Correction of abnormalities of refraction in children

In children, correction of refraction abnormalities pursues two goals: tactical (to do everything to improve vision) and strategic (to create conditions for the proper development of the organ of vision). Points for children are prescribed for medical purposes. In this case, the difference of refraction from zero in itself is not an indication for correction of ametropia. Corrections are subject to ametropia, accompanied by signs of decompensation. When the correction is prescribed, the children take into account the magnitude of ametropia, age, functional state of the eyes, the presence of concomitant ocular pathology, the possibility of subjective research.

Hypermetropia. Indications for correction of hypermetropia - signs of its decompensation: convergent strabismus (even periodic), amblyopia (decreased corrected visual acuity), decreased uncorrected visual acuity, asthenopia (visual fatigue). If signs of decompensation are revealed, any degree of hyperopia should be corrected. Correction is also necessary for hyperopia 4.0 dptr and more, even if there are no obvious signs of decompensation.

With hypermetropia, a correction is usually prescribed, 1.0 dpts lower than the refraction detected objectively in cycloplegia.

Children for the correction of hypermetropia are more often prescribed glasses. Recently, they use contact lenses. Correction of hypermetropia in children is prescribed for permanent wearing.

The age-functional approach to correction of hypermetropia

Age period	Main indications	Principle of correction	Type of correction	Correction mode
I (thoracic), 0-1 year	Afakia	Full correction	Contact lenses, glasses, primary implantation of intra-ocular lens	So long, As possible
II (infant), 1-3 years	Convergent strabismus	Correction by 1.0 D is weaker than refraction, revealed objectively in conditions of cycloplegia	Glasses	As long as possible
III (preschool), 3-7 years	Convergent strabismus, amblyopia, hypermetropia more than 4.0 D	Correction at 1.0 D is weaker than refraction, revealed objectively in cycloplegia	Glasses, contact lenses	For permanent wearing
IV (school), 7-18 years old	The same indications: a decrease in uncorrected visual acuity, asthenopia	The maximum complete tolerable correction for the highest visual acuity	Glasses, contact lenses	For permanent wearing

A special place is occupied by correction of aphakia after the removal of congenital cataracts, in which, as a rule, hypermetropia occurs more than 10.0 diopters. Correction of it presents special difficulties, especially if aphakia is one-sided. The best functional result is achieved with the use of contact lenses, worse - when wearing glasses. Recently, with aphakia, children are increasingly using a primary implantation intraocular lens.

Astigmatism. Indications for correction of astigmatism are signs of its decompensation: amblyopia, development and progression of myopia at least on one eye, cases when correction by the cylinder increases visual acuity in comparison with the sphere, asthenopia. As a rule, correction is subject to astigmatism of 1.0 dpt and more. Astigmatism less than 1.0 D is corrected in special cases. The general principle with astigmatism is a correction close to the full magnitude of astigmatism revealed objectively. Reduction of correction is possible with astigmatism more than 3.0 Dpt, and also in cases when full correction causes signs of disadaptation (space distortion, dizziness, nausea, etc.).

Children for the correction of astigmatism, usually assigned glasses. Recently, soft toric contact lenses have been increasingly used. Means of correcting astigmatism in children are prescribed for permanent wearing.

Age-functional approach to the correction of astigmatism

Age period	Main indications	Principle of correction	Type of correction	Correction mode
1 (thoracic), 0-1 year	Refractive anomalies requiring correction	Correction of more than half of the detected astigmatism	Glasses	As long as possible
II (infant), 1-3 years	Astigmatism more than 2.0 D	Correction of more than half of the detected astigmatism	Glasses	As long as possible
III (preschool), 3-7 years	Reduction of visual acuity due to astigmatism (usually with an astigmatism of 1.0 and more), amblyopia	Correction close to full	Glasses, contact lenses	For permanent wearing
IV (school), 7-18 years old	The same indications: development and progression of myopia, asthenopia	Correction close to complete, with de-adaptation - by tolerability	Glasses, contact lenses	For permanent wearing

Anisometropia. Indications for correction of anisometropia are signs of its decompensation: amblyopia of at least one eye, frustration of binocular vision, asthenopia. As a rule, if anisometropia is associated with an ametropia of the same sign, but of different magnitude, an anisometropy of 0.5 dpt and more is subject to correction. Correction of concomitant refraction is prescribed in accordance with the principles for this type of ametropia. The general principle is a correction that is close to the full value of anisometropia, revealed objectively. Reducing the correction of the difference in the refraction of the two eyes is possible with anisometropia of 6.0 dptr and more, and also in cases when the full correction causes the signs of disadaptation (distortion of space, double vision, dizziness, nausea, etc.).

Children can use eyeglasses to correct anisometropia. However, the best functional result is achieved with the use of contact lenses. Means for correcting anisometropia in children are prescribed for permanent wearing.

The age-functional approach to the correction of anisometropia

Age period	Main indications	Principle of correction	Type of correction	Correction mode
I (thoracic), 0-1 year	One-way aphakia	Full correction	Contact lenses	As long as possible
II (infant), 1-3 years	One-way aphakia, strabismus	Full correction	Contact lenses, glasses	As long as possible
III (preschool), 3-7 years	Strabismus, amblyopia	Full correction	Glasses, contact lenses	For permanent wearing
IV (school), 7-18 years old	The same indications + asthenopia	Correction close to complete, with disadaptation - by transferability	Glasses, contact lenses	For permanent wearing

[1], [2], [3], [4], [5], [6]