Should You Adjust Prescription for Hyperopia in Children?

Should the prescription for hyperopia be increased or decreased?

Hello Doctor, my daughter is a little over 6 years old.
She was diagnosed with congenital amblyopia when she was over 3 years old and has been wearing corrective glasses for more than 3 years.
Initially, her hyperopia was over +7.8 diopters.
The last prescription was in October 2014, and her current glasses have a prescription of +6.00 diopters for the right eye, +5.50 diopters for the left eye, and +1.50 diopters of astigmatism.
During a follow-up visit earlier this year, I asked the doctor if her glasses prescription needed adjustment.
The doctor mentioned that her progress has been slow and that there is insufficient stimulation for her brain, so they suggested trying to adjust the prescription.
The doctor recommended reducing the prescription by 0.50 diopters.
However, when we took her to the optical shop for an eye exam, they said that reducing the prescription by 0.50 or 0.25 diopters was not feasible, as she could not see clearly with those adjustments.
Interestingly, when we increased her current prescription by 0.25 diopters, she could see better than with her current glasses.
Should the hyperopia prescription be fully corrected? How should we adjust it? The staff at the optical shop said that hyperopia needs to be fully corrected to achieve the desired effect, so I am unclear about how to properly adjust the prescription for her benefit.
Thank you.

Xiao Mei, 30~39 year old female. Ask Date: 2016/01/12

Dr. Wang Zhishun reply Ophthalmology

Hello, for general hyperopia, it is important to have a proper prescription, but the most crucial aspect is to conduct a thorough eye examination and to try on the glasses.
Amblyopia training is also very important.

Reply Date: 2016/01/12

More Info

When it comes to managing hyperopia (farsightedness) in children, particularly in the context of a child with a history of amblyopia (lazy eye), it is crucial to approach the situation with careful consideration. Your daughter, who has been wearing glasses for several years to correct her significant hyperopia, presents a unique case that requires a nuanced understanding of both her visual needs and the developmental aspects of her vision.

Understanding Hyperopia and Its Treatment
Hyperopia occurs when the eye is shorter than normal or has a cornea that is too flat, causing light rays to focus behind the retina. In children, this can lead to difficulties with near vision, which may affect their ability to read and perform close-up tasks. In your daughter's case, her initial prescription of +7.8 diopters indicates a significant level of hyperopia, which can contribute to amblyopia if not adequately corrected.

Adjusting the Prescription
1. Current Prescription: Your daughter’s current prescription of +6.00 in the right eye and +5.50 in the left eye, along with astigmatism correction, suggests that she still has a considerable amount of hyperopia. The recommendation to reduce the prescription by 0.50 diopters was likely made to encourage more visual engagement and reduce the strain on her visual system. However, if she is unable to see clearly with a reduced prescription, it may not be appropriate to lower it.

2. Importance of Full Correction: The general consensus in pediatric optometry is that children should wear their full prescription to ensure optimal visual development. If your daughter sees better with an increased prescription, it indicates that her visual system may still require that level of correction to function effectively.
3. Trial and Error: It is not uncommon for children to undergo several adjustments in their prescriptions as they grow and their visual needs change. If the optometrist suggested a reduction but your daughter cannot tolerate it, it may be necessary to stick with her current prescription or even increase it slightly if she demonstrates improved clarity with a higher degree.

Visual Development Considerations
Given that your daughter has a history of amblyopia, it is essential to ensure that her visual system is being adequately stimulated. Here are some considerations:
- Regular Eye Exams: Frequent follow-ups with an eye care professional are crucial. They can monitor her visual acuity and make adjustments as needed based on her progress.

- Vision Therapy: If her visual development is lagging, vision therapy may be beneficial. This can help improve her eye coordination and strengthen her visual processing skills.

- Engagement in Visual Activities: Encourage activities that promote visual engagement, such as reading, puzzles, and games that require focusing on near objects. This can help stimulate her visual system.

Conclusion
In summary, it is essential to provide your daughter with the full correction for her hyperopia to support her visual development. If she is unable to tolerate a reduced prescription, it is advisable to maintain her current prescription or consider increasing it if it provides her with clearer vision. Regular follow-ups with her eye care provider will ensure that her visual needs are met as she grows. Additionally, incorporating visual activities and possibly exploring vision therapy can further support her visual development. Always consult with a pediatric optometrist or ophthalmologist for personalized advice tailored to her specific needs.

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