Short Eyes, Blurred Vision: A Case of Axial High Hyperopia and Suspected Amblyopia in Childhood
Main Article Content
Introduction. Hypermetropia is a common refractive error in children that, when significant, may impair visual function and increase the risk of amblyopia and strabismus. Amblyopia is a developmental visual disorder characterized by reduced best-corrected visual acuity due to abnormal visual experience during childhood. Early identification and appropriate refractive correction are important for maximizing visual development. Such cases may have reduced visual acuity despite initial refractive correction. This report describes the management of high hypermetropia with suspected bilateral ametropic amblyopia and aims to improve best-corrected visual acuity through proper correction. Methods. An 8-year-old student presenting with bilateral blurred vision for two months, aggravated by reading and mobile phone use, underwent ophthalmological assessment, including visual acuity measurement, pinhole testing, cycloplegic refraction, and crowding testing. Symptoms, daily screen exposure, spectacle prescription, and visual acuity at one-month follow-up were documented. Results. The patient reported no diplopia, squinting, redness, or watering of the eyes. The mother reported mobile phone use exceeding six hours daily without breaks. Initial visual acuity was 6/30 in both eyes, improving to 6/21 with pinhole testing. Cycloplegic refraction revealed +5.25 D spherical in both eyes, improving visual acuity to 6/18 and to 6/15 on crowding testing. The patient was prescribed +5.00 D spherical spectacles bilaterally. At one month, best-corrected visual acuity improved from 6/18 to 6/15. Conclusion. High hypermetropia with suspected bilateral ametropic amblyopia requires appropriate refractive correction and regular follow-up. Improved visual acuity after spectacle correction demonstrates potential visual benefit. Continued monitoring remains important to assess visual development.
2. Mavi S, Chan V, Virgili G, Biagini I, Congdon N, Piyasena P. The Impact of Hyperopia on Academic Performance Among Children: A Systematic Review. Asia-Pacific J Ophthalmol. 2022;11(1):36–51.
3. Rosenfield M. Refractive Status of the Eye. In: Butterworth H, editor. Borish’s Clinical Refraction. 2nd ed. USA: Elsevier; 2006. p. 9–11.
4. Mukherjeen P. Manual Optics and Refraction. In: Comprehensive Ophthalmology. 4th ed. New Delhi: Jaypee Brothers Medical Publishers; 2015. p. 72–7.
5. Khurana A. Optics and Refraction. In: Comprehensive Ophthalmology. 4th ed. New Delhi: New Age International Publisher; 2017. p. 38–9.
6. Yuliana J. Aspek Klinis Ambliopia. Cermin Dunia Kedokteran. 2022 Jan 3;49(1):19–22. doi:10.55175/cdk.v49i1.182
7. Hu B, Liu Z, Zhao J, Zeng L, Hao G, Shui D, et al. The Global Prevalence of Amblyopia in Children: A Systematic Review and Meta-Analysis. Front Pediatr. 2022 May 4;10. doi:10.3389/fped.2022.819998
8. Kulp MT, Ciner E, Ying G, Shuang, Candy TR, Moore BD, Orel-Bixler D. Vision Screening, Vision Disorders, and Impacts of Hyperopia in Young Children: Outcomes of the Vision in Preschoolers (VIP) and Vision in Preschoolers – Hyperopia in Preschoolers (VIP-HIP) Studies. Asia-Pacific Journal of Ophthalmology. 2022 Jan;11(1):52–8. doi:10.1097/APO.0000000000000483
9. Plasencia CR, Plasencia JP, García CC, Caballero-Alvarado J, Zavaleta-Corvera C. Risk factors associated with amblyopia in children: a case-control study. Russian Annals of Ophthalmology. 2026 Aug 18;142(4):46. doi:10.17116/oftalma202614204146
10. Blair K, Zeppieri M, Gulani AC. Amblyopia. 2024. PubMed PMID: 28613640.
11. Kalpadakis-Smith A V., Tailor VK, Dahlmann-Noor AH, Greenwood JA. Crowding changes appearance systematically in peripheral, amblyopic, and developing vision. J Vis. 2022 May 4;22(6):3. doi:10.1167/jov.22.6.3
12. Waugh SJ, Fronius M. Landolt C-Tests With “Fixed” Arcmin Separations Detect Amblyopia But Underestimate Crowding in Moderate-to-Severe Amblyopic Children and Adults. Invest Ophthalmol Vis Sci. 2024 Aug 23;65(10):33. doi:10.1167/iovs.65.10.33
13. Majumdar S, Tripathy K. Hyperopia. 2023. PubMed PMID: 32809551.
14. García-Montero M, Felipe-Márquez G, Arriola-Villalobos P, Garzón N. Pseudomyopia: A Review. Vision. 2022 Mar 4;6(1):17. doi:10.3390/vision6010017
15. Manna P, Karmakar S, Bhardwaj GK, Mondal A. Accommodative spasm and its different treatment approaches: A systematic review. Eur J Ophthalmol. 2023 May 16;33(3):1273–86. doi:10.1177/11206721221136438
16. Hutchinson AK, Morse CL, Hercinovic A, Cruz OA, Sprunger DT, Repka MX, et al. Pediatric Eye Evaluations Preferred Practice Pattern. Ophthalmology. 2023 Mar;130(3):P222–70. doi:10.1016/j.ophtha.2022.10.030. PubMed PMID: 36543602.
17. Cruz OA, Repka MX, Hercinovic A, Cotter SA, Lambert SR, Hutchinson AK, et al. Amblyopia Preferred Practice Pattern. Ophthalmology. 2023 Mar;130(3):P136–78. doi:10.1016/j.ophtha.2022.11.003
