Correction of refractive anomalies in children

In children, correction of refractive anomalies has two goals: tactical (to do everything to improve vision) and strategic (to create conditions for the correct development of the visual organ). Glasses are prescribed to children for therapeutic purposes. At the same time, the difference in refraction from zero in itself is not an indication for correction of ametropia. Ametropia accompanied by signs of decompensation is subject to correction. When prescribing correction to children, the magnitude of ametropia, age, functional state of the eyes, the presence of concomitant eye pathology, and the possibility of subjective examination are taken into account.

Hyperopia. Indications for correction of hyperopia are signs of its decompensation: convergent strabismus (even periodic), amblyopia (decrease in corrected visual acuity), decrease in uncorrected visual acuity, asthenopia (visual fatigue). If signs of decompensation are detected, hyperopia of any degree is subject to correction. Correction is also necessary for hyperopia of 4.0 D or more, even if there are no obvious signs of decompensation.

In case of hyperopia, correction is usually prescribed at 1.0 D weaker than the refraction determined objectively under cycloplegia conditions.

Children are often prescribed glasses to correct hyperopia. Recently, contact lenses have been used. Hyperopia correction in children is prescribed for constant wear.

Age-functional approach to hyperopia correction

Age period	Main indications	Correction principle	Type of correction	Correction mode
I (infant), 0-1 year	Afakia	Full correction	Contact lenses, glasses, primary intraocular lens implantation	So long, How is it possible?
II (infant), 1-3 years	Convergent strabismus	Correction is 1.0 D weaker than the refraction determined objectively under cycloplegia	Glasses	As long as possible
III (preschool), 3-7 years	Convergent strabismus, amblyopia, hypermetropia more than 4.0 diopters	Correction is 1.0 D weaker than the refraction determined objectively with cycloplegia	Glasses, contact lenses	For continuous wear
IV (school), 7-18 years	The same indications: decreased uncorrected visual acuity, asthenopia	The most complete tolerable correction for the highest visual acuity	Glasses, contact lenses	For continuous wear

A special place is occupied by the correction of aphakia after the removal of congenital cataract, which, as a rule, causes hyperopia of more than 10.0 D. Its correction presents special difficulties, especially if the aphakia is unilateral. The best functional result is achieved when using contact lenses, worse - when wearing glasses. Recently, primary implantation of an intraocular lens has been increasingly used for aphakia in children.

Astigmatism. Indications for astigmatism correction are signs of its decompensation: amblyopia, development and progression of myopia in at least one eye, cases when cylinder correction increases visual acuity compared to a sphere, asthenopia. As a rule, astigmatism of 1.0 D or more is subject to correction. Astigmatism of less than 1.0 D is corrected in special cases. The general principle for astigmatism is correction close to the full value of astigmatism detected objectively. Reduction of correction is possible with astigmatism of more than 3.0 D, as well as in cases when full correction causes signs of disadaptation (distortion of space, dizziness, nausea, etc.).

Children are usually prescribed glasses to correct astigmatism. Recently, soft toric contact lenses have been increasingly used. Astigmatism correction products for children are prescribed for constant wear.

Age-functional approach to astigmatism correction

Age period	Main indications	Correction principle	Type of correction	Correction mode
1 (infant), 0-1 year	Refractive errors requiring correction	Correction of more than 1/2 of the detected astigmatism	Glasses	As long as possible
II (infant), 1-3 years	Astigmatism more than 2.0 Dptr	Correction of more than 1/2 of the detected astigmatism	Glasses	As long as possible
III (preschool), 3-7 years	Decreased visual acuity due to astigmatism (usually with astigmatism of 1.0 D or more), amblyopia	Correction close to complete	Glasses, contact lenses	For continuous wear
IV (school), 7-18 years	The same indications: development and progression of myopia, asthenopia	Correction close to complete, in case of maladaptation - according to tolerance	Glasses, contact lenses	For continuous wear

Anisometropia. Indications for correction of anisometropia are signs of its decompensation: amblyopia of at least one eye, disorder of binocular vision, asthenopia. As a rule, if anisometropia is associated with ametropia of the same sign but different magnitudes, anisometropia of 0.5 D or more is subject to correction. Correction of concomitant refraction is prescribed in accordance with the principles for this type of ametropia. The general principle is correction close to the full value of anisometropia, identified objectively. Reducing the correction of the difference in refraction of the two eyes is possible with anisometropia of 6.0 D or more, as well as in cases where full correction causes signs of disadaptation (distortion of space, double vision, dizziness, nausea, etc.).

Children may be prescribed glasses to correct anisometropia. However, the best functional result is achieved using contact lenses. Means for correcting anisometropia in children are prescribed for constant wear.

Age-functional approach to the correction of anisometropia

Age period	Main indications	Correction principle	Type of correction	Correction mode
I (infant), 0-1 year	Unilateral aphakia	Full correction	Contact lenses	As long as possible
II (infant), 1-3 years	Unilateral aphakia, strabismus	Full correction	Contact lenses, glasses	As long as possible
III (preschool), 3-7 years	Strabismus, amblyopia	Full correction	Glasses, contact lenses	For continuous wear
IV (school), 7-18 years	Same indications + asthenopia	Correction, close to complete, in case of maladaptation - according to tolerance	Glasses, contact lenses	For continuous wear

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