A team of University of Arizona researchers has received a five-year, $4.1 million grant to study whether using eyeglasses to correct astigmatism in toddlers improves language, cognitive and motor development.

The study, funded by the National Eye Institute of the National Institutes of Health, is the first to use wearable sensors to determine how often children age 3 or younger are wearing their eyeglasses. Dubbed the SPEC Trial, for Spectacle Prescribing in Early Childhood, the project is designed to help parents and pediatricians determine if the benefits of treatment outweigh the expense and supervision required for eyeglasses for young children.

"Children who are nearsighted can see fine up close, and children who are farsighted can see fine at a distance, but for children with astigmatism, everything is blurry," said Erin M. Harvey, associate professor of ophthalmology and public health and co-principal investigator for the project. "The critical questions, then, are if eyeglasses are prescribed for astigmatism in this age range, will children wear them, and will they produce a measurable impact on vision and language, cognitive and motor development?"

With advances in technology, instrument-based vision screening is performed routinely at well-child checks beginning when a child turns 1 year old. Evidence-based treatment recommendations for asymptomatic children with moderate astigmatism, however, have not kept up with the advances in technology, and currently there are no rigorous, peer-reviewed data on spectacle wear to use for clinical guidance.

"The work being done by Dr. Harvey and Dr. Miller is a great example of how Fourth Industrial Revolution technology can improve human health in unprecedented ways," said UA President Robert C. Robbins. "Eyeglasses are, of course, not particularly high tech. But using sensors to determine whether and how much children are wearing eyeglasses is an innovation that has been made possible by the convergence of the physical, biological and data sciences. I look forward to following their progress and I am hopeful that their work will show how we can make a big difference for children with vision problems."

Astigmatism is the most prevalent type of vision problem in children between 1 and 3 years old, a time of immense physical and cognitive development. As a child grows, the shape of the eye changes and, in some cases, astigmatism can disappear. Evidence also suggests that using eyeglasses to treat young children with astigmatism may stimulate the development of normal vision.

"Based on years of experience, we know that some children love their glasses and will wear them, and some children don't and won't," said Dr. Joseph M. Miller, professor and head of the Department of Ophthalmology and Vision Science and the other co-principal investigator on the project. "So, the question is, if they wear their glasses to see better, do they do better?"

Working with local pediatricians from El Rio Health and Banner-University clinics, the researchers will divide children with astigmatism, ages 12-35 months, into two groups. The team will prescribe eyeglasses and provide traditional support to one group. They will also prescribe eyeglasses to the second group but will offer significant additional clinical support to encourage the children to wear their eyeglasses.

Simply asking parents to track wear time does not result in reliable data needed for a clinical trial, so Harvey came up with the idea of putting a heat-sensitive sensor on the eyeglasses strap.

"Comparing body temperature to room temperature fluctuations at 15-minute intervals, the button tracking device allows us to accurately measure when the eyeglasses are being worn," Harvey said.

The team decided to use the sensor while keeping in mind concerns about the safety of button batteries and children swallowing the device. The sensor attaches to the strap and is encased in puncture resistant, medical-grade, heat-shrink tubing.

Addressing concerns about medical privacy was important to Harvey and Miller as well. The sensor does not collect any identifiable data – only date, time and temperature – and only transmits the data when it is within inches of the computer programmed to receive the information. 

The team will collect the sensors and replace the eyeglass straps every two months. When the children turn 3 years old, the researchers will test their vision and measure their language, cognitive and motor development outcomes, using the Bayley Scales of Infant and Toddler Development. By correlating those results with wear-time data, Harvey and Miller will be able to determine whether more clinical support made a difference in how often the children wore their eyeglasses, and if more wear time had measurable effects on outcomes.