A Randomized Clinical Trial of Immediate versus Delayed Glasses for Moderate Hyperopia in Children 3 to 5 Years of Age

Abstract Purpose To compare VA and binocularity outcomes in moderately hyperopic children with normal VA and binocularity assigned to glasses versus observation. Design: Prospective randomized clinical trial (RCT) Methods 119 3- to 5-year-olds with hyperopia between +3.00 diopters (D) and +6.00D spherical equivalent were randomly assigned to glasses versus observation (with glasses prescribed if deteriorated for subnormal distance VA or near stereoacuity, or manifest strabismus). Follow-up occurred every 6 months. At 3 years, the treatment strategy was classified as “failed” if any of the following were met, both with and without correction: subnormal distance VA or stereoacuity; manifest strabismus; or strabismus surgery during follow-up. Results Of 84 (71%) completing the primary outcome examination, failure occurred in 5 (12%; 95% CI = 4% to 26%) of 41 assigned to glasses and 4 (9%; 95% CI = 3% to 22%) of 43 assigned to observation (difference = 3%; 95% CI = -12% to 18%; P = 0.72). Deterioration prior to 3 years (requiring glasses per protocol) occurred in 29% (95% CI = 19% to 43%) assigned to glasses and 27% (95% CI = 17% to 42%) assigned to observation. Conclusion In a RCT comparing glasses to observation for moderately hyperopic 3- to 5-year-olds with normal VA and binocularity, failure for VA or binocularity was not common. With insufficient enrollment and retention, our study was unable to determine whether immediate glasses prescription reduces failure rate, but low failure rates suggest immediate glasses prescription for these children may not be needed to prevent failure for VA and/or binocularity.