Associations of high hypermetropia in childhood

Main

Further to our findings on high myopia in childhood,¹ we reviewed 114 consecutive children under 10 years of age with high hypermetropia (greater than +5.00 dioptres) during a 5-year period and found both analogous and contrasting results (Table 1).

Table 1 Incidence of systemic, orthoptic and ocular abnormalities in children with high hypermetropia compared to high myopia¹

Whereas the myopic children were referred for the most part with nonspecific symptoms, 68% of the hypermetropic children were referred because of specific signs (strabismus 57%, hypermetropia 11%). Furthermore, the finding that initiated referral was confirmed in all but one case. Demographically the children were similar to the myopia group in terms of age at presentation and gender, but there was no over-representation of Asian children in the hypermetropia series.

In both series, the incidence of simple high refractive error was low (hyperopia 12%, myopia 8%). An orthoptic abnormality was present in 80% of the children with hypermetropia, usually accommodative esotropia (54%).

The spectrum of ocular associations was much narrower in the hypermetropic than the myopic group, but the overall incidence of ocular abnormality was almost identical (13% compared to 16%) (Table 2).

Table 2 Incidence of ocular abnormalities found in children with high hypermetropia

In total, 24 (21%) of the children with hypermetropia had a systemic association compared to 53% of the myopic children. In only one case of high hypermetropia was the systemic diagnosis made following recognition of the refractive error (Table 3).

Table 3 Incidence of systemic conditions affecting children found to have high hypermetropia

In conclusion, children with high hypermetropia are more likely to present with, and be referred for, definite signs and are less likely to harbour occult ocular or systemic pathology than children with high myopia.