Full Hyperopia Correction in Preschool Children With High Astigmatism: Six-Year Follow-up Case Report

Full Hyperopia Correction in Preschool Children With High Astigmatism: Six-Year Follow-up Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Full Hyperopia Correction in Preschool Children With High Astigmatism: Six-Year Follow-up Case Report Dan Jia, Yunteng Wang, Li Xiao, Min Ouyang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9158339/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Purpose : To evaluate the long-term impact of full cycloplegic correction of hyperopia in preschool children with high astigmatism on hyperopic reserve and axial elongation. Observations : A 3-year-old child with high astigmatism received full cycloplegic correction of hyperopia and astigmatism. Over six years of follow-up, binocular visual acuity improved to 1.2, hyperopic reserve decreased only + 0.75D, and axial elongation remained < 0.2 mm/year. Conclusions : Full hyperopia correction in preschool children with high astigmatism may help preserve hyperopic reserve and slow axial elongation. These findings provide preliminary evidence supporting full correction as a preventive strategy for myopia in high-risk pediatric populations, warranting further prospective studies. Myopia Control Astigmatism Hyperopia Reserve Hyperopia Reserve Cycloplegic Refraction Axial Length Pediatric Ophthalmology Figures Figure 1 Figure 2 Introduction Myopia has reached epidemic proportions worldwide, with projections indicating that nearly half of the global population will be affected by 2050, including more than 740 million children and adolescents 1 . This escalating burden underscores the urgent need for effective preventive strategies in pediatric populations. The concept of hyperopic reserve has evolved from a physiological phenomenon into a critical clinical indicator for myopia prevention. Children with high astigmatism are particularly vulnerable, as increased optical blur and accommodative demand place them at elevated risk of developing myopia compared with their peers 2 . Despite recognition of hyperopic reserve as a protective factor, clinical consensus remains lacking regarding whether hyperopia should be corrected fully in children. Some clinicians advocate partial correction to promote emmetropization, while others suggest that full correction may reduce accommodative strain and stabilize axial growth. Evidence supporting either approach remains limited, and long-term data in preschool children are scarce. Here, we report a six-year longitudinal case of a preschool child with high astigmatism who received full cycloplegic correction of hyperopia. This case provides preliminary evidence that full correction may preserve hyperopic reserve and slow axial elongation, offering a promising strategy for early myopia prevention in high-risk pediatric populations. Case Report A 3-year-old patient was referred due to refractive error detected during a routine physical examination.Both parents have high myopia. The anterior segment of both eyes showed no abnormalities, and intraocular pressure was normal. Results of dilated refraction with 1% atropine were as follows: Right eye: +2.75 sphere / -3.25 cylinder ×10 Left eye: +2.75 sphere / -3.25 cylinder ×180 Best-corrected visual acuity (BCVA) was 0.4 in both eyes. First gaze is normal; alternating occlusion shows no change. Axial length: R: 22.23mm,L: 22.21mm.Fundus SLO and OCT examinations showed no abnormalities, and intraocular pressure was normal. Pentcam corneal topography indicated a slightly steeper vertical superior curvature but ruled out keratoconus. Based on the dilated refraction results, full correction for hyperopia and astigmatism was prescribed. Follow-up Protocol: Dilated retinoscopy, BCVA, axial length measurement, and fundus examination every 6 months. Continuous monitoring for 6 years,as shown in Figures (1- 2). Follow-up results at age 9: Pupil-dilated refraction: R +2.00DS/-3.50DC × 13; L +2.00DS/-3.75DC × 178 Best-corrected visual acuity: Monocular 1.0+, Binocular 1.2 Axial length elongation: Right eye AL increased from 22.23mm at age 3 to 23.29 mm at age 9; left eye from 22.21 mm to 23.27 mm.<0.2 mm/year Hyperopic reserve decreased only +0.75D over 6 years Discussion Clinical Significance: Epidemiological Context: Myopia has become a global public health challenge, projected to affect nearly half of the world’s population by 2050. Children with high astigmatism are at particularly elevated risk of developing myopia due to increased optical blur and accommodative demand. Preservation of hyperopic reserve has therefore emerged as a critical clinical indicator in pediatric refractive management. Clinical Practice Controversies: Although hyperopic reserve is generally recognized as a protective factor, whether children should receive full correction of hyperopia remains controversial. Numerous clinical approaches have been explored to control myopia, such as low-intensity red light therapy, yet recent studies have raised concerns regarding its safety 3 . Low-concentration atropine has demonstrated significant efficacy in slowing myopia progression, but some children experience photophobia due to pupillary dilation 4 . Substantial evidence supports the effectiveness of orthokeratology lenses in controlling myopia progression 5 ; however, improper lens care may lead to corneal inflammation 6 . Therefore, whether full correction of physiological hyperopia can reduce accommodative burden and stabilize axial elongation requires validation through future large-scale studies. If proven effective, this strategy could serve as a complementary public health measure to reduce the prevalence of myopia in children. Comparison With Literature: To date, only one case report has demonstrated the positive effect of partial hyperopia correction on myopia control. This case involved two twins at risk for myopia, whose hyperopia was partially corrected (prescribing half the cycloplegic refraction value) starting at age 7 and monitored until age 16. During the 9-year follow-up, although the degree of hyperopia decreased in both subjects, neither progressed to myopia. At age 16, their equivalent spherical (SE) prescriptions were + 1.00D and + 1.25D, respectively 7 .However, Our case report proposes that full correction of hyperopia in children with high astigmatism may slow the progression toward emmetropization. In this case, after 6 years of follow-up, the child still had a hyperopic reserve of + 2.00D after dilation, with a decrease of only + 0.75D over 6 years—significantly slower than the typical rate of hyperopic reserve depletion. Clinical Implications This case challenges the traditional view that partial hyperopia correction is sufficient in children with high astigmatism. Our six-year follow-up demonstrates that full cycloplegic correction may preserve hyperopic reserve, reduce accommodative strain, and stabilize axial elongation. If validated in larger cohorts, this approach could represent a practical and cost-effective public health strategy to mitigate the rising burden of childhood myopia. Limitations and Future Directions: The primary limitation of this report is its single-case design, which restricts generalizability. Long-term outcomes beyond age nine remain unknown. Controlled, prospective trials comparing full versus partial correction strategies are needed to validate these findings and establish evidence-based guidelines for clinical practice. Conclusion This six-year longitudinal case highlights that full cycloplegic correction of hyperopia in preschool children with high astigmatism may preserve hyperopic reserve and slow axial elongation. Binocular visual acuity improved to 1.2, hyperopic reserve decreased only + 0.75D, and axial growth remained < 0.2 mm/year, contrasting with typical pediatric emmetropization patterns. These findings provide preliminary evidence that full correction may represent a promising preventive strategy for myopia in high-risk pediatric populations. While limited by its single-case design, this report underscores the need for prospective, controlled studies to compare full versus partial correction strategies and to establish evidence-based guidelines for pediatric refractive management. Declarations Consent for publication ： Written informed consent for publication of clinical details and clinical images was obtained from the patient’s parents. Data availability statement: The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Ethics statement: Approved by the Ethics Committee of Ganzhou Maternal and Child Health Hospital, Jiangxi Province, China. Written informed consent was obtained from the patient’s guardians. Author contributions: Dan Jia: Conceptualization, Data curation, Investigation, Writing-original draft, Review & editing. Yunteng Wang: Conceptualization, Data curation, Writing-original draft, Review & editing. Min Ouyang: Data curation, Review & editing. Li Xiao: Review & editing. Funding: Supported by the Key Research and Development Program of Ganzhou Science and Technology Bureau, Jiangxi Province, China (Grant No. GZ2024YLJ193). Conflict of interest: The authors declare no conflicts of interest. Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. References Modjtahedi BS, Abbott RL, Fong DS, et al. Reducing the global burden of myopia by delaying the onset of myopia and reducing myopic progression in children. Ophthalmology. 2021;128(6):816–26. 10.1016/j.ophtha.2020.10.040 . Kearney S, Shah R, Vlasak N. The role of astigmatism in myopia development, myopia progression and myopia control. Ophthalmic Physiologic Optic. 2025;45(7):1946–64. 10.1111/opo.70030 . Ostrin LA, Schill AW. Safety evaluation of 4 red light therapy devices for myopia. JAMA Ophthalmol Published online Febr. 2026;5:1–4. 10.1001/jamaophthalmol.2025.5660 . Ha A, Kim SJ, Shim SR, Kim YK, Jung JH. Efficacy and safety of 8 atropine concentrations for myopia control in children. Ophthalmology. 2022;129(3):322–33. 10.1016/j.ophtha.2021.10.016 . Zhang L, Kang Y, Yu X, et al. Efficacy of multifocal rigid gas permeable contact lenses to control myopia progression. Sci Rep. 2025;15(1):17261. 10.1038/s41598-025-01058-3 . Hou J, Zhang N, Li X, Wang Z, Wang J. The effects of spectacles or orthokeratology on the tear film in children and adolescents. Ophthalmol Ther. 2023;12(4):1913–27. 10.1007/s40123-023-00719-8 . Medina A. Prevention of myopia by partial correction of hyperopia: A twins study. Int Ophthalmol. 2018;38(2):577–83. 10.1007/s10792-017-0493-7 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 04 May, 2026 Reviews received at journal 30 Apr, 2026 Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers agreed at journal 19 Apr, 2026 Reviewers invited by journal 09 Apr, 2026 Editor assigned by journal 09 Apr, 2026 Editor invited by journal 24 Mar, 2026 Submission checks completed at journal 23 Mar, 2026 First submitted to journal 23 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9158339","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":622992758,"identity":"78ec9190-294a-443b-af44-94e3b9c1a9ef","order_by":0,"name":"Dan Jia","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBACxoYEIMkjIcfG3tj48APxWmQsjPl4DjcbSxBnD0iLTUXiPIn0NgEeYjQwtycfk/iQI8HYJvmwjUGCwU5Ot4GQw3qepUnOOCPBzCad2PaggCHZ2OwAIS0zcsykeXsk2IBa2g0kGA4kbiOsJf+b9N9/EjxskgfbJHiI05LDJg0MZAk2oHeI1NLzzNiyh0fCgI0nERjIBkT4xbA9+eGNHzx19fPbjz98+KHCTo6wlgYGFqQINCCgHATkgVFDVDIZBaNgFIyCEQwAiKI+IAPojSQAAAAASUVORK5CYII=","orcid":"","institution":"Ganzhou Maternal and Child Health Hospital","correspondingAuthor":true,"prefix":"","firstName":"Dan","middleName":"","lastName":"Jia","suffix":""},{"id":622992759,"identity":"362da596-7c4f-467d-9023-ddf03b059e62","order_by":1,"name":"Yunteng Wang","email":"","orcid":"","institution":"Ganzhou Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yunteng","middleName":"","lastName":"Wang","suffix":""},{"id":622992760,"identity":"6c8e5f0e-99e9-4289-ae98-8bd375ad44c7","order_by":2,"name":"Li Xiao","email":"","orcid":"","institution":"Ganzhou Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Xiao","suffix":""},{"id":622992761,"identity":"0dc5166b-382e-4987-a480-124db0e5a53f","order_by":3,"name":"Min Ouyang","email":"","orcid":"","institution":"Ganzhou Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Ouyang","suffix":""}],"badges":[],"createdAt":"2026-03-18 10:53:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9158339/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9158339/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107254021,"identity":"d1b97b9b-4e29-4179-a6a9-4bbe9397964f","added_by":"auto","created_at":"2026-04-19 11:59:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":340977,"visible":true,"origin":"","legend":"\u003cp\u003eThis figuresummarizes cycloplegic refraction, best-corrected visual acuity (BCVA), and axial length measurements from age 3 to age 9. Over six years of follow-up, binocular BCVA improved to 1.2, hyperopic reserve decreased only +0.75D, and axial elongation remained \u0026lt;0.2 mm/year, suggesting that full cycloplegic correction of hyperopia may stabilize refractive development in children with high astigmatism.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9158339/v1/b90147069064288c9caf8c4a.png"},{"id":107484522,"identity":"2135bec0-b8b6-4796-834c-916363c46ad6","added_by":"auto","created_at":"2026-04-22 02:32:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":167301,"visible":true,"origin":"","legend":"\u003cp\u003eThis figureillustrates axial length progression in both eyes from age 3 to age 9. The right eye (solid line) increased from 22.23 mm to 23.29 mm, while the left eye (dashed line) increased from 22.21 mm to 23.27 mm. Annual elongation remained \u0026lt;0.2 mm/year throughout the follow-up period. This slow progression contrasts with typical pediatric axial growth rates, suggesting that full cycloplegic correction of hyperopia may contribute to stabilization of axial elongation in children with high astigmatism.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9158339/v1/c76679e45a22868a1d0ea770.png"},{"id":107487124,"identity":"baac17c0-f878-4add-90a4-f68d4f73323d","added_by":"auto","created_at":"2026-04-22 02:39:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":765720,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9158339/v1/ad65814b-bfda-47dd-b650-e3a92656d980.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Full Hyperopia Correction in Preschool Children With High Astigmatism: Six-Year Follow-up Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMyopia has reached epidemic proportions worldwide, with projections indicating that nearly half of the global population will be affected by 2050, including more than 740\u0026nbsp;million children and adolescents\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. This escalating burden underscores the urgent need for effective preventive strategies in pediatric populations.\u003c/p\u003e \u003cp\u003eThe concept of \u003cb\u003ehyperopic reserve\u003c/b\u003e has evolved from a physiological phenomenon into a critical clinical indicator for myopia prevention. Children with high astigmatism are particularly vulnerable, as increased optical blur and accommodative demand place them at elevated risk of developing myopia compared with their peers\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite recognition of hyperopic reserve as a protective factor, \u003cb\u003eclinical consensus remains lacking\u003c/b\u003e regarding whether hyperopia should be corrected fully in children. Some clinicians advocate partial correction to promote emmetropization, while others suggest that full correction may reduce accommodative strain and stabilize axial growth. Evidence supporting either approach remains limited, and long-term data in preschool children are scarce.\u003c/p\u003e \u003cp\u003eHere, we report a \u003cb\u003esix-year longitudinal case\u003c/b\u003e of a preschool child with high astigmatism who received full cycloplegic correction of hyperopia. This case provides preliminary evidence that full correction may preserve hyperopic reserve and slow axial elongation, offering a promising strategy for early myopia prevention in high-risk pediatric populations.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 3-year-old patient was referred due to refractive error detected during a routine physical examination.Both parents have high myopia. The anterior segment of both eyes showed no abnormalities, and intraocular pressure was normal. Results of dilated refraction with 1% atropine were as follows:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRight eye: +2.75 sphere / -3.25 cylinder \u0026times;10\u003c/p\u003e\n\u003cp\u003eLeft eye: +2.75 sphere / -3.25 cylinder \u0026times;180\u003c/p\u003e\n\u003cp\u003eBest-corrected visual acuity (BCVA) was 0.4 in both eyes. First gaze is normal; alternating occlusion shows no change. Axial length: R: 22.23mm,L: 22.21mm.Fundus SLO and OCT examinations showed no abnormalities, and intraocular pressure was normal. Pentcam corneal topography indicated a slightly steeper vertical superior curvature but ruled out keratoconus. Based on the dilated refraction results, full correction for hyperopia and astigmatism was prescribed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-up Protocol:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDilated retinoscopy, BCVA, axial length measurement, and fundus examination every 6 months.\u003c/p\u003e\n\u003cp\u003eContinuous monitoring for 6 years,as shown in Figures (1- 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-up results at age 9:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePupil-dilated refraction: R +2.00DS/-3.50DC \u0026times; 13; L +2.00DS/-3.75DC \u0026times; 178\u003c/p\u003e\n\u003cp\u003eBest-corrected visual acuity: Monocular 1.0+, Binocular 1.2\u003c/p\u003e\n\u003cp\u003eAxial length elongation: Right eye AL increased from 22.23mm at age 3 to 23.29 mm at age 9; left eye from 22.21 mm to 23.27 mm.\u0026lt;0.2 mm/year\u003c/p\u003e\n\u003cp\u003eHyperopic reserve decreased only +0.75D over 6 years\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eClinical Significance: Epidemiological Context:\u003c/h2\u003e \u003cp\u003eMyopia has become a global public health challenge, projected to affect nearly half of the world\u0026rsquo;s population by 2050. Children with high astigmatism are at particularly elevated risk of developing myopia due to increased optical blur and accommodative demand. Preservation of hyperopic reserve has therefore emerged as a critical clinical indicator in pediatric refractive management.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Practice Controversies:\u003c/h3\u003e\n\u003cp\u003eAlthough hyperopic reserve is generally recognized as a protective factor, whether children should receive full correction of hyperopia remains controversial. Numerous clinical approaches have been explored to control myopia, such as low-intensity red light therapy, yet recent studies have raised concerns regarding its safety\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Low-concentration atropine has demonstrated significant efficacy in slowing myopia progression, but some children experience photophobia due to pupillary dilation\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Substantial evidence supports the effectiveness of orthokeratology lenses in controlling myopia progression\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e; however, improper lens care may lead to corneal inflammation\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Therefore, whether full correction of physiological hyperopia can reduce accommodative burden and stabilize axial elongation requires validation through future large-scale studies. If proven effective, this strategy could serve as a complementary public health measure to reduce the prevalence of myopia in children.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eComparison With Literature:\u003c/h2\u003e \u003cp\u003eTo date, only one case report has demonstrated the positive effect of partial hyperopia correction on myopia control. This case involved two twins at risk for myopia, whose hyperopia was partially corrected (prescribing half the cycloplegic refraction value) starting at age 7 and monitored until age 16. During the 9-year follow-up, although the degree of hyperopia decreased in both subjects, neither progressed to myopia. At age 16, their equivalent spherical (SE) prescriptions were +\u0026thinsp;1.00D and +\u0026thinsp;1.25D, respectively\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.However, Our case report proposes that full correction of hyperopia in children with high astigmatism may slow the progression toward emmetropization. In this case, after 6 years of follow-up, the child still had a hyperopic reserve of +\u0026thinsp;2.00D after dilation, with a decrease of only\u0026thinsp;+\u0026thinsp;0.75D over 6 years\u0026mdash;significantly slower than the typical rate of hyperopic reserve depletion.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Implications\u003c/h3\u003e\n\u003cp\u003eThis case challenges the traditional view that partial hyperopia correction is sufficient in children with high astigmatism. Our six-year follow-up demonstrates that full cycloplegic correction may preserve hyperopic reserve, reduce accommodative strain, and stabilize axial elongation. If validated in larger cohorts, this approach could represent a practical and cost-effective public health strategy to mitigate the rising burden of childhood myopia.\u003c/p\u003e\n\u003ch3\u003eLimitations and Future Directions:\u003c/h3\u003e\n\u003cp\u003eThe primary limitation of this report is its single-case design, which restricts generalizability. Long-term outcomes beyond age nine remain unknown. Controlled, prospective trials comparing full versus partial correction strategies are needed to validate these findings and establish evidence-based guidelines for clinical practice.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis six-year longitudinal case highlights that full cycloplegic correction of hyperopia in preschool children with high astigmatism may preserve hyperopic reserve and slow axial elongation. Binocular visual acuity improved to 1.2, hyperopic reserve decreased only\u0026thinsp;+\u0026thinsp;0.75D, and axial growth remained\u0026thinsp;\u0026lt;\u0026thinsp;0.2 mm/year, contrasting with typical pediatric emmetropization patterns.\u003c/p\u003e \u003cp\u003eThese findings provide preliminary evidence that full correction may represent a promising preventive strategy for myopia in high-risk pediatric populations. While limited by its single-case design, this report underscores the need for prospective, controlled studies to compare full versus partial correction strategies and to establish evidence-based guidelines for pediatric refractive management.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eWritten informed consent for publication of clinical details and clinical images was obtained from the patient\u0026rsquo;s parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement:\u0026nbsp;\u003c/strong\u003eApproved by the Ethics Committee of Ganzhou Maternal and Child Health Hospital, Jiangxi Province, China. Written informed consent was obtained from the patient\u0026rsquo;s guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003eDan Jia: Conceptualization, Data curation, Investigation, Writing-original draft, Review \u0026amp; editing. Yunteng Wang: Conceptualization, Data curation, Writing-original draft, Review \u0026amp; editing. Min Ouyang: Data curation, Review \u0026amp; editing. Li Xiao: Review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eSupported by the Key Research and Development Program of Ganzhou Science and Technology Bureau, Jiangxi Province, China (Grant No. GZ2024YLJ193).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublisher\u0026rsquo;s note:\u0026nbsp;\u003c/strong\u003eAll claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eModjtahedi BS, Abbott RL, Fong DS, et al. Reducing the global burden of myopia by delaying the onset of myopia and reducing myopic progression in children. Ophthalmology. 2021;128(6):816\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ophtha.2020.10.040\u003c/span\u003e\u003cspan address=\"10.1016/j.ophtha.2020.10.040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKearney S, Shah R, Vlasak N. The role of astigmatism in myopia development, myopia progression and myopia control. Ophthalmic Physiologic Optic. 2025;45(7):1946\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/opo.70030\u003c/span\u003e\u003cspan address=\"10.1111/opo.70030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOstrin LA, Schill AW. 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Efficacy of multifocal rigid gas permeable contact lenses to control myopia progression. Sci Rep. 2025;15(1):17261. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-025-01058-3\u003c/span\u003e\u003cspan address=\"10.1038/s41598-025-01058-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHou J, Zhang N, Li X, Wang Z, Wang J. The effects of spectacles or orthokeratology on the tear film in children and adolescents. Ophthalmol Ther. 2023;12(4):1913\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40123-023-00719-8\u003c/span\u003e\u003cspan address=\"10.1007/s40123-023-00719-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMedina A. Prevention of myopia by partial correction of hyperopia: A twins study. Int Ophthalmol. 2018;38(2):577\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10792-017-0493-7\u003c/span\u003e\u003cspan address=\"10.1007/s10792-017-0493-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Myopia Control, Astigmatism, Hyperopia Reserve, Hyperopia Reserve, Cycloplegic Refraction, Axial Length, Pediatric Ophthalmology","lastPublishedDoi":"10.21203/rs.3.rs-9158339/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9158339/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003ePurpose\u003c/b\u003e: To evaluate the long-term impact of full cycloplegic correction of hyperopia in preschool children with high astigmatism on hyperopic reserve and axial elongation.\u003c/p\u003e \u003cp\u003e \u003cb\u003eObservations\u003c/b\u003e: A 3-year-old child with high astigmatism received full cycloplegic correction of hyperopia and astigmatism. Over six years of follow-up, binocular visual acuity improved to 1.2, hyperopic reserve decreased only\u0026thinsp;+\u0026thinsp;0.75D, and axial elongation remained\u0026thinsp;\u0026lt;\u0026thinsp;0.2 mm/year.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e: Full hyperopia correction in preschool children with high astigmatism may help preserve hyperopic reserve and slow axial elongation. These findings provide preliminary evidence supporting full correction as a preventive strategy for myopia in high-risk pediatric populations, warranting further prospective studies.\u003c/p\u003e","manuscriptTitle":"Full Hyperopia Correction in Preschool Children With High Astigmatism: Six-Year Follow-up Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 11:59:31","doi":"10.21203/rs.3.rs-9158339/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-04T07:27:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T18:19:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-27T20:56:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"145003833517594175397827936328760990204","date":"2026-04-20T13:51:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265011380037049686476861387913597304375","date":"2026-04-20T02:42:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-09T05:01:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-09T04:56:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-24T04:50:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-23T13:33:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2026-03-23T10:18:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4dea4097-a9f7-43f5-ab1f-aa0a64a14486","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-04T07:27:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T18:19:27+00:00","index":48,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T14:39:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 11:59:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9158339","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9158339","identity":"rs-9158339","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}