To Emmetropize or Not to Emmetropize? The Question for Hyperopic Development

Emmetropization appears to be a rapid process, occurring in the first year of life. Failure to emmetropize leaves about 2 to 8% of children with potentially clinically significant hyperopia after infancy. Uncorrected hyperopia in childhood has a negative impact on distance acuity and the accuracy of the accommodative response for some unknown number of children. The clinical "gray zone" for these problems as judged by distance refractive error alone might begin somewhere around +2.00 to +3.00 D. Use of a refractive correction seems to improve distance acuity and the accuracy of accommodation. Clinicians' reluctance to prescribe hyperopic corrections to children to improve visual performance might be unwarranted. If emmetropization is largely complete, if defocus has only a minor effect on the development of refractive error in infancy or childhood, and if the hyperopic eye is already growing longer but not moving toward emmetropia, then there may be little reason to either wait or be concerned about interfering with emmetropization that may never happen. The immediate visual benefit may outweigh these concerns.