Longitudinal change and stability of refractive, Keratometric, And internal astigmatism in childhood

Erin M. Harvey, Joseph M. Miller, J. Daniel Twelker, Duane L. Sherrill

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


PURPOSE. To assess longitudinal change in refractive, keratometric, and internal astigmatism in a sample of students from a population with a high prevalence of with-the-rule (WTR) astigmatism and to determine the optical origins of changes in refractive astigmatism. METHODS. A retrospective analysis of longitudinal measurements of right eye refractive and keratometric astigmatism in Tohono O’odham Native American children was conducted. Changes in refractive and keratometric astigmatism per year were compared in a younger cohort (n = 1594, 3 to <11 years old) and an older cohort (n = 648, 11 to <19 years old). Data were analyzed in clinical notation (Cyl) and vector notation (J0, J45). RESULTS. On average, refractive astigmatism (means: 1.19 diopters [D] Cyl, þ0.54 J0, þ0.03 J45) resulted primarily from WTR corneal astigmatism (means: þ0.85 J0, -0.02 J45) and against-the-rule (ATR) internal astigmatism (means: -0.31 J0, þ0.05 J45). Mean longitudinal changes in astigmatism were statistically significant (younger cohort -0.02 D/y Cyl; older cohort þ0.06 D/y Cyl). In the younger cohort, astigmatism decreased with age in low and moderate astigmats (<3.00 D) and increased with age in high astigmats (<3.00 D). In the older cohort, astigmatism increased with age across all levels of astigmatism. Longitudinal changes in keratometric and internal astigmatism were negatively correlated in both cohorts. CONCLUSIONS. Cross-sectional data suggest the presence of a constant ATR contribution from internal astigmatism (0.60 D Cyl) that is close to the 0.50 D ATR constant reported by Javal and others. Highly astigmatic 3- to <11-year-old children and children older than age 11 years show a small (not clinically significant) increase in astigmatism with age. A negative correlation between changes in keratometric astigmatism and internal astigmatism suggests an active compensation that may contribute to the stability of astigmatism in Tohono O’odham children.

Original languageEnglish (US)
Pages (from-to)190-198
Number of pages9
JournalInvestigative Ophthalmology and Visual Science
Issue number1
StatePublished - Dec 16 2015


  • Astigmatism
  • Children
  • Native American
  • Refractive error development

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience


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