Infants, Toddlers, Children and Hyperopia: Is It All Clear? (2007)

OVS dedicates this entire issue to the management of infant and child hyperopia. While clinicians often act with confidence in their strategies on management, our Guest Editors frame the issues of infant, toddler, and child hyperopia correction in a very challenging way for all of us. They acknowledge two competing strategies for correction, which, to a large degree, mirrors competing strategies for clinicians primarily attentive to either normal vision function development (visual acuity, eye alignment, accommodation, and learning) or the assumption of residual hyperopic blur being needed to drive emmetropization. If hyperopic refractive error drives emmetropization then why correct it, says one school of thought? On the other hand if not corrected fully then what becomes of optimizing visual acuity, eye alignment, accurate ocular accommodation, and the child’s learning? While perhaps I am unfairly over simplifying in characterizing two extreme competing strategies, it does allow me, as Editor, to highlight the dilemma for the thoughtful clinician. In this issue you will see a paper that provides a perspective on the dilemma; the argument for the provision of full plus refractive error correction. Our author argues that hyperopia may not be a factor in emmetropization—at least for high hyperopes where the worry about strabismus and amblyopia are more compelling. But you will see other thoughts on this, expressed in the three invited perspectives from experts in the field. What will surely not escape your attention is the need for careful research that tests our assumptions about hyperopia. We need to determine whether we should fully correct the hyperopic infant, toddler or child, and at what age for what expressed purpose. Those trials are not of high priority for anisometropic hyperopic children where there is strong consensus and considerable clinical research literature to support that consensus. But surely clinical research trials are called for with the more challenging question of whether or not to fully correct the hyperopic infant, toddler, or child. There is considerable variance in the “clinical wisdom” genuinely applied to this question within optometry and ophthalmology. Some would argue that there are very different strategies generally between ophthalmology and optometry. Now that’s why two of our invited contributors, one a pediatric optometrist, and one a pediatric ophthalmologist, totally agree on the call for clinical research trials. Read on! For this Feature Issue OVS has benefited from the efforts of four superb and expert Guest Editors, two of whom, Susan Cotter and Donald Mutti, were involved in the Academy 2005 Monroe J Hirsch Symposium on Infant & Children’s vision. Another Guest Editor, Rowan Candy, a rising star in the infant vision field, is immersed in infant vision research that will surely enlighten clinicians in the months and years to come. Gunilla Haegerström Portnoy, the fourth Guest Editor and a regular member of the OVS Editorial Board, is a vision researcher, as well as a most experienced and talented clinician in infant and children’s vision. She brings considerable clinical wisdom to the issues of hyperopia correction and management for infants, toddlers and children. Together they represent an impressive team of Guest Editors. Susan Cotter and Donald Mutti, present the two Perspectives, one as a challenge to researchers and clinicians on the full correction of hyperopia (Mutti) and the other presenting an experienced pediatric optometrist perspective (Cotter). Both have impeccable credentials for their topics, as clinicians and researchers in the field. Sean Donohue, a well-known and highly regarded pediatric ophthalmologist from Vanderbilt University, who participated in the 2005 Academy of Optometry Hirsch Symposium, presents a thoughtful Perspective from the ophthalmologic view. We also present two Reviews of important literature in this field. The first by a pediatric ophthalmologist at the University of Southern California (Kristina Tarczy-Hornoch), and the second by a team from the United Kingdom (Janette Atkinson et al.) who have spent years dedicated to understanding the development, screening measurement and correction of infant and children’s refractive error. The Atkinson et al. Review is now available for public open access on line. Finally these Perspectives and Reviews are followed by five Original Article research contributions that address a range of issues of interest to both researchers and clinicians. I am excited about the insights, perspectives, and challenges this issue presents to those many of our readers who are committed to better understanding the management of “Infant and Child Hyperopia”. Anthony J. Adams Editor-in-Chief Berkeley, California