Velma Dobson, PhD, FAAO, Erin M. Harvey, PhD, Candice E. Clifford-Donaldson, MPH, Tina K. Green, MS, and Joseph M. Miller, MD, MPH

Amblyopia in Astigmatic Infants and Toddlers

publication date
2011 May 1
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To determine if reduced astigmatism-corrected acuity for vertical (V) and/or horizontal (H) gratings and/or meridional amblyopia (MA) are present prior to age three years in children who have with-the-rule astigmatism.



Subjects were 448 children, 6 months through 2 years of age with no known ocular abnormalities other than with-the-rule astigmatism, who were recruited through Women, Infants and Children clinics on the Tohono O’odham reservation. Children were classified as non-astigmats (≤ 2.00 D) or astigmats (> 2.00 D) based on right eye (RE) non-cycloplegic autorefraction measurements (Welch Allyn SureSight). RE astigmatism-corrected grating acuity for V and H stimuli was measured using the Teller Acuity Card procedure while children wore cross-cylinder lenses to correct their astigmatism or plano lenses if they had no astigmatism.



Astigmatism-corrected acuity for both V and H gratings was significantly poorer in the astigmats than in the non-astigmats, and the reduction in acuity for astigmats was present for children in all three age groups examined (6 months to <1 year, 1 to <2 years, 2 to <3 years). There was no significant difference in V-H grating acuity (no evidence of MA) for the astigmatic group as a whole, or when data were analyzed for each age group.



Even in the youngest age group, astigmats tested with astigmatism correction showed reduced acuity for both V and H gratings, which suggests that astigmatism is having a negative influence on visual development. We found no evidence of orientation-related differences in astigmatism-corrected grating acuity, indicating either that MA does not develop prior to age 3 years, or that most of the astigmatic children had a type of astigmatism, i.e., hyperopic, that has proven to be less likely than myopic or mixed astigmatism to result in MA.

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