Moderate Hyperopia in Children treatment necessary

Our son (4 years old)was diagnosed moderate hyperopia (+3.00 diopters). The reason for the consultation was a suspicion of vision disorder in a screening investigation (performed with all children in Germany at several age levels) three month ago. The ophthalmologist prescribed optical correction (+1,50 diopters)and told us that our son would get problems when entering school (in 1,5 years)without correction. Apart from a certain degree of photosensitivity and sometimes eye blinking we have not recognized any symptoms like discomfort in viewing books or disability to identify details in pictures. We have not recognized strabismus and it was not diagnosed either. Our questions: Is the optical correction necessary? Can an optical correction decrease the long term chance for normal vision? What are his chances for development of normal vision with or without optical correction? Thank you for your advice in advance.

[Forum-OD-MP]

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[aimee37]

"we have not recognized any symptoms like discomfort in viewing books or disability to identify details in pictures."

that doesnt mean anything at age 4.  if he really is +3.00, problems like that are pretty much inevitable IMO


"We have not recognized strabismus and it was not diagnosed either."

not surprising, but then again at age 4 the stimulus for accommodation is not high, either.  as soon as he starts reading a lot in say 2nd grade, accommodative esotropia is HIGHLY PROBABLE IMO

"Our questions: Is the optical correction necessary?"

i think so, yes.  there are varying opinion son this.  many docs dont Rx anything under say +5.00.  some docs rx everything over +0.50.  most of us fall somewhere inbetween.  but given that rx (+3.00) i would say at least 97% of eye docs would Rx *something*.

"Can an optical correction decrease the long term chance for normal vision?"

*NO*.  it can only help.

"What are his chances for development of normal vision with or without optical correction? Thank you for your advice in advance."

normal vision with correction:  probably near 100% chance.  normal vision if he does not wear any correction of any kind?  much, much less likely.  IMO say around 20% (80% chance of some vision problem...accommodative esotropia, refractive amblyopia, etc etc)

[aimee37]

I have 2,0 ? hyperopia now, in 43 y.o. When I was 4 y.o. my hyperopy was some more.  But i had no visual problems in my life anytime, include my ability to operate eyes of my patients. Certainly till near 35 years old, when I start wear glasses for near vision, as any old man.

But it be better to foolw recomendations of YOUR eye care doctor

                               Best regards from russian ophthalmologist

[aimee37]

...but 2 diopters is 1/3 less than 3 diopters.  plus the russian ophthalmologist presents what i consider to be anecdotal information in this case.  just b/c he didnt have problems doesnt mean your 4 year old wont.

[aimee37]

as patient to patient

[aimee37]

+3,0 D cycloplegic refraction in  4 y.o. without strabismus & ambliopy do not demand optcal correction. Visit opht-gist every 6 month.
Best regards.

[aimee37]

Hi.  Was researching something else and your post caught my eye.  I've been an ophthalmic technician for about 18 years and happen to be moderately hyperopic myself (+3.00), as is my daughter.  My hyperopia wasn't dx'd until I was in my middle twenties.  By then I had developed such an accomodative habit that I was very difficult to fit in lenses until my mid to late thrities.  I had also developed convergence/divergence problems that caused a lot of trouble with reading.  I was given a little prism and this fixed the problem, but now I am realizing I am also an early presbyope, needing bifocals at only 38.

The doctor that mentioned problems starting in second grade was right on.  My oldest dtr had no visual complaints, no obvious strabismus, and no apparent accomodative issues until she began to read on a regular basis in the second grade.  When she told me about seeing double at near, I immediately took her to the local pediatric oph who dx'd her with exactly the same amount of hyperopia and convergence/divergence issues I had.  He chose not to correct her at that time, his theory being that I had overcome the problems and she would, too.

About 6 months later, she began to complain of daily headaches after school.  No headaches on weekends.  I suspected accomodative spasm and took her to a local OD and asked him to correct her.  He gave her +1.50 of +3.00and the headaches stopped.  Even better, she has become a recreational reader.

As someone who has been through the trials of uncorrected hyperopia personally, with some muscle issues to boot, I was pretty adamant about my daughter being corrected in spite of advice that she would be fine.  When she became symptomatic, I decided a second opinion was in order...and probably would have sought a third, fourth, etc, until I found someone to fit her.

All that to say this :  I agree...let him wear the correction.  If for no other reason, he'll be less stressed out, especially when he goes to school.  He's more likely to have fewer problems.  I ascribe to the idea...completely unscientific...that hyperopic patients, when chronically uncorrected, develop high anxiety-type personalities....myself included.  The constant stress of attempting to accomodate to see ANYTHING is greater than most people would believe.  When I put on my first pair of glasses at 25, my entire head breathed a huge sigh of relief.  Migraines I had suffered for years almost disappeared.  

Don't mean to step on any toes, just thought I'd throw in my two cents of personal experience mixed with a few years in the trenches of eye care.  Hope it is a little helpful.  Good luck with your son.  Hyperopes are good people ;)

[aimee37]

Hi, it was very stresful for me to read this comment. It indeed went deep in my heart. I am 25 years old and I am hyperopic (+4; +4.5) I do not wear glasses even now. But I am suffering results. I am a very successful lawyer. I read and work at the computer almost constantly since my childhood. I have discovered my hyperopia only last year, while doing my masters degree.

This is indeed an awful feeling that I experience. I am really getting anxious and nervous person. I fully realize my problem and notice that changes in my personality are related to my "desease".

I resist to wearing glasses. I categoricaly refuse to do that. I am very very afraid that this will change my appearence, I will get totally dependent on glasses, while now I can manage without them somehow. of course this causes unbelieveble hardship to me. Though, I am very proud of my achievments which are indeed surprising in view of my age (plus hyperopia :))and I am also scared that I will loose a lot in future because of my "disability". I won't be able to fully realize myself in my professional career.

Don't know what to do. It seems that I have already firmly decided not to wear glasses at least till 30's, if I manage of course. Sounds silly, I know...

Do you have any information about eye therapy, does it work at all???