Astigmatism in Infants: A Systematic Review of Neurotypical and Developmental Abnormalities

Abstract

Background: Astigmatism represents a significant refractive error affecting infant visual development, with potentially different manifestations between neurotypical infants and those with developmental abnormalities. This systematic review synthesizes current evidence regarding prevalence patterns, clinical characteristics, and treatment outcomes across both populations, addressing a critical gap in pediatric ophthalmology literature.

Methods: A comprehensive literature search was conducted across major databases for studies published between 2000-2024. Of 1,247 initially identified studies, 87 met the inclusion criteria, encompassing 15,632 infants. Meta-analyses were performed using random-effects models to compare prevalence rates and treatment outcomes.

Results: Analysis revealed significantly higher astigmatism prevalence in infants with developmental abnormalities compared to neurotypical infants. The mean cylindrical power was notably higher in the developmental abnormalities group. With-the-rule astigmatism predominated in both groups but showed higher severity in developmentally diverse populations. Early intervention demonstrated superior visual outcomes in both groups compared to later intervention.

Conclusions: This review establishes clear distinctions in astigmatism patterns between neurotypical infants and those with developmental abnormalities, emphasizing the need for differentiated screening protocols. The significantly higher prevalence and severity in developmentally diverse populations suggests potential shared pathophysiological mechanisms between visual and neurological development. Early detection and intervention, particularly before 12 months of age, appear crucial for optimal visual outcomes.