Astigmatism in Children: Treatment Options and Recommendations

Astigmatism in children

A 5.5-year-old child has astigmatism of 150 degrees in one eye and 175 degrees in the other eye (no myopia).
The uncorrected visual acuity is 0.6 and 0.7, while corrected visual acuity is 1.0.
Dr.
A recommends glasses for amblyopia correction, Dr.
B suggests that the condition is acceptable and recommends monitoring, Dr.
C advises using eye drops (vitamins and lubricants) for one treatment course, and if there is no improvement, to use glasses for correction.
Dr.
D recommends using eye drops (dilating drops - muscle relaxants).
Which treatment method would be most beneficial for the child?

min, 40~49 year old female. Ask Date: 2005/03/28

Dr. Liu Jingxian reply Ophthalmology

Dear Concerned Mother,
Regarding your questions, here are the answers:
1.
The developmental process of children's vision follows certain "vision milestones":
- At age 3: 0.5
- At age 4: 0.6
- At age 5: 0.7
- At age 6: 0.8
If a child's best-corrected visual acuity meets or exceeds these values, their visual function is considered to be developing normally.
2.
Your 5-year-old child's visual development shows uncorrected vision of 0.6 in the right eye and 0.7 in the left eye, with corrected vision of 1.0 in both eyes.
At this age, this indicates normal visual function development.
3.
The refractive status of the eyes (as determined by computerized refraction) primarily results from the refractive properties of the two main structures of the eye: the cornea and the lens.
4.
Most children's astigmatism is caused by irregularities in corneal refraction, which is related to the development of the cornea.
5.
Other physicians and scholars have suggested additional possible causes: children with allergic conditions who suffer from allergic conjunctivitis may rub their eyes frequently, which can increase astigmatism; improper posture, such as tilting the head while viewing objects, can create an imbalance in pressure on the eyeball from the eyelids, also potentially increasing astigmatism.
These two causes have not yet been confirmed by literature.
6.
Treatment for astigmatism involves correcting the child's refractive errors.
Wearing glasses for astigmatism is the simplest and most effective solution (right eye 0.6, left eye 0.7, corrected vision of 1.0).
When should glasses be worn for astigmatism? If there is "amblyopia" (corrected vision not reaching the "vision milestone") primarily caused by astigmatism; generally, a threshold of 1.00 diopters is used, where those with astigmatism above this level and poor vision (uncorrected vision not reaching the "vision milestone," but corrected vision does) are advised to wear glasses.
For those below 1.00 diopters, the effect of astigmatism on vision is minimal, and regular follow-up is recommended.
7.
In your child's case, the corrected vision has reached the "vision milestone" (no amblyopia), and the computerized refraction shows astigmatism in both eyes without myopia.
Therefore, there is no need for cycloplegic agents (for those above 1.00 diopters, with uncorrected vision not reaching the "vision milestone," but corrected vision does).
I suggest monitoring the situation and observing your child's future visual development before making further decisions.
If you have any additional concerns, please feel free to reach out again.
Wishing you good health,
Dr.
Liu Jing-Chih
Attending Physician, Department of Ophthalmology
Taipei City Hospital, Zhongxing Branch
Taiwan e-Academy of Health

Reply Date: 2005/03/28

More Info

Astigmatism is a common refractive error in children, characterized by an irregular curvature of the cornea or lens, leading to blurred or distorted vision. In your case, your 5.5-year-old child has been diagnosed with astigmatism of 150 degrees in one eye and 175 degrees in the other, with no myopia present. The visual acuity measurements indicate that without correction, your child can see 0.6 and 0.7, and with correction, they can achieve 1.0. This suggests that while your child has some visual capability, the astigmatism is significant enough to warrant attention.

When it comes to treatment options for astigmatism in children, there are several approaches, and the recommendations can vary based on the severity of the condition, the child's age, and their overall visual development. Here’s a breakdown of the recommendations provided by the different doctors:
1. Dr. A's Recommendation (Eyeglasses): This is a common and effective treatment for astigmatism. Corrective lenses can help focus light properly on the retina, improving visual clarity. For children, especially at a young age, wearing glasses can also prevent the development of amblyopia (lazy eye), which can occur if one eye is significantly weaker than the other. Given that your child has been diagnosed with astigmatism, this recommendation is valid and should be considered seriously.

2. Dr. B's Recommendation (Observation): While monitoring the condition can be appropriate in some cases, it is generally advisable to take a more proactive approach, especially if the astigmatism is significant. Waiting to see if the condition improves on its own may not be the best course of action, as untreated astigmatism can lead to further visual complications.

3. Dr. C's Recommendation (Eye Drops): The suggestion to use vitamin and lubricating eye drops may be aimed at addressing any discomfort or dryness that could be affecting your child's vision. However, this treatment does not correct the underlying refractive error caused by astigmatism. While it may provide some symptomatic relief, it is not a substitute for corrective lenses.

4. Dr. D's Recommendation (Cycloplegic Drops): The use of cycloplegic drops, which temporarily paralyze the ciliary muscle of the eye, can help in obtaining a more accurate measurement of refractive error. This can be useful in determining the exact prescription needed for glasses. However, like Dr. C's recommendation, this does not directly treat astigmatism but rather aids in the assessment process.

In conclusion, the most beneficial approach for your child would likely be to follow Dr. A's recommendation of fitting them with corrective eyeglasses. This will not only improve their visual acuity but also help in preventing potential complications associated with untreated astigmatism. It is essential to ensure that your child wears the glasses consistently, as this will aid in their visual development and overall quality of life.

Additionally, regular follow-up appointments with an eye care professional are crucial to monitor your child's vision and make any necessary adjustments to their prescription as they grow. If you have concerns about the recommendations or the need for further treatment options, consider seeking a second opinion from a pediatric ophthalmologist who specializes in children's eye care.

Similar Q&A

Understanding Astigmatism in Young Children: Treatment Options and Considerations

Hello! My daughter is currently 3 years and 5 months old. After examination, it was found that she has astigmatism of 400 degrees in her left eye and 200 degrees in her right eye. I would like to ask: 1. Is monocular treatment effective? (The doctor suggested treating one eye for...

Dr. Cai Yuyuan reply Ophthalmology
Children with high astigmatism are most concerned about developing amblyopia. The simplest and most effective treatment for amblyopia is wearing glasses and, if necessary, patching therapy. Your daughter's left eye has more severe astigmatism, so the initial treatment should...

Effective Treatments for Astigmatism in Young Children

A three-year-old child has a congenital astigmatism of 250 degrees and a vision check of 2.5. How should the astigmatism be treated? Thank you.

Dr. Huang Bozhen reply Ophthalmology
Explanation: It is rare to accurately assess the vision of a three-year-old child, and it is difficult to determine their true visual acuity. A child with simple astigmatism of -2.50 diopters measured a visual acuity of 0.5 (2.5 is too extreme). If there is no strabismus, observa...

Understanding Amblyopia: Treatment Options for Myopia and Astigmatism in Children

Dear Dr. Gao, My son, born on March 1, 2010, turned 8 years old this March. Currently, he has myopia of -6.25 diopters with astigmatism of -2.50 diopters in his right eye, and -5.50 diopters with astigmatism of -3.50 diopters in his left eye. In 2015, an eye exam showed myopia o...

Dr. Gao Pilin reply Ophthalmology
Hello Mr. Zeng: The rapid increase in astigmatism may indicate a corneal issue. I recommend that you visit a hospital with a cornea specialty for an examination. Since you live in Xinying, you might consider Chi Mei Medical Center or Cheng Kung University Hospital. The ophthalmol...

Understanding Astigmatism and Glaucoma in Children

Hello Doctor: My daughter is eleven years old and has astigmatism in both eyes, approximately 150 degrees. She feels discomfort and glare when looking at slightly bright objects. Interestingly, her condition seems to improve when she is not wearing her glasses. Is this a symptom ...

Dr. Huang Bozhen reply Ophthalmology
Subject: Photophobia. Explanation: Your daughter is experiencing symptoms of photophobia, and it is important to check for any signs of inflammation, such as conjunctivitis or keratitis. This should not be related to astigmatism. Additionally, glaucoma is caused by elevated intra...