Parent strategies for improving compliance with eyeglass wear in young children.

SIGNIFICANCE: Results of this study provide preliminary data on parent strategies for improving compliance with eyeglass treatment in young children, an age group for which previous data are limited. Parent responses provide important insights to support parents of young children who wear eyeglasses and provide preliminary data to guide additional research. PURPOSE: The goal of this exploratory study was to learn more about parents' strategies to improve compliance with eyeglass treatment of young children. METHODS: An online survey of parents of 1-year-old to less than 5-year-old children who wear eyeglasses was conducted. Parents indicated whether they used various strategies to encourage wear and were asked to provide advice for parents of young children recently prescribed eyeglasses. Use of various strategies by age was determined. Open-ended responses regarding advice for other parents were analyzed using qualitative content analysis. RESULTS: The final sample included 104 parents who were predominantly White (81%), non-Hispanic (76%), and college graduates (68%). During the 2 weeks prior to survey completion, 74% of parents reported their child wore their eyeglasses ≥8 hours/day. Use of strategies for improving eyeglass wear varied by child age. The most frequent recommendations that parents provided for other parents were to be consistent in encouraging wear, use social modeling, provide positive reinforcement when the eyeglasses are worn, and ensure that the eyeglasses fit well and were comfortable. CONCLUSIONS: Parents provided many useful insights into their experiences. However, results may not be broadly generalizable, because of the limited diversity and high rate of compliance in the study sample. Further research with more diverse populations and research on effectiveness of various strategies to increase compliance in this age group are recommended to support eyeglass treatment compliance in young children.

Interrater and Test-Retest Reliability of the Beery Visual-Motor Integration in Schoolchildren.

PURPOSE: To assess interrater and test-retest reliability of the 6th Edition Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) and test-retest reliability of the VMI Visual Perception Supplemental Test (VMIp) in school-age children. METHODS: Subjects were 163 Native American third- to eighth-grade students with no significant refractive error (astigmatism <1.00 D, myopia <0.75 D, hyperopia <2.50 D, anisometropia <1.50 D) or ocular abnormalities. The VMI and VMIp were administered twice, on separate days. All VMI tests were scored by two trained scorers, and a subset of 50 tests was also scored by an experienced scorer. Scorers strictly applied objective scoring criteria. Analyses included interrater and test-retest assessments of bias, 95% limits of agreement, and intraclass correlation analysis. RESULTS: Trained scorers had no significant scoring bias compared with the experienced scorer. One of the two trained scorers tended to provide higher scores than the other (mean difference in standardized scores = 1.54). Interrater correlations were strong (0.75 to 0.88). VMI and VMIp test-retest comparisons indicated no significant bias (subjects did not tend to score better on retest). Test-retest correlations were moderate (0.54 to 0.58). The 95% limits of agreement for the VMI were -24.14 to 24.67 (scorer 1) and -26.06 to 26.58 (scorer 2), and the 95% limits of agreement for the VMIp were -27.11 to 27.34. CONCLUSIONS: The 95% limit of agreement for test-retest differences will be useful for determining if the VMI and VMIp have sufficient sensitivity for detecting change with treatment in both clinical and research settings. Further research on test-retest reliability reporting 95% limits of agreement for children across different age ranges is recommended, particularly if the test is to be used to detect changes due to intervention or treatment.

Reading Fluency in School-Aged Children with Bilateral Astigmatism.

PURPOSE: To compare oral reading fluency (ORF) in students with no/low astigmatism and moderate/high astigmatism and to assess the impact of spectacle correction on ORF in moderate and high astigmats. METHODS: Subjects were third- to eighth-grade students from a highly astigmatic population. Refractive error was determined through subjectively refined cycloplegic autorefraction. Data from students with ocular abnormalities, anisometropia, symptomatic binocular vision disorders, or refractive error that did not meet study criteria (no/low [cylinder < 1.00 both eyes, no significant myopia/hyperopia], moderate [cylinder ≥ 1.00 D both eyes, mean ≥ 1.00 D and < 3.00 D], or high astigmatism group [cylinder ≥ 1.00 D both eyes, mean ≥ 3.00 D]) were excluded. Oral reading fluency was tested with a modified version of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) Next test of ORF. No/low astigmats were tested without spectacles; astigmats were tested with and without spectacles. Mean ORF was compared in no/low astigmats and astigmats (with and without correction). Improvement in ORF with spectacles was compared between moderate and high astigmats. RESULTS: The sample included 130 no/low, 67 moderate, and 76 high astigmats. ORF was lower in uncorrected astigmats than in no/low astigmats (p = 0.011). ORF did not significantly differ in no/low astigmats and corrected astigmats (p = 0.10). ORF significantly improved with spectacle correction in high astigmats (p = 0.001; mean improvement, 6.55 words per minute) but not in moderate astigmats (p = 0.193; mean improvement, 1.87 words per minute). Effects of spectacle wear were observed in students who read smaller text stimuli (older grades). CONCLUSIONS: ORF is significantly reduced in students with bilateral astigmatism (≥1.00D) when uncorrected but not when best-corrected compared with their nonastigmatic peers. Improvement in ORF with spectacle correction is seen in high astigmats but not in moderate astigmats. These data support the recommendation for full-time spectacle wear in astigmatic students, particularly those with high astigmatism.

Rasch analysis of the Student Refractive Error and Eyeglass Questionnaire.

PURPOSE: To evaluate and refine a newly developed instrument, the Student Refractive Error and Eyeglasses Questionnaire (SREEQ), designed to measure the impact of uncorrected and corrected refractive error on vision-related quality of life (VRQoL) in school-aged children. METHODS: A 38-statement instrument consisting of two parts was developed: part A relates to perceptions regarding uncorrected vision and part B relates to perceptions regarding corrected vision and includes other statements regarding VRQoL with spectacle correction. The SREEQ was administered to 200 Native American 6th- through 12th-grade students known to have previously worn and who currently require eyeglasses. Rasch analysis was conducted to evaluate the functioning of the SREEQ. Statements on parts A and B were analyzed to examine the dimensionality and constructs of the questionnaire, how well the items functioned, and the appropriateness of the response scale used. RESULTS: Rasch analysis suggested two items be eliminated and the measurement scale for matching items be reduced from a four-point response scale to a three-point response scale. With these modifications, categorical data were converted to interval-level data to conduct an item and person analysis. A shortened version of the SREEQ was constructed with these modifications, the SREEQ-R, which included the statements that were able to capture changes in VRQoL associated with spectacle wear for those with significant refractive error in our study population. CONCLUSIONS: Although part B of the SREEQ appears to have a less-than-optimal reliability to assess the impact of spectacle correction on VRQoL in our student population, it is able to detect statistically significant differences from pretest to posttest on both the group and individual levels to show that the instrument can assess the impact that glasses have on VRQoL. Further modifications to the questionnaire, such as those included in the SREEQ-R, could enhance its functionality.

Astigmatism and myopia in Tohono O'odham Native American children.

PURPOSE: To describe change in spherical equivalent (M) in a longitudinal sample of Tohono O'odham students ages 3 to 18 years and to test the hypothesis that astigmatism creates complex cues to emmetropization, resulting in increased change in M in the direction of increasing myopia and increased occurrence of myopia. METHODS: Subjects were 777 Tohono O'odham Native American children on whom cycloplegic right eye autorefraction was measured on at least two study encounters between ages 3 and 18 years (first encounter prior to age 5.5 years, final encounter ≥3 years later). Regression lines were fit to individual subjects' longitudinal M data to estimate rate of change in M (regression slope, D/yr). Regression was also used to predict if a subject would be myopic (≤-0.75 D M) by age 18 years. Analysis of covariance was used to assess the relation between M slope and magnitude of baseline M and astigmatism. Chi-square analyses were used to assess the relation between predicted myopia onset and magnitude of baseline M and astigmatism. RESULTS: Mean M slope was significantly more negative for hyperopes (M ≥ +2.00) than for myopes (M ≤ -0.75) or for subjects neither hyperopic nor myopic (NHM, M > -0.75 and < +2.00), but there was no significant difference between the myopic and NHM groups. Chi-square analysis indicated that final myopia status varied across level of baseline astigmatism. Subjects with high astigmatism were more likely to be predicted to have significant myopia by age 18 years. CONCLUSIONS: The association between greater shift in M towards myopia with age in subjects who were hyperopic at baseline is consistent with continued emmetropization in the school years. Results regarding predicted myopia development imply that degradation of image quality due to refractive astigmatism creates complex cues to emmetropization, resulting in increased occurrence of myopia.

The Intersection of Behavioral Economics and the General Medicine Literature.

Judgment and decision-making influence health-related behavior and clinical decision-making and, ultimately, health. It has been estimated that more than half of health disorders derive from behavioral consequences of unhealthy choices. We considered the question of how to better understand and improve decision-making in health and medicine through a narrative review of use and examples of concepts from Behavioral Economics, a field of study that combines insights from behavioral science and economic decision-making, in the 3 highest-impact general medicine journals.

Objective Assessment of Spectacle Wear in Infants and Toddlers Using a Wearable Sensor.

Purpose: To assess the feasibility of using a thermal microsensor to monitor spectacle wear in infants and toddlers, to determine the inter-method reliability of two methods of estimating spectacle wear from sensor data, and to validate sensor estimates of wear. Methods: Fourteen children, 3 to <48 months of age, and one adult were provided pediatric spectacles containing their spectacle prescription. A thermal microsensor attached to the spectacle headband recorded date, time, and ambient temperature every 15 minutes for 14 days. Parents were asked for daily spectacle wear reports, and the adult recorded wear using a smartphone app. Sensor data were dichotomized (wear/non-wear) using two methods: temperature threshold (TT) and human judgment (HJ). Kappa statistics assessed inter-method reliability (child data) and accuracy (adult data). Results: Data from two child participants were excluded (one because of corrupted sensor data and the other because of no parent log data). Sensor data were collected more reliably than parent wear reports. The TT and HJ analysis of child data yielded similar reliability. Adult sensor data scored using the HJ method provided more valid estimates of wear than the TT method (κ = 0.94 vs. 0.78). Conclusions: We have demonstrated that it is feasible to deduce periods of spectacle wear using a thermal data logger and that the sensor is tolerated by children. Translational Relevance: Results indicate that it is feasible to use a thermal microsensor to measure spectacle wear for use in clinical monitoring or for research on spectacle treatment in children under 4 years of age.

Amblyopia in astigmatic infants and toddlers.

PURPOSE: To determine whether reduced astigmatism-corrected acuity for vertical (V) and/or horizontal (H) gratings and/or meridional amblyopia (MA) are present before 3 years of age in children who have with-the-rule astigmatism. METHODS: Subjects were 448 children, 6 months through 2 years of age with no known ocular abnormalities other than with-the-rule astigmatism, who were recruited through Women, Infants and Children clinics on the Tohono O'odham reservation. Children were classified as non-astigmats (< or =2.00 diopters) or astigmats (>2.00 diopters) based on right eye non-cycloplegic autorefraction measurements (Welch Allyn SureSight). Right eye astigmatism-corrected grating acuity for V and H stimuli was measured using the Teller Acuity Card procedure while children wore cross-cylinder lenses to correct their astigmatism or plano lenses if they had no astigmatism. RESULTS: Astigmatism-corrected acuity for both V and H gratings was significantly poorer in the astigmats than in the non-astigmats, and the reduction in acuity for astigmats was present for children in all three age groups examined (6 months to <1 year, 1 to <2 years, and 2 to <3 years). There was no significant difference in V-H grating acuity (no evidence of MA) for the astigmatic group as a whole, or when data were analyzed for each age group. CONCLUSIONS: Even in the youngest age group, astigmats tested with astigmatism correction showed reduced acuity for both V and H gratings, which suggests that astigmatism is having a negative influence on visual development. We found no evidence of orientation-related differences in astigmatism-corrected grating acuity, indicating either that MA does not develop before 3 years of age, or that most of the astigmatic children had a type of astigmatism, i.e., hyperopic, that has proven to be less likely than myopic or mixed astigmatism to result in MA.

Prevalence of astigmatism in Native American infants and children.

PURPOSE: To describe the prevalence of high astigmatism in infants and young children who are members of a Native American tribe with a high prevalence of astigmatism. METHODS: SureSight autorefraction measurements were obtained for 1461 Tohono O'odham children aged 6 months to 8 years. RESULTS: The prevalence of astigmatism >2.00 diopters was 30% in Tohono O'odham children during infancy (6 months to <1 year of age) and was 23 to 29% at ages 2 to 7 years. However, prevalence dipped to 14% in children 1 to <2 years of age. At all ages, axis of astigmatism was with-the-rule (plus cylinder axis 90 degrees +/- 30 degrees ) in at least 94% of cases. CONCLUSIONS: As in non-Native American populations, Tohono O'odham infants show a high prevalence of astigmatism, which decreases in the second year of life. However, the prevalence of high astigmatism in Tohono O'odham children increases by age 2 to <3 years to a level near that seen in infancy and remains at that level until at least age 8 years. Longitudinal data are needed to determine whether the increase in high astigmatism after infancy occurs in infants who had astigmatism as infants or is due to the development of high astigmatism in children who did not show astigmatism during infancy.

Telemedicine distance and near visual acuity tests for adults and children.

We describe a set of distance and near, adult and child, visual acuity tests for home use. The five charts are packaged in a PDF document and are also available as JPEG images that can be printed on standard letter paper or displayed on a monitor or handheld device. Adult distance visual acuity is tested using a modified ETDRS Chart R; child distance vision is tested using a similarly formatted HOTV logMAR chart. Testing distance is 5 or 10 feet, appropriate for home use. Near visual acuity is displayed in the range of J16 to J1 using random words (for adults) or in HOTV matching format (for young children). An Amsler Grid and HOTV matching card are included. The charts include a calibration circle. For those without a printer, sending a JPEG image as an email attachment initiates onscreen testing with a single click. Devices with smaller screens require an assistant to scroll through the display. The test can performed without assistance from a printed page.

Optical treatment reduces amblyopia in astigmatic children who receive spectacles before kindergarten.

OBJECTIVE: To examine the effect of spectacle correction of astigmatism during preschool on best-corrected recognition visual acuity (VA), grating VA, and meridional amblyopia (difference between acuity for vertical versus horizontal gratings) once the children reach kindergarten. DESIGN: Comparative case series. PARTICIPANTS: Seventy-three astigmatic (right eye > or =1.50 diopters [D] cylinder) Native American (Tohono O'odham) children 5 to 7 years of age. All had with-the-rule astigmatism. In 28 children, the astigmatism was simple myopic, compound myopic, or mixed (M/MA), and in 45 children, it was simple or compound hyperopic (HA). INTERVENTION: Thirty-nine children (Treated Group) had spectacle correction of refractive error, prescribed for full-time wear, in preschool (0.8-2.4 years before testing). Thirty-four children (Untreated Group) had no prior correction. MAIN OUTCOME MEASURE: Comparison of Treated versus Untreated Groups for mean best-corrected right-eye recognition VA, measured with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and the Lea Symbols chart, for grating VA, measured with modified Teller acuity card stimuli, and for meridional amblyopia, based on grating acuity results. RESULTS: Mean ETDRS VA was significantly better in the Treated Group (20/37) than in the Untreated Group (20/48; P<0.003), but the difference between mean Lea Symbols VA in the Treated Group (20/33) and in the Untreated Group (20/38) was not significant. No significant Treated versus Untreated Group differences were found for either vertical or horizontal grating acuity. Meridional amblyopia differed between the M/MA group, which showed better acuity for vertical than for horizontal gratings, and the HA group, which showed better acuity for horizontal than for vertical gratings. However, in neither the M/MA group nor the HA group was there a significant difference in magnitude of meridional amblyopia in the Treated versus the Untreated Group. CONCLUSIONS: Spectacle correction during the preschool years results in a significant improvement in best-corrected letter recognition acuity in astigmatic children by the time they reach kindergarten. However, grating acuity was not improved and magnitude of meridional amblyopia was not reduced in children who had received early spectacle correction. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Normative monocular visual acuity for early treatment diabetic retinopathy study charts in emmetropic children 5 to 12 years of age.

OBJECTIVE: To provide normative data for children tested with Early Treatment Diabetic Retinopathy Study (ETDRS) charts. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 252 Native American (Tohono O'odham) children aged 5 to 12 years. On the basis of cycloplegic refraction conducted on the day of testing, all were emmetropic (myopia < or =0.25 diopter [D] spherical equivalent, hyperopia < or =1.00 D spherical equivalent, and astigmatism < or =0.50 D in both eyes). METHODS: Monocular visual acuity was tested at 4 m, using 1 ETDRS chart for the right eye (RE) and another for the left eye (LE). MAIN OUTCOME MEASURES: Visual acuity was scored as the total number of letters correctly identified, by naming or matching to letters on a lap card, and as the smallest letter size for which the child identified 3 of 5 letters correctly. RESULTS: Visual acuity results did not differ for the RE versus the LE, so data are reported for the RE only. Mean visual acuity for 5-year-olds (0.16 logarithm of the minimum angle of resolution [logMAR] [20/29]) was significantly worse than for 8-, 9-, 10-, 11-, and 12-year-olds (0.05 logMAR [20/22] or better at each age). The lower 95% prediction limit for determining whether a child has visual acuity within the normal range was 0.38 (20/48) for 5-year-olds and 0.30 (20/40) for 6- to 12-year-olds, which was reduced to 0.32 (20/42) for 5-year-olds and 0.21 (20/32) for 6- to 12-year-olds when recalculated with outlying data points removed. Mean interocular acuity difference did not vary by age, averaging less than 1 logMAR line at each age, with a lower 95% prediction limit of 0.17 log unit (1.7 logMAR lines) across all ages. CONCLUSIONS: For monocular visual acuity based on ETDRS charts to be in the normal range, it must be better than 20/50 for 5-year-olds and better than 20/40 for 6- to 12-year-olds. Normal interocular acuity difference includes values of less than 2 logMAR lines. Normative ETDRS visual acuity values are not as good as norms reported for adults, suggesting that a child's visual acuity results should be compared with norms based on data from children, not with adult norms.

Development and treatment of astigmatism-related amblyopia.

Blur induced by uncorrected astigmatism during early development can result in amblyopia, as evidenced by reduced best-corrected vision relative to normal, in measures of grating acuity, vernier acuity, contrast sensitivity across a range of spatial frequencies, recognition acuity, and stereoacuity. In addition, uncorrected astigmatism during early development can result in meridional amblyopia, or best-corrected visual deficits that are greater for, or are present only for, specific stimulus orientations. Astigmatism-related amblyopia can be successfully treated with optical correction in children as old as school age, but the amblyopia may not be completely eliminated with optical treatment alone, and the age at which optical treatment is most effective has yet to be determined. Future research on determining the period of susceptibility of the visual system to negative effects of uncorrected astigmatism and exploration of alternative or complimentary treatment methods, in addition to optical correction, are warranted.

Changes in visual function following optical treatment of astigmatism-related amblyopia.

Effects of optical correction on best-corrected grating acuity (vertical (V), horizontal (H), oblique (O)), vernier acuity (V, H, O), contrast sensitivity (1.5, 6.0, and 18.0 cy/deg spatial frequency, V and H), and stereoacuity were evaluated prospectively in 4- to 13-year-old astigmats and a non-astigmatic age-matched control group. Measurements made at baseline (eyeglasses dispensed for astigmats), 6 weeks, and 1 year showed greater improvement in astigmatic than non-astigmatic children for all measures. Treatment effects occurred by 6 weeks, and did not differ by cohort (<8 vs. >or= 8 years), but astigmatic children did not attain normal levels of visual function.

Spectacle Wear in Toddlers: Frequency of Wear and Impact of Treatment on the Child and Family.

PURPOSE: We assessed the frequency of spectacle wear and impact of spectacle treatment in toddlers. METHODS: Children 12 to <36 months old with significant refractive error were provided spectacles. After 12 (±6) weeks, parents reported the frequency of spectacle wear and completed the Amblyopia Treatment Index (ATI, modified for spectacle treatment). Factor analysis assessed usefulness of ATI for spectacle treatment. Spectacle wear and ATI results were compared across age (1- vs. 2-year-olds) and sex. RESULTS: Participants were 91 children (60% male; mean age, 22.98 [SD 6.24] months, 41 1- and 50 2-year-olds) prescribed spectacles for astigmatism (92%), hyperopia (9%), or myopia (1%). Reported frequency of wear was low (<2 hours/day) in 41%, moderate in 23% (2 to <6 hours/day), and high (≥6 hours/day) in 36% and did not differ across age or sex. ATI factor analysis identified three subscales: adverse effects, treatment compliance, and perceived benefit. One-year-olds had poorer scores on adverse effects (P = 0.026) and treatment compliance scales (P = 0.049). Low frequency of spectacle wear was associated with poorer scores on treatment compliance (P < 0.001) and perceived benefit scales (P = 0.004). CONCLUSIONS: Frequency of spectacle wear was not related to age or sex. Younger children may have more difficulty adjusting to treatment. Parents of children with low spectacle wear reported less perceived benefit of treatment. TRANSLATIONAL RELEVANCE: Data on factors associated with frequency of spectacle wear in toddlers is valuable for parents and clinicians and may lead to methods to improve compliance and reduce the negative impact of treatment.

A preliminary study of astigmatism and early childhood development.

PURPOSE: To determine whether uncorrected astigmatism in toddlers is associated with poorer performance on the Bayley Scales of Infant and Toddler Development, 3rd edition (BSITD-III). METHODS: Subjects were 12- to 35-month-olds who failed an instrument-based vision screening at a well-child check. A cycloplegic eye examination was conducted. Full-term children with no known medical or developmental conditions were invited to participate in a BSITD-III assessment conducted by an examiner masked to the child's eye examination results. Independent samples t tests were used to compare Cognitive, Language (Receptive and Expressive), and Motor (Fine and Gross) scores for children with moderate/high astigmatism (>2.00 D) versus children with no/low refractive error (ie, children who had a false-positive vision screening). RESULTS: The sample included 13 children in each group. The groups did not differ on sex or mean age. Children with moderate/high astigmatism had significantly poorer mean scores on the Cognitive and Language scales and the Receptive Communication Language subscale compared to children with no/low refractive error. Children with moderate/high astigmatism had poorer mean scores on the Motor scale, Fine and Gross Motor subscales, and the Expressive Communication subscale, but these differences were not statistically significant. CONCLUSIONS: The results suggest that uncorrected astigmatism in toddlers may be associated with poorer performance on cognitive and language tasks. Further studies assessing the effects of uncorrected refractive error on developmental task performance and of spectacle correction of refractive error in toddlers on developmental outcomes are needed to support the development of evidence-based spectacle prescribing guidelines.

Optical treatment of amblyopia in astigmatic children: the sensitive period for successful treatment.

OBJECTIVE: To compare the effectiveness of eyeglass treatment of astigmatism-related amblyopia in children younger than 8 years (range, 4.75-7.99 years) versus children 8 years of age and older (range, 8.00-13.53 years) over short (6-week) and long (1-year) treatment intervals. DESIGN: Prospective, interventional, comparative case-control study. PARTICIPANTS: Four hundred forty-six nonastigmatic (right and left eye, <0.75 diopters [D]) and 310 astigmatic (RE, > or =1.00 D) Native American (Tohono O'odham) children in kindergarten or grades 1 through 6. INTERVENTION: Eyeglass correction of refractive error, prescribed for full-time wear, in astigmatic children. MAIN OUTCOME MEASURES: Amount of change in mean right-eye best-corrected letter visual acuity for treated astigmatic children versus untreated, age-matched nonastigmatic children after short (6-week) and long (1-year) treatment intervals. RESULTS: Astigmatic children had significantly reduced mean best-corrected visual acuity at baseline compared to nonastigmatic children. Astigmats showed significantly greater improvement in mean best-corrected visual acuity (0.08 logarithm of the minimum angle of resolution [logMAR] unit; approximately 1 line), than the nonastigmatic children (0.01 logMAR unit) over the 6-week treatment interval. No additional treatment effect was observed between 6 weeks and 1 year. Treatment effectiveness was not dependent on age group (<8 years vs. > or =8 years) and was not influenced by previous eyeglass treatment. Despite significant improvement, mean best-corrected visual acuity in astigmatic children remained significantly poorer than in nonastigmatic children after 1 year of eyeglass treatment, even when analyses were limited to results from highly compliant children. CONCLUSIONS: Sustained eyeglass correction results in significant improvement in best-corrected visual acuity in astigmatic children, including those previously believed to be beyond the sensitive period for successful treatment.

Amblyopia in astigmatic children: patterns of deficits.

Neural changes that result from disruption of normal visual experience during development are termed amblyopia. To characterize visual deficits specific to astigmatism-related amblyopia, we compared best-corrected visual performance in 330 astigmatic and 475 non-astigmatic kindergarten through 6th grade children. Astigmatism was associated with deficits in letter, grating and vernier acuity, high and middle spatial frequency contrast sensitivity, and stereoacuity. Although grating acuity, vernier acuity, and contrast sensitivity were reduced across stimulus orientation, astigmats demonstrated orientation-dependent deficits (meridional amblyopia) only for grating acuity. Astigmatic children are at risk for deficits across a range of visual functions.