Hyperopia in schoolchildren: Investigating the impact on vision and determining appropriate methods for screening

Introduction: Hyperopia is associated with reduced vision and educational out-comes in schoolchildren. This study explored the impact of clinically significanthyperopia (≥+2.00 D) on visual function in schoolchildren and compared the abil-ity of different screening tests (alone and in combination) to detect this level ofhyperopia.

Methods: Vision testing including monocular logMAR visual acuity (VA) measuredto threshold (distance [DVA], near [NVA] and DVA through a plus lens [+2.50 D]),stereoacuity and cycloplegic autorefraction (tropicamide 1%) were undertakenon 263 schoolchildren (mean age: 11.76 years ± 3.38) in Queensland, Australia.Vision measures were compared between children with clinically significant hy-peropia in at least one meridian (≥+2.00 D) and emmetropia/low hyperopia (>0.00and <+2.00 D). Receiver operating curve (ROC) analysis was performed to identifyoptimal pass/fail criteria for each test and the diagnostic accuracy of individual andcombinations of tests.

Results: Thirty-two children had clinically significant hyperopia and 225 had em-metropia/low hyperopia. DVA and NVA were worse (p < 0.01), while the differencein DVA through a plus lens was less in children with clinically significant hyperopia(p < 0.01). ROC analysis for individual tests resulted in areas under the curve (AUCs)ranging from 0.65 to 0.85. Combining screening tests revealed that failing one ormore of the following tests was most effective for detecting hyperopia: DVA, NVAand difference in DVA through a plus lens, resulting in a sensitivity and specificityof 72% and 81%, respectively.

Conclusion: Significant differences in visual function existed between school-children with clinically significant hyperopia and emmetropia/low hyperopia.Combining measures of DVA and NVA and the difference in DVA through a pluslens demonstrated good discriminative ability for detecting clinically significanthyperopia in this population.