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Correction of abnormalities of refraction in children

 
, medical expert
Last reviewed: 23.04.2024
 
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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

trusted-source[1], [2], [3], [4], [5], [6]

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