Optometry and Vision Science (OVS)Evaluation of a Pilot Protocol for Detecting Infant Hyperopia

A pilot screening program evaluated the efficacy of tropicamide autorefraction for identifying high hyperopia in infants, presenting an opportunity for optometrists to detect and address this prevalent condition early on, potentially preventing future vision problems.

Optometrists play a vital role in identifying and managing vision conditions in patients of all ages. A recent study conducted a pilot screening program to evaluate the effectiveness of tropicamide autorefraction in detecting high hyperopia in 2-month-old infants. The aim was to identify the prevalence of this condition and explore an early detection method suitable for a pediatric medical practice in Columbus, Ohio.

The study involved 473 infants, with a gender distribution of 55.4% female, who attended their 2-month well-baby visit at a pediatrician’s medical practice. Cycloplegic refractive error measurements were taken using retinoscopy and the Welch Allyn SureSight autorefractor. A subset of 35 infants with a hyperopia measurement of ≥+5.00 D in the most hyperopic meridian during the screening underwent repeat cycloplegic retinoscopy (using 1% cyclopentolate) during a subsequent visit.

The results showed that out of the 473 infants, 28 (5.9%) had high hyperopia with a spherical equivalent of ≥+5.00 D. Additionally, 61 infants (12.9%) exhibited high hyperopia in at least one meridian of at least one eye, as confirmed by retinoscopy with 1% tropicamide. The mean spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D, while the SureSight autorefractor yielded +2.29 ± 1.64 D. Notably, retinoscopy using 1% cyclopentolate showed a 0.44 ± 0.54 D more hyperopic measurement in spherical equivalent compared to tropicamide (P < .001).

These findings highlight the prevalence of high hyperopia among 2-month-old infants and demonstrate the effectiveness of tropicamide autorefraction for early detection. By implementing cycloplegic autorefraction screenings, optometrists can proactively identify infants at risk of high hyperopia, enabling timely intervention to mitigate potential vision-related problems such as strabismus, amblyopia, and early literacy and reading difficulties.

In conclusion, this pilot screening program showcases the value of collaboration between pediatric primary vision and medical care. Optometrists can leverage cycloplegic autorefraction using tropicamide to effectively identify high hyperopia in infants, opening avenues for early intervention and improved vision screenings for this vulnerable population.