97th DOG Annual Meeting 1999

V483

THE INFLUENCE OF ACCOMMODATION OF REFRACTIVE ERROR CHANGES IN HYPEROPIC PATIENTS WITH ESOTROPIA: CAN DECREASING ACCOMMODATION WITH BIFOCALS HINDER MYOPIC SHIFT?

A. Eckstein, M. Fischer, J. Esser .


Background: Accommodation is one of the central variables that may influence the progression of myopia. Among school-age children a slower progression rate of myopia was found for instance during holidays in comparison to the school season. In 1998 the NIH initiated a long-term, 5 year prospective study to determine if bifocal glasses could slow down the progression of myopia. This study was performed to determine if the same theory applies to hyperopic patients.

Patients and Methods: Changes of refractive error were evaluated in 104 children with esotropia and hyperopia. Eighty-nine children, who had accommodative convergence excess (in addition to hyperopia and esotropia) were evaluated. The children with convergence excess were treated with bifocals. The groups were age matched and all of the children had normal accommodation. In addition, 11 orthophoric age matched children with uncorrected hyperopia were examined.

Results:

 

With bifocals

Without bifocals

Age at first refraction (years)

5,6 ± 1,8

5,3± 1,4

First refraction (dpt) (R1)

+2,87± 1,6

+3,55± 2,1

Age at last refraction (years)

11,7± 2,6

11,3± 2,7

Follow up (years)

6,1± 2,6

6,2± 1,9

Last refraction (dpt) (R2)

+2,64± 1,8

+2,8± 2,42

Difference (R1-R2)

-0,23

-0,75

 

p<0,00023 (t-Test)




The children with bifocals, who accommodate less in near distance, had a significant slower myopic shift. The 11 patients with orthophoria and uncorrected hyperopia showd a myopic shift of 1,71 dioptors during the follow up of 4,53 years.

Conclusion: The influence of accommodation on myopic shift (decrease of hyperopia) could be shown in hyperopic patients as well. The myopic shift is lower in hyperopic children in comparison to age matched groups of myopic children. One reason could be the higher susceptibility of myopes to accommodatively related nearwork aftereffects.

University Eye Hospital, D - 45122 Essen, Hufelandstraße 55, Germany


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