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Attention and Visual Motor Integration in Young Children with Uncorrected Hyperopia

Kulp, Marjean, Taylor, OD, MS, FAAO1*; Ciner, Elise, OD, FAAO2; Maguire, Maureen, PhD3; Pistilli, Maxwell, MS, MEd3; Candy, T., Rowan, PhD, FAAO4; Ying, Gui-shuang, PhD3; Quinn, Graham, MD, MSCE5; Cyert, Lynn, PhD, OD, FAAO6; Moore, Bruce, OD, FAAO7for the Vision in Preschoolers-Hyperopia in Preschoolers Study Group

doi: 10.1097/OPX.0000000000001123

SIGNIFICANCE Among 4- and 5-year-old children, deficits in measures of attention, visual-motor integration (VMI) and visual perception (VP) are associated with moderate, uncorrected hyperopia (3 to 6 diopters [D]) accompanied by reduced near visual function (near visual acuity worse than 20/40 or stereoacuity worse than 240 seconds of arc).

PURPOSE To compare attention, visual motor, and visual perceptual skills in uncorrected hyperopes and emmetropes attending preschool or kindergarten and evaluate their associations with visual function.

METHODS Participants were 4 and 5 years of age with either hyperopia (≥3 to ≤6 D, astigmatism ≤1.5 D, anisometropia ≤1 D) or emmetropia (hyperopia ≤1 D; astigmatism, anisometropia, and myopia each <1 D), without amblyopia or strabismus. Examiners masked to refractive status administered tests of attention (sustained, receptive, and expressive), VMI, and VP. Binocular visual acuity, stereoacuity, and accommodative accuracy were also assessed at near. Analyses were adjusted for age, sex, race/ethnicity, and parent's/caregiver's education.

RESULTS Two hundred forty-four hyperopes (mean, +3.8 ± [SD] 0.8 D) and 248 emmetropes (+0.5 ± 0.5 D) completed testing. Mean sustained attention score was worse in hyperopes compared with emmetropes (mean difference, −4.1; P < .001 for 3 to 6 D). Mean Receptive Attention score was worse in 4 to 6 D hyperopes compared with emmetropes (by −2.6, P = .01). Hyperopes with reduced near visual acuity (20/40 or worse) had worse scores than emmetropes (−6.4, P < .001 for sustained attention; −3.0, P = .004 for Receptive Attention; −0.7, P = .006 for VMI; −1.3, P = .008 for VP). Hyperopes with stereoacuity of 240 seconds of arc or worse scored significantly worse than emmetropes (−6.7, P < .001 for sustained attention; −3.4, P = .03 for Expressive Attention; −2.2, P = .03 for Receptive Attention; −0.7, P = .01 for VMI; −1.7, P < .001 for VP). Overall, hyperopes with better near visual function generally performed similarly to emmetropes.

CONCLUSIONS Moderately hyperopic children were found to have deficits in measures of attention. Hyperopic children with reduced near visual function also had lower scores on VMI and VP than emmetropic children.

1The Ohio State University, College of Optometry, Columbus, Ohio

2Salus University, Pennsylvania College of Optometry Elkins Park, Pennsylvania

3Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania

4Indiana University School of Optometry, Bloomington, Indiana

5Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

6Northeastern State University College of Optometry, Tahlequah, Oklahoma

7New England College of Optometry, Boston, Massachusetts *

Submitted: January 3, 2017

Accepted: June 11, 2017

Corrected: June 1, 2018

Funding/Support: This work was supported by the National Eye Institute of the National Institutes of Health, Department of Health and Human Services R01EY021141, and by the Ohio Lions Eye Research Foundation. The funding organizations had no role in the design or conduct of this research.

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions and Acknowledgments: Conceptualization: MTK, EC, MM, GY, GQ, LC, BM; Funding Acquisition: MTK, EC, MM, GY, GQ, LC, BM; Investigation: MTK, EC, BM; Methodology: MTK, EC, MM, MP, TRC, GY, GQ, LC, BM; Project Administration: MTK, EC, MM; Resources: MTK, EC; Supervision: MTK, EC, MM; Writing — Original Draft: MTK, MP; Writing — Review and Editing: MTK, EC, MM, MP, TRC, GY, GQ, LC, BM; Data Curation: MM, MP; Formal Analysis: MM, MP, GY; Validation: MM, MP, GY.

The authors thank the following: Velma Dobson, PhD, who contributed to the design of the study; NEI liaison: Maryann Redford, DDS, MPH; Jack Naglieri, PhD, who provided consultation regarding administration and interpretation of the Cognitive Assessment System attention testing.

Presented in part at the Association for Research in Vision and Ophthalmology (Attention) and American Academy of Optometry (Visual-Motor Integration) Meetings, 2016.

Vision in Preschoolers-Hyperopia in Preschoolers (VIP-HIP) Study Group

Pennsylvania College of Optometry at Salus University: Elise Ciner, OD (principal investigator [PI], eye examiner [EE]); Whitley Harbison (coordinator [C], educational assessor [EA]); Zack Margolies, MSW (EA); Sarah McHugh-Grant (C, EA); Erin Engle (EA); Richard Schulang, MEd (EA); Gale Orlansky, OD, MEd (EE); Leah Sack (C); Jasmine Campbell (C).

The Ohio State University College of Optometry: Marjean Taylor Kulp, OD, MS (PI); Julie Preston, OD, PhD, MEd (EA); Andrew Toole, OD, PhD (EE); Tamara Oechslin, OD, PhD (EE); Nancy Stevens, MS, RD, LD (C); Pam Wessel (C). New England College of Optometry: Bruce Moore, OD (PI); Marcia Feist-Moore, MEd (EA); Catherine Johnson, OD (EE); Stacy Lyons, OD (EE); Nicole Quinn, OD (EE); Renee Mills, BS (C).

Data Coordinating Center at University of Pennsylvania: Maureen Maguire, PhD (PI); Maria Blanco; Mary Brightwell-Arnold; James Dattilo; Sandra Harkins; Christopher Helker, MSPH; Ellen Peskin, MA; Maxwell Pistilli, MS; Gui-Shuang Ying, PhD.

Vision in Preschoolers-Hyperopia in Preschoolers Executive Committee: Marjean Taylor Kulp, OD, MS (Study Chair); Elise Ciner, OD; Maureen Maguire, PhD; Bruce Moore, OD; Lynn Cyert, OD, PhD; Graham Quinn, MD, MSCE; T. Rowan Candy, PhD; Jill Pentimonti, PhD, Gui-Shuang Ying, PhD.

Educational consultants: Robert H. Bradley, PhD, Laura Justice, PhD, CCC-SLP, Jill Pentimonti, PhD.

© 2017 American Academy of Optometry