of bias for each individual optotype also indicated different values with the picture tests. Conclusions: Previous studies of the threshold acuity of young children and adults have indicated differences in acuity estimates across paediatric tests. A recognition acuity task typically requires resolving the difference information between optotypes. The performance of the 6‐year‐olds here reveals variance in similarity and bias values for picture tests, particularly for the Allen figures when compared with the Lea Symbols. Ideally, this analysis should be performed when designing new tests, and these results motivate progression from the use of current picture tests to well calibrated letter or number tests at the earliest possible age. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate associations between visual function and the level of uncorrected hyperopia in 4‐ and 5‐year‐old children without strabismus or amblyopia. Methods: Children with spherical equivalent (SE) cycloplegic refractive error of −0.75 to +6.00 on eligibility testing for the Vision in Preschoolers–Hyperopia in Preschoolers (VIP‐HIP) study were included. Children were grouped as emmetropic (<1D SE myopia or hyperopia), low hyperopic (+1 to <+3D SE) or moderate hyperopic (+3 to +6D SE). Children with anisometropia or astigmatism (≥1D), amblyopia or strabismus were excluded. Visual functions assessed were monocular distance visual acuity (VA) and binocular near VA with crowded HOTV charts, accommodative lag using the Monocular Estimation Method and near stereoacuity by 'Preschool Assessment of Stereopsis with a Smile'. Visual functions were compared as continuous measures among refractive error groups. Results: 554 children (mean age 58 months) were included in the analysis. Mean SE (SD) {N} for emmetropia, low and moderate hyperopia were +0.52D (0.49) {N = 270}, +2.18D (0.57) {N = 171} and +3.95D (0.78) {N = 113}, respectively. There was a consistent trend of poorer visual function with increasing hyperopia (p < 0.001). Although all children had age‐normal distance VA, logMAR (Snellen) VA of 0.00 (6/6) or better was achieved (distance, near) among more emmetropic (52%, 26%) and low hyperopic (47%, 15%) children than moderate hyperopes (25%, 9%). Mean (SD) distance logMAR VA declined from emmetropic 0.05 (0.10), to low hyperopic 0.06 (0.10) to moderately hyperopic children 0.12 (0.11) (p < 0.001); A mild progressive decrease in near VA also was observed from the emmetropic 0.13 (0.11) to low hyperopic 0.15 (0.10) to moderate hyperopic 0.19 (0.11) groups, (p < 0.001). Accommodative responses showed an increased lag with increasing hyperopia (ρ = 0.50, p < 0.001). Median near stereoacuity for emmetropes, low and moderate hyperopes was 40, 60 and 120 sec arc, respectively. The percentage of these groups with no reduced near visual functions was 83%, 61%, and 34%, respectively. Conclusions: Decreasing visual function was associated with increasing hyperopia in 4‐ and 5‐year‐olds without strabismus or amblyopia. As hyperopia with reduced visual function has been associated with early literacy deficits, near visual function should be evaluated in these children. [ABSTRACT FROM AUTHOR]

Purpose Heterophoria is the misalignment of the eyes in monocular viewing and represents the accuracy of vergence driven by all classical cues except disparity. It is challenging to assess restless children using clinical cover tests, and phoria in early childhood is poorly understood. Here we used eye tracking to assess phoria as a function of viewing distance and target in adults and young children, with comparison to clinical cover tests. Methods Purkinje image tracking ( MCS PowerRefractor) was used to record eye alignment in adults (19-28 years, N = 24) and typically developing children (3-5 years, N = 24). Objective unilateral and alternating cover tests were performed using an infrared filter while participants viewed a pseudo-randomised sequence of Lea symbols (0.18 log MAR; Snellen: 20/30 or 6/9) and animated cartoon movies at distances of 40 cm, 1 m, and 6 m. For the unilateral cover test, a 10 s binocular period preceded and followed 30 s of occlusion of the right eye. For the alternating cover test, a 10 s binocular period preceded and followed alternate covering of right and left eyes for 3-s each. Phoria was derived from the difference in weighted average binocular and monocular alignment. A masked prism-neutralised clinical cover test was performed for each of the conditions for comparison. Results Closer viewing distance resulted in greater exophoria for both children and adults ( p < 0.001). Phorias were similar for adults and children for each viewing distance and target, with mean differences of less than 2 prism dioptres (pd). Overall, the average PowerRefractor phorias (pooled across protocols) for adults were 1.3, 2.3 and 3.8 pd exophoria and for children were 0.1 pd esophoria, 0.94 and 3.8 pd exophoria for the 6 m, 1 m and 40 cm distances respectively. The corresponding clinical cover test values were 0.7, 1.9, and 4.1 pd exophoria for adults and 0, 1.5 and 3.3 pd exophoria for the children. Refractive states were also similar (≤0.5 D difference) for viewing the Lea symbols or movie for any protocol tested. Conclusions Phoria estimation can be challenging for a pre-school child. These data suggest that by 3-5 years of age objective eye-tracking measures in a typically developing group are adult-like at the range of distances tested, and that use of an animated movie produces similar average results to a small optotype (0.18 log MAR; Snellen 20/30 or 6/9). [ABSTRACT FROM AUTHOR]