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Resumo Objetivo: Comparar as alterações da refração e da biometria ocular na população infantil hipermetrópica com e sem correção óptica total. Métodos: Realizou-se estudo prospectivo longitudinal não randomizado em 41 pacientes com hipermetropia, entre 3 e 6 dioptrias ou/e com esotropia acomodativa pura nos ambulatórios do Hospital Geral Universitário e Oftalmocenter Santa Rosa, com idade inicial entre 4 e 6 anos. Os pacientes foram divididos em dois grupos, em que o Grupo 1 compôs-se pelos pacientes hipermétropes que não necessitavam usar sua correção óptica ou poderiam usá-la parcialmente, e o Grupo 2 por pacientes com esotropia acomodativa pura e pelos hipermétropes que necessitavam usar toda sua correção óptica. Os pacientes submeteram-se a exame oftalmológico completo, incluindo refração objetiva em autorrefrator com cicloplegia, biometria óptica e topografia corneana em uma medida inicial e outra 3 anos mais tarde. Comparou-se a refração e parâmetros biométricos com teste T student. Resultados: A média da idade inicial foi de 5,23 ± 0,81 e 5,36 ± 0,74 anos, a refração inicial foi +3,99 ± 0,92 e +4,27 ± 0,85 D, o diâmetro anteroposterior do globo ocular foi de 21,42 ± 0,84 e 21,22 ± 0,86 mm, e a ceratometria foi de 42,55 ± 1,24 e 42,39 ± 1,22 D, para os Grupos 1 e 2, respectivamente. Em relação à refração, houve redução significativa do poder esférico no Grupo 1, em 3 anos; e não houve no Grupo 2 (p<0,05). Com relação ao diâmetro anteroposterior do globo ocular, ocorreu aumento significativo no Grupo 1 e não houve no Grupo 2 (p<0,05 ). Não se verificou diferença significativa na comparação das ceratometrias em 3 anos nos Grupos 1 e 2. Conclusão: Estes dados permitiram concluir que a correção total da hipermetropia pode prejudicar a emetropização natural em crianças.

Abstract Objective: To compare changes in refraction and ocular biometric parameters in hyperopic children with and without full optical correction. Methods: Non-randomized prospecting study with 41 subjects (21 males and 20 females) aged 4 to 6 years with accommodative esotropia and or hyperopia between 3 to 6 diopters, select in Hospital Geral Universitário and Oftalmocenter Santa Rosa. The patients were divided in two groups: group 1 for hyperopic patients that did not need to use optical correction or could use partial correction, and group 2 for patients with accommodative esotropia or hyperopia who needed to use full optical correction all the time. The patients were examined to a complete ophthalmological examination, including objective cycloplegic refraction with auto refractometer, optical biometry and corneal topography, in baseline measurements and 3 years after that. Refraction and ocular biometric parameters were compared using T student test. Results: The mean initial age was 5.23 ± 0.81 and 5.36 ± 0.74 years; the initial refractive error in average was +3.99 ± 0.92 e +4.27 ± 0.85 D, the initial axial length was 21.42 ± 0.84 and 21.22 ± 0.86 mm, and initial keratometry was 42.55 ± 1.24 e 42.39 ± 1.22 D for group 1 and 2, respectively. In relation to refractive error, there was a significant decrease in group 1 and there was not in group 2 (p < 0.05). In relation to axial length, there was significant increase in group1 and there was not in group 2 (p<0.05). The 3-year comparison showed no statistically significant differences in keratometry for both groups. Conclusion: This study suggests that full optical correction of hyperopia may inhibit natural emmetropization during early and late childhood.

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PURPOSE: This study explores the natural history of hyperopic refractive error in relation to the recalled age of first distance prescription. METHODS: A population of adult office workers, coming for a general health check-up without refractive selection, completed a questionnaire about age of first distance prescription and were refracted by an ophthalmologist with non-cycloplegic subjective procedures. Hyperopia was defined as a spherical equivalent of +0.75 diopters or more. This study included 145 hyperopes aged 50-65 years at interview. RESULTS: The hyperopic subjects were first prescribed spectacles for distance vision in a broad spectrum of ages, from early childhood to adulthood. The subjects with older ages of first prescription tended to develop lower amounts of refractive error but this relation was not significant (Spearman's rho -0.126, p = 0.131). CONCLUSIONS: The age of first spectacle prescription in hyperopes is not strongly related to the final refractive error developed in adulthood.

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We have been using an Excimer Laser with flying spot technology to perform LASIK for the past 3 months. Both eyes are treated at the same sitting unless surgery is indicated in only one. Thirty-one patients have been treated, 30 had both eyes done while one had only one. The author has been privileged to follow the progress of 32 eyes of 16 patients. Target correction was achieved in 72 percent; correction acceptable to patient in 87.5 percent, enhancements were required in (4 eyes) 12.5 percent. Follow-up extended over 2 weeks to 3 months. Refractive errors corrected: hyperopia (two eyes), myopia (2 eyes) hyperopic astigmatism (10), myopic astigmatism (14), mixed astigmatism (4) Range of errors -8:50 DS to + 3:00 DS, and up to -4.25 DC. Age ranged from 26-68yrs; with 2 patients in their 60s and 3 in their 40s. Pre-operative best corrected visual acuity (BCVA) was 20/20 for distance and 20/20 for near, in all eyes. No loss of BCVA was recorded. COMPLICATIONS AND SIDE EFFECTS: One eye suffered a button-hole flap leading to minor off-axis scarring. Uncorrected vision of 20/20 for near was achieved as desired. One patient needs spectacles for glare at night. One patient is experiencing fluctuating vision at 2 weeks post op. (20/20 to 20/40). One eye with undesired astigmatism of -1.75 DC. Undercorrection in one eye: myopic ending -0.75; -1.50 being desired. These results have been very encouraging. The patients came from businesses and professional groups with one office clerk, an airline pilot and a sporting personality. With enhancements and the development of personal nomograms, a high success rate is anticipated. (AU)

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Selection of patients, identification of the dominant eye and several other issues are analyzed. The results in 167 patients are presented. The best results were obtained in previous hyperopic patients in whom, of the 100 percent of patients with previous vision worse than 20/40 and J4, 90 percent were better than 20/25 and J2. In hyperopia, an overcorrection of the nondominant eye was induced while in myopia an undercorrection of the nondominant was the target. In this group 93 percent of the patients had vision worse than 20/100, J1 and 86 percent obtained better vision of 20/25 preserving J1. Examples of the different procedures are presented and at the end recommendations to get good results given. (AU)

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Se reportan los resultados de 194 altas anisometropías tratadas c.c. total mediante lentes de contacto, mayoritariamente en pacientes adultos. El alto porcentaje de éxitos alcanzados en estos pacientes, en cuanto a la curación de la ambliopía y a la restitución de la visión binocular con estereopsia, se oponen a diversos conceptos arraigados en la literatura, que se relaciona con la diferente modalidad de su corrección, con las limitaciones determinadas por la edad del paciente, y al mal pronóstico que se le atribuye tanto a su ambliopía como a la posibilidad en recuperar su visión binocular en el adulto

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